CHAPTER XXII
Providing the Means for Evacuation by Land
Supplying enough ambulances and rail cars of suitable typesfor the transportation of patients in the United States and in overseas areaswas a continuing problem. Plans for improved types were being made before thewar started, and when it ended new ones were still being developed and ordered.Numerous difficulties were encountered in this process, as well as in manningand equipping hospital trains.
Motor Ambulances
Of all conveyances the motor ambulance was the most widelyused and transported the largest number of patients. The type in greatest usewas the general-service ambulance. Capable of serving in training camps in theUnited States as well as in communications and combat zones of theaters ofoperations, it was called at different times the field ambulance, the stationambulance, and the cross-country ambulance. Others of more specialized-andtherefore more limited-use were the metropolitan and multipatient ambulances.
General-Service Ambulances
Because general-service ambulances were basic conveyances forpatients in both peace and war, experiments to improve them were made betweenWorld Wars I and II. In 1932 a field ambulance on a (4 x 2)1chassis of 1?-ton capacity was developed by the Medical Department EquipmentLaboratory and by 1939 it had replaced ambulances of World War I type. Althoughthis ambulance was designed for use at Army posts and camps in the United Statesas well as for field service with tactical units, it was not entirelysatisfactory for either. It rode too roughly and was too poorly heated andventilated for the comfort of patients in the United States, and it got stuck inthe mud too easily for satisfactory service in the field or in forward areas oftheaters of operation.2 The Surgeon General'sOffice concluded that heavier ambulances, perhaps of the metropolitan typenormally used by civilian hospitals, should be used not only at Army hospitalsin the United States but also in communications zones of theaters, and that alight ambulance, able to oper-
1That is, having four wheels, two of which were attached to the engine drive-shaft.
2(1) Ltr, SG to TAG, 21 Feb 34, sub: Repl of Wartime Ambs. HRS: G-4/29094. (2) Ltr, QMG to TAG, 15 Apr 35, sub: Mil Characteristics for Ambs, Light Fld Type. QMG: 451.8. For letters on motor vehicular requirements and assignment of ambulances see files HRS: G-4/29714 and QMG: 451.8; for changes in specifications and rear spring improvements see files SG: 451.8-1 and 451.8-1 (Carlisle Bks).
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ate over bad terrain, should be developed for use in combatzones.3
Beginning in 1937 the Medical Department and theQuartermaster Corps had experimented with development of such an ambulance.Meanwhile the General Staff reaffirmed its policy of limiting the types ofchassis used by the Army in order both to assure the mass production of vehiclesand to simplify the procurement and distribution of spare parts as well as themaintenance and repair of vehicles. It announced in August 1939 that alltactical vehicles (that is, those used by table-of-organization units) would beall-wheel-drive types, and that only five chassis would be considered standardfor the Army: ?-ton, 1?-ton, 2?-ton, 4-ton, and 7?-ton.4The Medical Department Equipment Laboratory and Holabird QuartermasterDepot then concentrated on experiments with a ?-ton (4 x 4) chassis, and inJune 1940 The Surgeon General announced that the ambulance built on it would be"accepted as the new cross-country motor ambulance for use in alldivisional and corps units in the combat zone."5This ambulance, like the one it was to replace, could carry four litterpatients. When the first of this type was delivered for testing early in January1941, the Surgeon General's Office and the Laboratory found that the ambulancewhich had been developed primarily for use in combat zones rode so comfortablyand was so well heated and ventilated that it would serve satisfactorily forhospitals in the zone of interior as well.6In short, the new cross-country ambulance was a better general-serviceambulance than the 1?-ton (4 x 2) field ambulance.
A change in standard chassis required a change in the newambulance during 1942. In 1941 two new chassis-?-ton (4 x 4) and ?-ton (4 x4)-were introduced, and the ?-ton (4 x 4) was dropped from the Army'sstandard list. As early as February 1942 the Quartermaster Corps wasanticipating issuing ?-ton ambulances in place of ?-ton vehicles.7About four months later plans for the change had been completed, and?-ton ambulances were ordered along with other ?-ton vehicles. Althoughsimilar in appearance to the ?-ton ambulance, the new ?-ton ambulance had ashorter wheelbase, larger tires, and more clearance under the axle.8The Medical Department Equipment Laboratory thought that these differences madeit more comfortable for patients and less apt to get stuck in mud and sand.
While the cross-country ambulance was designed mainly for usein theaters of operations, it was used widely in the zone of interior as well.The stoppage of passenger-car production early in the war curtailed theprocurement and use of metropolitan ambulances built on pas-
32d ind, SG to TAG, 3 Jan 40, on Ltr, SG to TAG, 25 Nov 39, sub: Fld Ambs, Motor. SG: 451.8-1. Also see the following T/Os: 8-508, Sta Hosp, 25 Jul 40; 8-507, Gen Hosp, 25 Jul 40.
4Ltr AG 451 (6-15-39) Misc-D, TAG to SG, 12 Aug 39, sub: Standardization of Motor Vehs. AG: 451 (8-12-39).
5(1) For letters on these experiments see files QMG: 451.8 and 400.112 T-M, 1937-40, and SG: 451.8-1 and 451.8-1 (Carlisle Bks), 1937-40. (2) Ltr, SG to Dir MD Equip Lab, 1 Jun 40, sub: Critical Measurement Data on Cross-Country Amb. HD: McKinney files, Jun 40.
6Memo, Col G[arfield] L. McKinney (Planning Subdiv) for SG, 14 Jan 41, sub: New Cross-Country Amb; Insp at Carlisle Bks, 13 Jan 41. Off file, Research and Dev Bd SGO, "Cross-Country Amb."
7(1) Ltr QM 451 M-ES, QMG to SG, 14 Feb 42, sub: Reclassification of Amb, Fld, with 3 inds. QMG: 451.8. (2) Memo, TAG for CGs AGF and AAF, C of Arms and Servs, 6 Apr 42, sub: Standardization of Wheeled Motor Veh Chassis and Trailers. AG: 451 (4-4-42).
8(1) TM 9-2800, 1 Sep 43, Standard Military Motor Vehicles.
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PLACING THE FOURTH LITTER PATIENT IN A FIELD AMBULANCE
senger-car frames.9 TheMedical Department therefore used what was available. As ambulances of thecross-country type were delivered to the Army, they were first distributed totable-of-organization units. Those of the older type (1?-ton field ambulance)that were no longer needed by such units were divided among posts, camps, andstations in the United States.10 As ambulancesof the old type wore out or as requirements exceeded supply, ambulances of thenew types were issued to zone of interior installations. In addition, 356chassis for l?-ton (4 x 4) trucks were taken from a civilian pool of motorvehicles in 1943 and were used to build modified field ambulances for service inlieu of unavailable metropolitan ambulances.11
Thus, in addition to the metropolitan ambulances either onhand or procured from available stocks at the beginning of the war, hospitals inthe United States used four types of ambulances: the 1?-ton (4 x 2) fieldambulance; the 1?-ton (4 x 4) modified field ambulance; the ?-ton (4 x
9For letters on efforts to secure additional metropolitan ambulances and their procurement and distribution see file SG: 451.8-1 (1939-43). Also see History of the Automotive Division, War Production Board, 1941-45 (1945). Natl Archives: WPB 020.1.
10SG Cir 81, 8 Aug 41, sub: Admin Motor Veh. For letters on distribution and redistribution of field ambulances from tactical units to zone of interior hospitals see files: SG: 451.8-1, AG: 451.8, and HRS: G-4/29714 for 1940-43.
11Memo, ACofS for Oprs ASF for CofOrd, 6 May 43, sub: Reqmts for Fld Ambs. AG: 451.8 (5-6-43).
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FIELD AND METROPOLITAN AMBULANCES USED IN 1942
4) cross-country ambulance; and the ?-ton (4 x 4) ambulance.
By the winter of 1942-43 it appeared that the ?-tonambulance was not entirely satisfactory for overseas use. SOS headquartersthought it took up too much shipping space, and some theaters expresseddissatisfaction with its performance. The Southwest Pacific, for instance,stated that lighter vehicles with greater traction were needed for the roughmuddy trails over which patients had to be transported, while reports from NorthAfrica indicated that the ?-ton ambulance was difficult to land from lighters,lacked the traction and drive needed in that theater, and had insufficientangles of approach and departure to allow it to operate easily over ditches andhills of rough terrain.12 The SOS RequirementsDivision in January 1943 proposed several methods of overcoming thesedifficulties: shipment of the standard ambulance in a two-unit pack forreassembly in theaters of operations, replacement of its metal body with bowsand a tarpaulin top, and provision of "litter kits" for use inadapting stand-
12(1) Diary, SOS Hosp and Evac Br, 13, 16, 22, and 28 Jan 43. HD: Wilson files, "Diary." (2) Ltr, CinC SWPA to CG SOS, 21 Nov 42, sub: Improvement of Equip and Orgn, US Army, with 3 inds. SG: 322.15-1. (3) Memo, Col Robert C. McDonald, Hosp and Evac Br Oprs Div ASF for Gen [Le Roy] Lutes, 21 Apr 43, sub: Gen Kenner's Rpts, with incls. HD: Wilson files, "Book IV, 16 Mar 43-17 Jun 43." (4) Ltr, Joseph A. Keeney, Army Med Serv Tec Cmtee to Col Calvin H. Goddard, 7 Jul 52. HD: 314 (Correspondence on MS) XI.
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ard vehicles to the transportation of patients.13
The Surgeon General's Office countered with a different proposal. TheMedical Department Equipment Laboratory had already begun to evaluateexperiments of medical units in replacing litter bearers with motor vehicles-particularly?-ton (4 x 4) trucks, or jeeps-to transport patients from battalion aidstations to collecting stations. By the middle of 1942 it had decided that noneof the standard vehicles of the Army were satisfactory for this purpose. Somewere too rough; some had silhouettes that were too high; and others-notablythe unprotected and uncovered jeep-were so small that litters protruded overtheir sides or ends. Consequently the Medical Department Technical Committee andthe Surgeon General's Office had proposed in August 1942 the development of alight forward-area ambulance on a nonstandard chassis-a ?-ton (4 x 4) chassisto which an extra axle and two wheels were added, making it a ?-ton (6 x 6)chassis. SOS headquarters had disapproved this proposal because it conflictedwith the War Department's policy of using only standard chassis.14The Surgeon General's Office still believed that this vehicle was a practicalsolution to the dual problem of saving space on ships and furnishing theaterswith ambulances that could be used far forward in rough terrain and in February
13Memo, CG SOS for SG, 30 Jan 43, sub: Ambs. SG: 451.8-1.
14(1) Mins, MD Tec Cmtee, 17 Aug 42. (2) 1st ind, CG SOS to SG, [29 Aug 42], on unknown basic ltr. (3) Memo, Chief Dev Br Research and Dev Div SGO for Chief Fld Equip Br Research and Dev Div SGO, 3 Sep 42, sub: Forward Area Amb. All in Off file, Research and Dev Bd SGO, "Amb, Forward Area."
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1943 recommended again that this type should be developed atonce. The SOS Requirements Division referred this recommendation to the ArmyGround Forces, principal user of front-line ambulances. Rather than introduce anew type of chassis, AGF headquarters recommended the modification of the ?-ton(4 x 4) ambulance and the issuance of "litter kits" for use withstandard field trucks.15 The Surgeon General'sOffice consented, and during the early part of 1943 the Ordnance Department andthe Medical Department Equipment Laboratory collaborated in the development ofan ambulance on a ?-ton (4 x 4) chassis that incorporated improvements desiredfor field use and had a body that could be "knocked down" forshipment. By July 1943 two experimental vehicles had been tested, and in Augustthe Surgeon General's Office recommended that one with plywood and steelpaneling be adopted as standard.16 As the 1944 ambulance procurementprogram was nearing completion (April 1944), the new "knock down"ambulance was standardized, and the older ?-ton vehicle, which had been issuedwidely to units in all areas, was reclassified as a limited standard item.17
Metropolitan Ambulances
The possibility of procuring metropolitan ambulances inaddition to those on hand or acquired at the beginning of the war was raised inthe middle of 1944. Early in June the War Production Board called the attentionof ASF headquarters to an opinion of the Ambulance Body Manufacturers IndustryAdvisory Committee that "The Army may not have considered the need forstreet ambulances to be used in connection with [Army] hospitals in thiscountry."18 Referring the matter to theSurgeon General's Office on 21 June 1944, ASF headquarters routinely calledfor recommendations as to possible Army requirements for "street"ambulances. When The Surgeon General took this opportunity to insist upon theprocurement of 200 metropolitan ambulances, ASF headquarters disapproved,stating that no suitable commercial chassis were in production, that theconversion of passenger cars frozen in the civilian pool would be too expensive,and that requirements for metropolitan ambulances could continue to be met byusing field (or general-service) ambulances.19The Surgeon General's Office then surveyed service command needs and inJanuary 1945 reported its findings. The 149 metropolitan ambulances already inuse were so badly worn as to require replacement, and 151 additional vehicles ofthat type were needed by ASF and AAF hospitals. Accordingly The Surgeon Generalrequested
151st ind, SG to CG SOS, 5 Feb 43, 2d ind, CG SOS (Reqmts Div) to CG AGF, 18 Feb 43, and 3d ind, CG AGF to CG ASF, 10 Apr 43, on Memo, CG SOS for SG, 30 Jan 43, sub: Amb. AG: 451.8 (1-30-43) and Off file, Research and Dev Bd SGO, "Cross-Country Amb."
16(1) Memo, CG ASF for SG, 19 Apr 43, sub: Amb, with ind. SG: 451.8-1. (2) Ord Tec Cmtee, Item 20641, 12 Jun 43. HD: 451.8. (3) Ltrs, MD Equip Lab to SG, 18 Aug, 21 Oct 43, sub: Amb, Cross-Country, Improvements, with inds. SG: 451.8-1.
17(1) Memo, CofOrd for CG ASF (Reqmts Div), 10 Mar 44, sub: Truck, ?-ton, 4 x 4, Amb KD-Standardization and Rev of Mil Characteristics, with 2 inds. AG: 451.2. (2) Ord Tec Cmtee, Item 23100, 9 Mar 44. HD: 451.8. Limited standard vehicles were usable substitutes for standard vehicles and were issued as long as the supply on hand lasted.
18Ltr, WPB to ASF, 9 Jun 44. SG: 451.8-1.
19(1) Memo, CG ASF for SG, 21 Jun 44, sub: Street Amb for Use in US, with 2 inds. (2) Memo, CG ASF for SG, 20 Jul 44, sub: Amb, Metropolitan, ?-ton, 4 x 2, with 2 inds. Both in SG: 451.8-1.
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ASF headquarters to authorize the development of "substitutestandard" metropolitan ambulances by the conversion of light sedans whichthe War Department had on hand. The Ordnance Department began such a project,but the war ended before it was completed.20
Multipatient Ambulances
Toward the end of the war the Medical Department succeeded in getting amultipatient ambulance and thus achieved, in part at least, a goal toward whichit had worked in the early war years. From 1939 until the middle of 1943 theSurgeon General's Office and the Medical Department Equipment Laboratory hadconducted almost continuous experiments to develop a single large vehicle thatcould serve not only as a multipatient ambulance both in the zone of interiorand in combat areas but also as housing for mobile laboratories, operatingrooms, and wards and as a means of transporting surgical, shock, and otherspecialized teams to areas where they were critically needed.21They had experimented with 2?-ton (4 x 2) front-wheel-drive bus-typevehicles, van-type semitrailers pulled by 1?-ton and 2?-ton tractors, and2?-ton (6 x 6) trucks.22 These experimentsfailed mainly because an attempt was being made to use a single vehicle forseveral purposes, and none possessed all of the characteristics required. Forexample, the front-wheel-drive bus was a nonstandard vehicle and lackedsufficient traction for cross-country use, while the semitrailer lackedmaneuverability in combat areas and was too rough for patients. The 2?-ton (6 x6) truck, on the Army's standard list, was successfully used in thedevelopment of a surgical truck for armored divisions, but the QuartermasterCorps thought that it would be unsatisfactory as an ambulance because full loadsof ambulatory patients would overload its front axles and wheels. Thus theMedical Department reached the middle of 1943 without having developed astandard multipatient ambulance. Meanwhile its Equipment Laboratory convertedeight experimental, nonstandard, front-wheel-drive bus-type vehicles, which hadbeen procured in 1940 and 1941 and had been found unsatisfactory for field use,into multipatient ambulances for service at ports in the United States. In Junefour apiece were issued to Letterman and Halloran General Hospitals in place ofthe passenger buses requested by Letterman, and instead of the additionalstandard general-service ambulances requested for Halloran by the second ServiceCommand.23 The next month the Laboratoryrecommended that the project for the development of a multipatient ambulance becontinued, but Surgeon General
20(1) Ltr, SG to all SvCs, 26 Sep 44, sub: Amb, Metropolitan, ?-ton, 4 x 2, Reqmts, with replies. SG: 451.8-1. (2) Ltr, SG to CG 7th SvC, 15 Sep 44, sub: Trans of PW Pnts in Carry-alls, with 7 inds. Ord: 451.8-39. (3) Ord Tec Cmtee, Item 27294, 20 Mar 45, sub: Amb, ?-ton, 4 x 2, Light Metropolitan. HD: 451.8.
21Ltr, MD Equip Lab to SG, 27 Dec 45, sub: Hist of Amb, Bus-Type, Experimental, MD Equip Lab Proj F 2. HD: 451.8.
22For documents on these experiments see files for 1940-43 as follows: SG: 451.8-1 (Carlisle Barracks), 451.8-1, 451.2-1, and AG: 451.8.
23(1) Ltr, Letterman Gen Hosp to 9th SvC, 22 Mar 43, sub: Req for Passenger Buses, with 2 inds. SG: 451.8-1 (9th SvC). (2) Memo, 2d SvC Ord Br for DepCofOrd Tank-Auto Ctr (Detroit), 24 Apr 43, sub: Motor Vehs, with 6 inds. SG: 451.8 (2d SvC). (3) Ltr, SG to CG ASF, 14 Jun 43, sub: Conversion of Surg Hosp Vehs to Bus-Type Ambs. SG: 451.2-1 (Carlisle Bks).
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Kirk directed that it be dropped.24During the following year his Office and the Laboratory concentrated onthe development of such special purpose vehicles as mobile medical and dentallaboratories, optical repair units, and dental and surgical operating trucks.25
In the second half of 1944 the question of furnishingmultipatient ambulances was reopened. In July Letterman General Hospital askedfor the replacement of the four worn-out multipatient ambulances which it hadreceived in mid-1943. To this request Ninth Service Command headquarters addedfour more for other debarkation hospitals on the west coast (two for BirminghamGeneral Hospital and two for Fort Lewis). By October the number requested forthe Ninth Service Command was doubled.26 Meanwhile,during July and early August, Mitchel Field, which served as a debarkation pointfor air evacuees, converted four Ordnance maintenance trucks into specialmultipatient ambulances for the transportation of patients from planes to theMitchel Field Hospital and from that installation to Halloran General Hospital.
To meet the need thus demonstrated, the Surgeon General'sOffice proposed on 11 September 1944 the development of a special ambulance tobe used only in the United States and to carry twelve to sixteen litterpatients. This limitation was expected to eliminate difficulties encounteredearlier in attempts to develop multi-patient ambulances that could carry eitherlitter or ambulatory patients in both the zone of interior and combat zones. Atfirst ASF headquarters was reluctant to approve a developmental project for avehicle in small demand. It proposed, instead, that The Surgeon General submit alist of standard military vehicles that would be satisfactory, when modified,for the use intended. Believing that no standard military vehicle was suitable,the Ordnance and Medical Departments decided that front-wheel-drive bus-typevehicles of the kind procured for experimental purposes in 1940 and 1941 shouldbe used. An important factor in this decision was the statement by the companymaking such vehicles that it had "open production facilities" andcould therefore "offer favorable delivery," if standard engines,transmissions, and axles were made available to them.27In addition, The Surgeon General pointed out, a pilot model had alreadybeen developed in 1940. He requested, therefore, that the Chief of Ordnance beauthorized to procure twenty-four such vehicles for Medical Department use. Thisrequest was approved by ASF headquarters on 4 November 1944.28
24(1) Ltr, SG to MD Equip Lab, 6 Jul 43, sub: Dropping and/or Suspension of Dev Projects, with ind. SG: 451.8-1. (2) Ltr, SG to CG ASF (Reqmts Div), 22 Jul 43, sub: Bus-Type Amb (Project F-2 and Mobile Hosp Ward (F 15.01)). Same file. (3) Memo, Chief Fld Equip Dev Br SGO for Chief Research Coord Br SGO, 27 Jul 43, sub: Experimental ?-ton Amb. Off file, Research and Dev Bd SGO, "Bus-Type Amb, F-2."
25For full discussions of these projects, see John B. Johnson, Jr, and Graves H. Wilson, A History of Wartime Research and Development of Medical Field Equipment (1946), pp. 295-730. HD.
26(1) Memo, CG Letterman Gen Hosp for CG 9th SvC, 20 Jul 44, sub: Repl of Ambs, Bus-type, with 3 inds. SG: 451.8 (9th SvC). (2) Ltr, SG to CG Letterman Gen Hosp, 26 Sep 44, sub: Multi-litter Ambs (Bus-Type), with 2 inds. Same file.
27Having "open production facilities" meant that the company's plant could begin production immediately without having to await the completion of other orders.
28Ltr, CG ASF (Dir of Sup) to CG 2d SvC, 21 Jun 44, sub: Trucks, 1?-ton, (4 x 4) Ord Maintenance, for Mitchel Fld, with 12 inds. SG: 451.8.
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EXTERIOR VIEW OF MULTIPATIENT METROPOLITAN AMBULANCE, 1945
Production of the new 12-litter ambulances began almostimmediately after the contract was awarded late in December 1944. Preliminarywork on blueprints and specifications had already been completed, and on 8January 1945 construction of the first model began. At the end of February itwas road-tested by Ordnance and Medical Department representatives. By lateMarch the first two were delivered to the Army, and during May-the month whenthe greatest number of patients arrived from theaters of operations-othermultipatient ambulances were ready for delivery to hospitals.29
Meanwhile, the Surgeon General's Office had surveyedrequirements and found that additional ambulances of this type would be needed-forty-sevenfor service commands and fifty-one for the Air Forces. In June 1945 ASFheadquarters approved their procurement. The next month the Ordnance Departmentbegan the process of standardizing the new ambulance. Before this was done inSep-
29(1) Ltr, SG to CGs SvCs, 26 Feb 45, sub: Amb, 1-ton, 4 x 2, 12 litter, Metropolitan Front Drive, with replies. SG: 451.8 (SvCs). (2) See letters on development and inspections, modifications in litter supports, and changes in rear springs in Off file, Research and Dev Bd SGO, "Amb, Bus-Type, Experimental, F-2."
369
INTERIOR OF THE MULTIPATIENT METROPOLITAN AMBULANCE
tember 1945, V-J Day occurred and the contract forninety-eight additional multipatient ambulances was canceled.30
Hospital Trains
At the beginning of 1939 the Medical Department had nohospital trains on hand and only indefinite plans for procuring them in theevent of war. The Army had disposed of its World War I hospital cars because itwas cheaper to transport the few patients who required movement in peacetime inPullman cars and tourist sleepers of regularly scheduled trains. Thereafter theMedical Department had assumed that three types of trains would be used in theevent of another war: (1) trains made up entirely of government-owned cars; (2)"semipermanent" trains composed of one government-owned administrativecar, called a unit car, and an appropriate number of commercial baggage cars,Pullman cars, tourist sleepers, and chair cars; and (3) improvised trains
30(1) Ord Tec Cmtee, Items: 28530, 26 Jul 45; 29055, 13 Sep 45; 29740, 8 Oct 45, sub: Amb, 1?-ton, 4 x 2, 12-litter Metropolitan. HD: 451.8. (2) Memo, SG for CG ASF (Reqmts and Stock Control Div), 6 Sep 45, sub: Ambs. SG: 451.8.
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consisting of any available commercial rolling stock. Trainsof the last type were considered undesirable because they lacked accommodationsfor the emergency treatment of patients and for train administration. There weredoubts that those of the first type could be constructed in sufficient numbersduring wartime. Hence, emphasis was placed upon planning for the conversion ofcommercial cars into unit cars. Such plans were drawn during the twenties andapproved by the General Staff in 1931.31
Development of the "Ideal" Unit Car
During 1939 more specific planning for hospital trains wasinspired by planning for rail transportation undertaken by the Army Engineers,urged on by the deteriorating international situation. As a part of a moregeneral project to furnish lightweight trains for use on damaged or poorly laidtracks in theaters of operations, the Engineers in January 1939 proposed agovernment-owned hospital train built from standard military cars (20-ton,28-foot-long, four-wheeled box cars). It was to consist of a personnel car, adressing (or operating) car, nineteen ward cars, and a kitchen car, and was tobe used, according to the Engineers, to transport patients "from the frontline to any point in the Communications Zone or Zone of Interior." TheSurgeon General's Office and the Medical Department Board agreed to adopt thistrain "for planning purposes," believing that they were not therebyeliminating the possibility of using other types of trains in communicationszones. On 4 August 1939 the Engineers announced that they were basing plans forall trains in theaters of operations on the use of 20-ton railway cars. Shortlyafterward, before committing itself further, the Surgeon General's Officeturned to a study of trains used during World War I both in theaters ofoperations and in the zone of interior.32
This study showed that trains made up entirely ofgovernment-owned cars had been used effectively in Europe but that thesemipermanent, or unit-car, type of train had been more successful in the UnitedStates. The unit car had had a kitchen large enough to feed 250 people, spacefor transporting 28 litter patients, and quarters for 1 officer, 2noncommissioned officers, and 2 cooks. Among its advantages had been itsflexibility, its economy of procurement and operation, and its provisions forfeeding patients. As a single car attached to a regularly scheduled train, ithad been used to transport twenty-eight or fewer patients; with one or twoPullman cars, it had been attached to regularly scheduled trains to carry morepatients; and it had been used, along with Pullman cars, tourist sleepers, chaircars, and baggage cars, to make up a special hospital train with accommodationsfor over 200 patients. Conversion of a Pullman car into a unit car was thoughtto have been cheaper than the construction of cars for an entire train.Moreover, since other cars used in connection with it had been owned either byrailroads or by the Pullman Company, only the unit car
31(1) Ltr, QMG to SG, 29 Dec 21, sub: Disposition of Hosp Cars, with 5 inds. Natl Archives, SG: 531.4-1. (2) Ltr, Bd of Engr Equip to CofEngrs, 9 Mar 31, sub: US Army Specifications, Car, Unit, Hosp, with 2 inds. CE: 531.43, pt 1. (3) US Army Specification 43-13, with drawing 43190, 30 Jul 31. SG: 453.-1. (4) Ltr, SG to Comite International de la Croix-Rouge, Geneve, 15 Feb 36. Natl Archives, SG: 322.2-5.
32(1) Memo, Engr Bd for CofEngrs, 12 Jan 39, sub: SP 70, Type Plans and Specifications for Motive Power and Rolling Stock on Standard Gauge Rys (Rpt 559, Prelim Rpt on Hosp Tns, Engr Bd, 23 Dec 38), with 9 inds. SG: 453.-1. (2) Rpt, MD Bd MFSS Carlisle Bks, Pa, 30 Mar 39. Same file.
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had had to be "deadheaded" (returned empty) to thetrains' point of origin. Furthermore, the unit car's kitchen facilities hadhelped to solve one of the major problems of World War I-the feeding ofpatients. Because of these advantages, and since the Engineers were alreadyworking on plans for cars for completely government-owned trains, the SurgeonGeneral's Office concentrated in the winter of 1939-40 on the development ofplans for an "ideal" unit car.33
The plans drawn were for a car that differed considerablyfrom the unit car of World War I and to some extent from one that had beenplanned in 1931. The latter presumably represented an improvement over the WorldWar I car. It was to have side doors for loading patients and, in addition tothe kitchen, an operating or dressing room and more space for attendants, butits capacity for patients had been reduced from twenty-eight to ten. In the fallof 1939 the Surgeon General's Plans and Training Division decided to eliminateall spaces for patients, in order to increase the feeding capacity of thekitchen to 500, enlarge the operating room and make an aisle around it, provideroomier quarters for more medical attendants, and furnish storage space forfoods and medical supplies. These changes were intended to produce a car whichwould have most of the facilities planned by the Engineers for the severaladministrative cars (dressing, kitchen, and personnel) of the proposed overseastrain and would be "ideal" for use in mass evacuation in the UnitedStates.34
After preliminary plans for the unit car had been drawn, theMedical Department Board and the Surgeon General's Office studied "in anew light" the Engineers' proposal to use only lightweight trains intheaters of operations. They found that the General Staff had "notspecifically approved" the 20-ton car for a hospital train, but that it hadapproved (in 1931) the unit car. Moreover, they considered the train proposed bythe Engineers to be "unsatisfactory" and "a reversion to that[type] used prior to 1863." Finally, they had an alternative to offer: theunit car "included all the necessary facilities for the care of the sickand wounded" and could be used with commercial cars to make a completehospital train either in the zone of interior or in theaters of operations. TheSurgeon General and the Engineers then reached a compromise on 8 May 1940. Thelatter agreed with The Surgeon General that, as a first choice, hospital trainsin theaters of operations should consist of the unit car and other heavy carsappropriate to it. The Surgeon General agreed that hospital trains oflightweight cars could be used in areas where the construction of roadbeds madethe use of heavier equipment impractical.35Thereafter, the Surgeon General's Office and the Medical Department Boardcollaborated with the Quartermaster General's Office and the Pullman Companyin completing specifications for the unit car, and with the Engineers in
33(1) Memo, Maj H[erbert] E. Tomlinson (SGO) for Col [Robert Du R.] Harden, 25 Aug 39, sub: Hosp Tns in World War. SG: 453.-1. (2) The Medical Department . . . in the World War (1923), vol. I, pp. 334-35; (1923), vol. V, pp. 180-86; (1925), vol. VIII, pp. 37-41.
34(1) Memo, SG (Capt Joe A. Bain) for QMG, 4 Oct 39, sub: Hosp Unit Car. SG: 453.-1. (2) Memo, SG (Col James E. Baylis, Exec Off) for MD Bd, 6 Feb 40. Same file.
35(1) 9th ind, SG to CofEngrs, 15 Apr 40; 10th ind, CofEngrs to SG, 4 Jun 40; 11th ind, SG to MFSS, 8 Jun 40, on Memo, Engr Bd for CofEngrs, 12 Jan 39, sub: SP 70, Type Plans and Specifications for Motive Power and Rolling Stock on Standard Gauge Rys. SG: 453-1. (2) Notes on Conf on Hosp Tns, TofOpns, by Capt Bain, 8 May 40. Same file.
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STATIONARY BEDS IN HOSPITAL WARD CAR, 1941
making preliminary designs for cars for the lightweighttrain.36
In the fall of 1940, when the establishment of Army bases inthe Atlantic and the prospective passage of selective service legislationcreated a potential need for hospital trains, the Surgeon General's Officerequested that two Pullman cars be converted into unit cars. This request wasapproved. Furthermore, in December 1940 the Engineers ordered, along with otherrailway equipment, enough 20-ton cars to test some for use in hospital trains.37
Need for Ward Cars and Their Development
About the time the first unit cars were delivered, the SurgeonGeneral's Office found, contrary to its expectations, that government-ownedhospital cars of another type would be needed. When the decision was made toeliminate spaces for patients in the unit car, the Planning and TrainingDivision had expected that litter patients would be carried in tourist sleepers.About a year later, in February 1941, it discovered that tourist sleepers, like
36(1) Memo, SG for TAG, 6 May 40, sub: Hosp Unit Car. TC: 531.4. (2) Rpts, MD Bd No 190, 27 Aug 40, Hosp Unit Car; No 174, 27 Aug 40, Hosp Tn, Combat Area; No 174, 9 Sep 40, Berth for Hosp Tn. SG: 453.-1.
37(1) Memo SG for TAG, 5 Sep 40, sub: Hosp Tns, with 4 inds. SG: 453.-1. (2) Purchase Order 51536, 16 Dec 40, Haffner-Thrall Co, Chicago. CE: 453, Pt 6. (3) Extract from History of the Development of Railroad Equipment, prep by Hist Staff, Engr Bd, Ft Belvoir, Va. HD: 531.4.
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Pullman cars, had washrooms at either end, instead ofstraight through-and-through aisles, and that patients on litters couldtherefore not be carried from sleepers to unit-car operating rooms.38For the latter to be of any use, it was necessary to develop a specialward car. During the spring of 1941 the Pullman Company, followingrecommendations of the Medical Department, prepared plans for convertingstandard Pullman cars into ward cars. This was to be done by removing existingwashrooms and installing other toilet and washing facilities in such a way as toleave a straight aisle; by adding wide side doors to permit easy loading andunloading of litter patients; and by replacing the Pullman berths with sixteentwo-tiered stationary beds made by the Simmons Company. Such beds were chosen,instead of Glennan adjustable beds used during World War I, because they werethought to be more comfortable and cheaper to procure. In July 1941 the GeneralStaff approved a request from The Surgeon General for four cars of this type,and contracts were let with the Pullman Company in September. It was thenanticipated that a hospital train would consist of one government-owned unitcar, two government-owned ward cars, a baggage car, and a variable number ofstandard Pullman or chair cars. The four ward cars were delivered in Novemberand December 1941.39 (Table 17)
When the Japanese attacked Pearl Harbor, the Army had twounit cars and four ward cars-enough government-owned equipment to serve as thenuclei of two hospital trains. The unit cars had not been used during 1941because they were not air-conditioned and no ward cars were available for usewith them. The ward cars just delivered had not been used either, but they had been favorably received by MedicalDepartment officers who had seen them. Enough rail equipment for six additionalhospital trains was needed, according to previous plans, for a full mobilizationof the Army.40
Ward Dressing Cars Replace Unit Cars
Early in January 1942 the Surgeon General's Office began toplan for additional hospital cars. In the course of a few months the concept ofthe types of cars needed changed radically. Despite lack of experience with thenew unit cars, the Surgeon General's Planning and Training Division decided toabandon them as a type. In view of earlier statements and subsequent experienceit is probable that the following factors accounted for this decision. The unitcar developed in 1940 had no space for patients. Capable of feeding up to 500persons, its kitchen could be used to capacity only with trains consisting ofabout eighteen cars. On such trains, serving food from a unit car to patients inother cars was a real problem. Moreover, since patients transported in theUnited States did not normally require surgery en route, the operating room ofthe unit
38(1) Ltr, SG (Col Albert G. Love) to Hq 8th CA (Col A[lbert]P. Clark), 19 Mar 40. Off file, Research and Dev Bd SGO, "Unit Car."(2) Memo, Capt Bain for Brig Gen Albert G. Love, 6 Feb 41, sub: Hosp Unit Car.Same file.
39(1) Ltrs, SG to Pullman Co, Chicago, 4 Mar, 20 Mar, 2 May, and 9 May 41; Pullman Co to SG, 14 Mar, 22 Apr, 24 Apr, 5 May, and 27 May 41. SG: 453.-1. (2) Ltr, SG to CofEngrs, 31 May 41, sub: Hosp Ward Cars. CE: 453, pt 6. (3) Ltr, SG to TAG, 31 May 41, same sub, with 4 inds. SG: 453. (4) Memo, CofEngrs for QMG, 25 Nov 41, same sub. CE: 453, pt 6.
40(1) Rpt, Observer, Second and Third Army Maneuvers,Sabine-Red River-Louisiana-Area, 15-26 Sep 41. SG: 354.2-1 (Maneuvers, Gen).(2) Memo, SG for TAG, 6 May 40, sub: Hosp Unit Car. SG: 453.-1.
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TABLE 17-HOSPITAL CAR PROCUREMENT PROGRAM, 1940-45
Ordered | Type of Car | Delivered | Numbers Assigned | Declared Surplus | |
Date | Number | ||||
| Total | 380 | --- | --- | --- | --- |
November 1940 | 2 | Unit | February 1941 | 1 and 2 (Changed to 8200-8201, Jul 42 and to 89200-201, Aug 44) | November 1945-February 1946 |
September 1941 | 4 | Ward | November-December 1941. | 1-4 (Changed to 8900-8903, Jul 42). | November 1945-February 1946 |
March 1942 | 6 | Ward Dressing | July-August 1942. | 8917-8922 (Changed to 89000-005, Apr 43). | November 1945-February 1946 |
March 1942 | 12 | Ward | July-August 1942. | 8904-8915 | November 1945-February 1946 |
January 1943 | 32 | Ward Dressing | September - December 1943. | 89006-89037 | November 1945-February 1946 |
January 1943 | 64 | Ward | September - December 1943. | 8916-8979 | November 1945-February 1946 |
August 1943 | 40 | Kitchen | March - September 1944. | 8731-8770 | March-June 1946 |
May 1944 | 100 | New Unit | November 1944-May 1945. | 89300-89399 | March-June 1946 |
January 1945 | 100 | New Unit | May-August 1945. | 89400-89499 | Retained |
February 1945 | 20 | Kitchen | March-July 1945. | 8711-8730 | October - November 1945 |
Sources: Hosp. Cars in Interchange Service-All Standard Gauge. HD: 453.1 (Hosp. Car Procment). (2) Correspondence filed in AG Technical Records: SG 453.1 and 531.4; TC, same file numbers.
car was larger and more elaborate than was needed.41
To replace the unit car the Surgeon General's Office andthe Pullman Company developed a ward dressing car in the early months of 1942.It contained a small surgical dressing room and space for thirty litterpatients, but it lacked kitchen facilities. It differed from the ward car onlyin the replacement of a toilet and berths for two patients with an operating ordressing room. This room, which could also be used as a loading room, wasequipped with an operating or dressing table, a washstand, a sterilizer, and a locker for surgicalinstruments. The dressing table could be used in the center of the room, moveddown the aisle of the car to a patient's berth, or stored at the side of thecar. Food would come from commercial dining cars. Thus the Medical Depart-
41(1)Rpt of MD Bd to consider MD Bd Project No 190, Hosp Unit Car, 8 Jul 41. SG: 453.-1. (2) Ltr, SG (Maj Thomas N. Page) to Pullman Co, 13 Jan 42. Off file, Research and Dev Bd SGO, "Hosp Ward Car." (3) Ltr, SG (Lt Col H[oward] T. Wickert) to Pullman Co, 13 Feb 42. SG: 453-1. (4) Ltr, Lt Col Thomas N. Page to Modern Hosp Pub Co, Chicago, 1 Dec 42. Same file.
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ment placed its reliance early in World War II, as ithad in World War I before the unit car was developed, upon railroad and Pullmancompanies for feeding patients. Instead of stationary Simmons beds, two-tieredGlennan adjustable berths were to be used in both ward and ward dressing cars.Chief advantage of the latter was that upper berths could be pulled down to formbacks for lower berths and thus make places for patients to sit. To provideenough government-owned equipment for six hospital trains, in addition to thatalready available for two, the Engineers ordered six ward dressing cars andtwelve ward cars in March 1942. They were delivered to the Charleston, NewOrleans, San Francisco, and New York Ports in July and August.42 (SeeTable 17.)
DRESSING ROOM IN HOSPITAL WARD DRESSING CAR, 1942
Air-Conditioning Hospital Cars
About a month before the new cars were delivered, the SurgeonGeneral's Office initiated action to get them air-conditioned. In response toa hospital train commander's request, that Office asked SOS headquarters inJune 1942 to have air-conditioning equipment installed in all hospital cars.Action on this request was delayed because of differences of opinion about themore desirable kind of equipment between the Surgeon General's Office on theone hand and the Engineers and the Transportation Corps on the other. Both theEngineers and the Transportation Corps favored the use of ice-activatedair-conditioning equipment, apparently because it was simpler to install andbecause it was commonly used on Pullman cars at the time. The Surgeon General'sOffice preferred a type of mechanical air-conditioning equipment which was thought toinsure more even temperatures and was not dependent upon batteries for operationwhen hospital cars were standing.43 A mechanical system of this type,produced by Mountain Aire Products, Incorporated, was installed in one hospitalcar for testing in the fall of 1942. Subsequently, as a result of these tests,differences of opinion arose
42(1) Ltrs, Pullman Co to SG, 13 Jan, 26 Jan, 10 Feb 42, with blueprints, Plan 4103-A, 4103-B. SG: 453.-1. (2) Specifications for Remodeling 18 Pullman Parlor Cars to Hosp Ward Cars for WD, from Pullman Co, 30 Jan42. Off file, Research and Dev Bd SGO, "Hosp Ward Cars."
43(1) Ltr, Med Sec 1927 CASU, Hosp Tn No 1 (SanFrancisco) to Surg 9th CA, 22 May 42, sub: Air-Conditioning for Hosp Tn No 1,with 5 inds. SG: 453.-1. (2) Memo SPOPM 673, ACofS for Oprs SOS for CofEngrs,18 Jun 42, sub: Mechanical Air Conditioning for Unit Cars. Same file.
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PLANS FOR HOSPITAL CARS, 1941-42
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even within the Transportation Corps as to whether this or anice-activated system was desirable but officially the Transportation Corps inDecember 1942 recommended installation of ice-activated systems and"declined to accept responsibility" for the performance of MountainAire systems. Despite this "veiled threat," the Surgeon General'sOffice requested that Mountain Aire equipment be installed in all ward and warddressing cars. SOS headquarters resolved this deadlock by directing the Chief ofTransportation to install air-conditioning equipment in all cars and by allowinghim to determine the type of equipment that would meet performance requirementsrecommended by The Surgeon General.44 After the Transportation Corpsand the Medical Department agreed upon desirable performance standards, theformer in the spring of 1943 had ice-activated air-conditioning equipmentinstalled in the ward and ward dressing cars which had been delivered during1941 and 1942. The installation of such equipment in hospital cars ordered afterthe fall of 1942 raised no problem, because they were procured with theair-conditioning systems normally used by companies supplying the cars-somemechanical and some ice-activated.45 Later, during 1945, the MountainAire system was removed from the car in which it had been installed and wasreplaced with an ice-activated system.46 Toward the end of the warthe Transportation Corps as well as the Surgeon General's Office came toprefer mechanical air-conditioning systems, because of the difficulty of icingcars en route and the fear of ice shortages, but they considered a changeundesirable at that time lest it delay completion of additional cars beingordered.47
Disagreement About the Type and Number of Cars
Soon after the Surgeon General's Office first requestedair-conditioning for hospital cars, SOS headquarters raised the question ofwhether those being procured were of the proper type and number. At that timeneither the Surgeon General's Office nor SOS headquarters had had experiencein the operation of hospital trains during World War II. Moreover, with themajority of troops still in training in the United States, the ultimate strengthof theaters of operations and the number of casualties to be returned to thezone of interior were not yet fully envisioned. Nor was the strain which the warwas to put on commercial transportation entirely comprehended. Nevertheless,officers concerned with secret planning for the North African invasion wereanticipating the reception of casualties from that operation, and thoseintimately involved in transportation problems were beginning to be aware ofsome of the difficulties
44(1) Memo, Engr Bd for CofEngrs, 7 Oct 42, sub: Air Conditioning of Pullman Type Hosp Cars, with 2 inds. SG: 453.-1. (2) Memo, CofT (Rail Div) for SGO (Lt Col J. B. Klopp), 12 Dec 42, sub: Mountain Aire Air-Conditioning System, with 4 inds. Same file. (3) Memo, Col H. T. Wickert for Gen [Larry B.] McAfee, 5 Jan 43. Off file, Research and Dev Bd SGO, "Hosp Tns, Air Conditioning."
45(1) Memo, CofT (Rail Div) for SG (Col J. B. Klopp), 4 Feb43, sub: Air Conditioning for Hosp Cars, with incl "Mil Characteristics ofAir Conditioning for Hosp Cars." SG: 453.-1. (2) Ltr, CofT for CGs 1st,2d, 3d, 4th, 8th, and 9th SvCs, 10 Feb 43, sub: Air Conditioning of Hosp Cars.TC: 531.4 (Hosp Cars).
46(1) Memo, CofT for SG, 21 Nov 44, sub: Air Conditioning on Ward Dressing Car 89002. SG: 453.1. (2) Memo, CofT (Rail Div) for Procmt Div OCT, Cincinnati, 13 Mar 45, sub: Cooling Syst on Hosp Car 89002. TC: 531.4.
47Memo, Sup Div OCT to Rail Div OCT, 19 Jan 45. TC: 531.4.
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railroads would encounter in meeting transportation needs ofboth the civilian population and the armed forces. In this atmosphere theAssistant Chief of Staff for Operations of SOS headquarters, to whoseHospitalization and Evacuation Branch a Medical Corps officer, Lt. Col. WilliamC. Keller, had recently been assigned for the purpose of advising on railevacuation, issued a directive on 23 July 1942 that provoked a re-examination ofthe hospital train program. It called upon the Engineers to develop a new typeof hospital car, called a rail ambulance car, and suggested that twenty-seven ofthem-three for each of the nine service commands-should be procured by 1January 1943. The reason for this directive, apparently, was a belief in SOSheadquarters, first, that the hospital cars being procured were of anunsatisfactory type because they had to be supplemented with commercialPullmans, sleepers, diners, and baggage cars, and second, that available railwayfacilities would be inadequate when patients began to arrive from theaters inlarge numbers. The proposed car was to have spaces for twenty to thirty-threepatients, depending upon whether berths were two-or three-tiered; quarters formedical attendants, including one officer, one nurse, and four enlisted men;kitchen facilities capable of feeding both patients and attendants; and adressing room and pharmacy. Because of a developing shortage of Pullman cars andtourist sleepers, lounge cars were to be used for conversion. Each lounge carthus converted would decrease demands of the Medical Department for commercialsleepers and would, at the same time, relieve the railway dining service of someof its load. From seven to eighteen cars of this type could make up completehospital trains; or single cars, attached to regularly scheduled trains, could move patients insmall groups.48
The Surgeon General objected both to the proposed type of carand to the suggestion that additional hospital cars were needed. He pointed outthat small numbers of patients could still be moved in Pullman cars of regularlyscheduled trains. For the mass movement of patients he preferred a completetrain made up of government-owned ward and ward dressing cars and commercialbaggage, sleeping, and dining cars to one consisting entirely ofgovernment-owned rail ambulance cars. A train of the latter type, he contended,was wasteful of both personnel and equipment. One having 10 cars would have 10dressing rooms and 10 kitchens and would require 10 officers, 10 nurses, and 40enlisted men. The Surgeon General stated that patients were not put on trainsuntil doctors felt reasonably sure that they would need little treatment intransit. Hence so many dressing rooms were not needed. Moreover, he believedthat regular dining car service could be used for feeding patients either inPullman cars of regularly scheduled trains or in the cars of complete hospitaltrains. In his opinion the transportation of sick and wounded would rate so higha priority that the Medical Department would always be able to get sufficientcommercial cars for its use. Furthermore, the Surgeon General's Office opposedthe use of three-tiered berths because it was difficult to get litterpatients into the top one.49
48(1) Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrsthru SG, 23 Jul 42, sub: Proposed Rail Amb Car. SG: 322.2-5.
491st ind, SG to CofEngrs, 1 Aug 42, on Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrsthru SG, 23 Jul 42, sub: Proposed Rail Amb Car; also 2d ind, CofEngrs to CG SOS thru SG, 24 Aug 42; and 3d ind, SG to CG SOS, 29 Aug 42 (init Col H. T. Wickert). SG: 322.2-5.
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After first stating that the eight hospital trains which hisOffice had planned would be sufficient, The Surgeon General reviewedrequirements about a month and a half later and concluded in October 1942 thatadditional trains would be needed. On the basis of four litter patients per1,000 troops per month from a total overseas strength of 2,500,000, he estimatedthat 10,000 litter patients would have to be moved from ports to hospitals eachmonth. The eight trains (twenty-four cars) already planned, making three1,000-mile trips per month, could move 2,160 litter patients per month. For the remainder, TheSurgeon General estimated that thirty-two additional hospital trains would beneeded. He recommended, therefore, that instead of rail ambulance carsthirty-two ward dressing cars and sixty-four ward cars be procured.50 Thisrecommendation, as well as types of hospital cars in general, was discussed on 9October 1942 in a conference of representatives of the Surgeon General'sOffice, the Engineers, the Transportation Corps, and the SOS Hospitalization andEvacuation Branch.51 The Surgeon General later expressed the belief thatthis conference had settled the issue in favor of ward and ward dressing cars.
Before giving The Surgeon General's recommendations formalapproval, SOS headquarters asked the Transportation Corps about the prospectiveavailability of commercial diners and sleepers. In this connection it calledattention to World War I experience, especially to difficulties in feedingpatients.52 In reply the Transportation Corps emphasized the burden alreadyplaced upon commercial dining car service by wartime travel and troop movementsand, in addition, raised a new point. Instead of using one ward dressing and two ward cars as the nucleus of a complete hospitaltrain, the Transportation Corps proposed that one rail ambulance car be used forthat purpose. If this should be done only 32 hospital cars would be needed,instead of 96, and the remaining 64 cars could be used for regular troopmovements.53 It seems that the Transportation Corps believed thatcommercial dining cars would not be available in sufficient numbers but thatPullman and tourist sleepers would. SOS headquarters therefore decided not toapprove The Surgeon General's recommendation, but directed the Engineersinstead to procure thirty-two self-contained rail ambulance cars.54
The Surgeon General's Office, which "considered thecontroversial matter [of the types and numbers of hospital cars required]finally settled" by the 9 October 1942 conference, was displeased with thisaction and on 18 November asked for another conference "to arrive at acomplete and final decision."55 During that meeting The Surgeon General'srepresentative stated that he preferred ward
504th ind SPOPH 322.15, ACofS for Oprs SOS to SG, 25 Sep 42; 5th ind SPMCP 322.2-5, SG to CG SOS, 10 Oct 42, on Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrs thru SG, 23 Jul 42, sub: Proposed Rail Amb Car. SG: 322.2-5.
51Rpt, Conf, 9 Oct 42, sub: Adequacy of Hosp Tn Equip. SG:453.-1.
52Memo SPOPH 322.15, CG SOS for CofT, 22 Oct 42, sub:Rail Amb Cars. TC: 531.4.
53(1) Memo, Mvmts Div OCT for Maj Gen C[harles] P. Gross, 29 Oct 42, sub: Rail Hosp Tns. TC: 531.4. (2) Memo, CofT (Maj Gen C. P. Gross) for ACofS for Oprs SOS, 30 Oct 42, sub: Rail Amb Cars. Same file.
546th ind SPOPH 370.05, ACofS for Oprs SOS to CofEngrs thruSG, 6 Nov 42, on Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrs thru SG, 23Jul 42, sub: Proposed Rail Amb Car. SG: 453.-1.
55(1) Diary, SOS Hosp and Evac Br (Keller), 16 Nov 42. HD: Wilsonfiles, "Diary." (2) Memo, SG for CG SOS, 18 Nov 42. HRS: Hq ASFControl Div file, "Evac."
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and ward dressing cars, regardless of the number procured, torail ambulance cars. In addition the Surgeon General's Office went on recordas preferring to feed patients from kitchens improvised in railway baggage cars,if diners should not be available, rather than to agree to the procurement ofrail ambulance cars. After this conference SOS headquarters reversed itsdecision and on 24 November directed the Transportation Corps to procure notless than forty and, if practical, as many as ninety-six ward and ward dressingcars. Contracts for the higher number were let in January 1943.56 (See Table17.)
Development of a Hospital Train for Overseas Use
In the course of discussions about the numbers and types ofhospital cars needed for the zone of interior, the question of trains fortheaters of operations came up. Before mid-1942 the Engineers had switched froma 20- to a 40-ton car as the standard for overseas military trains. Afterstudying blueprints and proposals for 40-ton cars, the Surgeon General'sOffice and the SOS Hospitalization and Evacuation Branch agreed in August 1942to use them in hospital trains built for theaters of operations.57 FollowingMedical Department recommendations, the Engineers completed preliminary drawingsand specifications for a combat-zone hospital train of twenty-one 40-toncars (operating, personnel, kitchen, and ward cars) by the end of November 1942.The Surgeon General's Office then suggested changes in the proposedspecifications and in January 1943 recommended to the Chief of Transportationthat one train of 40-ton cars should be constructed immediately for servicetesting and that all trains included in the Army supply program should beprocured as soon as possible after completion of such tests.58
In February 1943 the Army supply program included fortyoverseas hospital trains of twenty-one cars each for procurement in 1943 and1944, but none had been ordered and SOS headquarters doubted that these figuresactually represented requirements. The SOS Hospitalization and Evacuation Branchtherefore conferred on 18 February 1943 with representatives of the SOSRequirements Division, the Surgeon General's Office, and the TransportationCorps. The Surgeon General's representative informed SOS headquarters thatonly fifteen overseas trains would be needed in 1943 and five more in 1944. On23 February 1943 SOS headquarters directed Transportation Corps to procure thatnumber, plus one additional train of ten cars for experimental and trainingpurposes. Soon afterward the War Department learned that the European theaterwas procuring twenty-three hospital trains in the United Kingdom and on 8 April1943 the Surgeon General's Office requested the Transportation Corps to haveonly the experimental train constructed.59
56(1) Memo SPAOG 370.05, ACofS for Oprs SOS for CofT, 24Nov 42, sub: Ward Cars (Med). TC: 531.4. (2) Memo SPMC 322.2-5, SG for CG SOS, 25 Nov 42.Same file.
57(1) Diary, SOS Hosp and Evac Br (Keller), 6-7 Aug 42. HD: Wilson files, "Diary." (2) Memo, ACofS for Oprs SOS for CofT, 10 Aug 42, sub: Conf on Rail Evac. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42."
582d ind, SG to CofT (Rail Div), 8 Jan 43, on Memo, EngrBd for CofT (Rail Div), 30 Nov 42, sub: Lightweight, Combat Zone, Hosp Tn, with 10 drawings and 10specifications. SG: 453.-1.
59(1) Memo, SOS Reqmts Div for SOS Plans Div Hosp and Evac Br, 11 Feb 43, sub: Hosp Cars, with Memo for Record. AG: 531.43 (9-29-42). (2) Memo, SOS Reqmts Div for CofT, 23 Feb 43. AG: 322.38. (3) Memo, CofT for SG, 25 Mar 43, sub: Hosp Tn for Tng Purposes, with 2 inds. SG: 453.-1.
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During the latter half of 1943 this train was completed andexhibited to the public on a cross-country trip. It was then used for theevacuation of patients from the California-Arizona Maneuver Area, returned toHampton Roads for two test runs, sent to Camp Ellis (Illinois) for use intraining hospital train units, returned to the manufacturer for the correctionof deficiencies, and displayed as a part of the Fifth War Bond Drive in New YorkCity. Complaints about the mechanical aspects of the train were numerous, butthe most important from the viewpoint of patient evacuation were that the wardcars were poorly ventilated, crowded even when they carried a normal load ofpatients (sixteen in each car), and uncomfortably rough even at speeds of lessthan thirty-five miles per hour.60 Finding no further need for thistrain in the United States, the Technical Division of the Surgeon General'sOffice in July 1944 drafted messages in which the War Department queried theEuropean and North African theaters as to whether or not they could use it. Thelatter agreed to accept the train and in September 1944 it was taken to HamptonRoads for shipment to southern France.61
Improvement of Existing Cars and Procurement of Kitchen Cars
In late 1942 and the first half of 1943, while the types andnumbers of hospital cars needed for the zone of interior were being discussedand the program for trains for theaters was being re-examined, experience madeit possible to evaluate the hospital unit, ward, and ward dressing cars. Theunit cars had proved to be of little use, for reasons already explained. Wardand ward dressing cars appeared to fulfill their purposes and required only minor modification, such as the installation of storagelockers, floor lights, bulletin boards, and bedside holders for patients' foodtrays. These changes were incorporated in specifications for new cars. They werealso made in the ward and ward dressing cars already delivered.62
Two major problems in the operation of hospital trainsappeared: safeguarding neuropsychiatric patients during transit and feedingpatients and medical attendants from commercial diners. Hospital traincommanders found that in transporting mentally disturbed patients eitherrestraints and sedation had to be used or additional attendants had to beassigned. As a partial solution to this problem, they recommended the use ofwire screens inside car windows.63 Throughout late 1943 and early1944, the Medical Department collaborated with the Transportation Corps and thePullman Company in developing a standard screen to meet this need. It was madeof heavy mesh wire and was designed to fit inside the windows of standardtourist and Pullman cars. It was re-
60(1) Memo, Col I. Sewell Morris, OCT for Mvmt Div OCT, 4 Nov 43, sub: Hosp Tn for Calif-Ariz Maneuver Area.HD: 453.1 (10-Car Hosp Tn, Overseas). (2) Ltr, CO 3d Hosp Tn to SG, 15 Dec 43. TC: 531.4. (3) Memo, CofT for SG, 20 Apr 44, sub: Ten-Car Hosp Tn. . . . SG: 453.-1. (4) Ltr, CofT to SG, 4 Apr 44, sub: Hosp Tn, Contract W-2789-tc-1201. TC: 531.4.
61(1) Draft rad prepared by Tec Div SGO for dispatch toETO, 1 Jul 44. SG: 322 (Hosp Tn)H. (2) Weekly Diary, Tec Div SGO, 29 Jul-4 Aug 44. HD: 453.1 (10-Car Hosp Tn, Overseas). (3) Routing Forms, AAR, 13 Sep 44. TC: 511 "Main 39595."
62(1) Memo, SG for CofT, 4 Mar 43, sub: Hosp CarChanges. SG: 453.-1. (2) Memo SPTSY 453, CofT for SG, 8 Mar 43, sub: HospCars, with Rpt of Insp of Cars being Air-Conditioned. Off file, Research and DevBd SGO, "Hosp Tns, Air Conditioning."
63(1) Ltr, Hq 2d SvC to Hosp Tn No 2, Ft Monmouth, N.J.,and Hosp Tn No 1, Tilton Gen Hosp, Ft Dix, N.J., 3 Apr 43, with 4 inds. SG: 322.2-5.(2) See other train reports, SG: 322.2-5 and TC: 531.4 (Hosp Tn Mvmts).
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movable and could be locked in place by means of the standardbunk key carried by all Pullman porters. Issued on the basis of a set ofthirty-two (enough for one car) for each hospital train, these guards werehelpful in preventing patients from hurting themselves on car windows and fromattempting to escape.64
The feeding problem was more complicated. Train commanderswere almost unanimous in complaints about difficulties of feeding patients fromcommercial diners. These diners often failed to meet Army standards ofsanitation, carried no foods for special diets, served meals that becamemonotonous, provided midmorning or midafternoon nourishment for patients only atexcessive costs, were not open for meals for attendants on night duty, and wereoften uncoupled at junction points, leaving both patients and attendants withoutmeals for the remainder of their journeys.65 Moreover, the fear thatdining cars would be unavailable for all needs-expressed by SOS headquarters andthe Transportation Corps in the fall of 1942-was becoming a reality. Theentire problem was discussed in February 1943 in a series of conferences onrailway rates between railroad officials and representatives of the SurgeonGeneral's Office, the Transportation Corps, and the SOS Hospitalization andEvacuation Branch. At that time the railroads agreed to supply hospital trainswith dining cars or, if diners were not available, with baggage cars that couldbe used as kitchen cars.66 Soon afterward the Transportation Corpsasked the General Staff for authority to convert twenty-one idle Coast Artillerykitchen cars into hospital kitchen cars. After spending several months modifyingand testing one, the Medical Department and the Transportation Corps decidedthat they were too small and lightweight to operate with fast passenger trains. InJuly 1943, therefore, they agreed to seek authority to procure forty kitchencars of the type being built for use with troop trains. Since cars in thatnumber would provide one kitchen car for each group of three ward and warddressing cars-the same ratio by which kitchen cars were provided for troopcars-ASF headquarters approved the request on 16 August 1943. By December onehospital kitchen car was delivered for service testing, and the remainder,incorporating minor changes made as a result of this test, were delivered during1944.67 (See Table 17.)
Development of a "New-Type" Unit Car
Within two months after ASF headquarters approved the procurement of hospitalkitchen cars and before all ward
64(1) Ltr, SG (Tec Cmtee) to CG ASF (Reqmts Div), 22 Jul 43, sub: Window Guards for Hosp Tns. SG: 453.1. (2) Ltr, SG to MD Equip Lab, 15 Sep 43, sub: Window Guards for Tourist and Hosp Ward Cars. Same file. (3) Ltr, SG for CGs all SvCs, 26 Apr 44, sub: Window Guards for Hosp Tns. SG: 453.1 (SvCs).
65Reports of hospital train movements are replete with descriptions ofdifficulties involved. See TC: 531.4 (Hosp Tn Rpts) and scattered rpts in SG: 322.2-5 and 453.1.
66(1) Ltr, Interterritorial Mil Cmtee Rail Carriers to CofT (Tfc Control Div), 25 Jan 43, with incls. TC: 531.4. (2) Diary, SOS Hosp and Evac Br (Keller), 24-26 Feb 43. HD: Wilson files, "Diary." (3) Ltr,Interterritorial Mil Cmtee Rail Carriers to SG, 6 Apr 43, with incl. SG: 453.1. (4) Memo W55-33-43, sub: Trans of Hosp Cars and Tns, 10 Aug 43. AG: 531.4 (6 Aug 43).
67(1) Memo, CofT (Tfc Control Div) for ACofS OPD WDGS, 2 Mar 43, sub:Kitchen Cars. TC: 531.4. (2) Memo, SG for CofT, 7 May 43, same sub. Same file. (3) Memo, SG for CofT, 29 Jul 43, same sub. SG: 453.1. (4) Memo, Dep Dir of Oprs ASF for CofT, 16Aug 43, same sub. HD: Wilson files, "Day File, Aug 43." (5) Rpt, 1247SCSU for CG 2d SvC, 23 Dec 43, sub: Rpt of USA Kitchen Car, 8731. Same file.
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and ward dressing cars already ordered had been delivered,the Surgeon General's Office in October 1943 requested that additional cars ofstill another type be provided. The reason was that a change was gradually beingmade in the distribution of patients among general hospitals. Establishment of apolicy of caring for patients from theaters of operations in hospitals neartheir homes and designation of particular hospitals for the specializedtreatment of certain disabilities meant that patients arriving on a single shipwould be distributed among many different general hospitals. For a time thepractice of sending a complete trainload of patients (from 200 to 300) to onegeneral hospital continued, and it was often necessary to retransfer patients toother hospitals. During the latter half of 1943, however, the Second ServiceCommand began to try to send patients directly from the debarkation hospital inNew York to the general hospitals in which they would receive treatment. Thiswas done by making up trains in sections which could be cut off at intermediatepoints for routing to different general hospitals. Each section consisted of acombination of ward cars, ward dressing cars, and commercial sleeping cars. Thechief difficulty encountered in this practice was in feeding patients. Untilkitchen cars were delivered, the entire train had to depend upon uncertaincommercial dining car service. Even if kitchen cars had been available, eachsection separated from the main train would have still been dependent uponcommercial dining service.68 On 15 October 1943, therefore, theSurgeon General's Office requested the Transportation Corps to provide fifty"new type unit cars" by May 1944. These cars, for which a sketch hadbeen drawn by the Hospital Construction Branch, were to be similar to the rail ambulance car designedby the Engineers in the fall of 1942.69 They were to be used as parts ofcomplete hospital trains; for secondary movements from the main, or primaryroutes of hospital trains; and for the transportation of small groups ofpatients on nonhospital trains. Although ASF headquarters had formerly advocatedthe use of such cars, it replied in November 1943 that no new developmentalproject should be started unless it was essential to winning the war anddirected, as a preliminary step to further action on The Surgeon General'srequest, an evaluation of the passenger traffic problem with particularreference to the transportation of patients. The next month this headquartersmodified its position by authorizing the conversion of the two unit cars thathad been delivered to the Army in 1941 into pilot models for the new type.70
Reappraisal of the Hospital Train Program
Before the pilot models were completed for service testing,the Surgeon General's Office re-examined the entire hospital train program.Early in 1944, it will be recalled, a group in this Office had completed adetailed study of the anticipated patient load.71 It was estimated that30,000 patients per month would have to be moved by train by October 1944 andthat at least 75 percent of them would have to be moved in government-owned
68(1) Ltr, CO 1247 SCSU 2d SvC to SG, 2 Oct 43, sub:Cons of Hosp Unit Cars. TC: 531.4. (2) Memo, CofT for SG, 23 Sep 43, sub: Govt-OwnedHosp Cars, with 1 ind. Same file.
69Memo, SG for CofT, 15 Oct 43, sub: Unit Car, NewType, with Drawing (7 Oct 43). TC: 531.4. See above, pp. 377-80.
70Memo, SG for CofT, 18 Sep 43 (corrected 18 Oct 43), sub: Unit Car, New Type, with 5 inds. TC: 531.4.
71See above, pp. 323-25.
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PLANS FOR RAIL AMBULANCE CAR AND NEW HOSPITAL UNIT CAR
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cars. Assuming that each car could carry twenty-five patientsper trip and could make four trips per month, 225 cars would be needed. Since120 were already available or authorized, The Surgeon General requested 105additional hospital cars of the new unit type. At the same time he asked thatbuffet kitchens be installed in all ward and ward dressing cars. TheTransportation Corps agreed with The Surgeon General as to the type of carsdesired but believed, on the basis of a study just made, that as many as 200additional hospital cars would be needed. On 11 April 1944 representatives ofASF headquarters, the Surgeon General's Office, and the Transportation Corpsagreed that it would be quicker and more economical to construct new cars thanto try to lease commercial cars for conversion. Two weeks later ASF headquartersapproved both the alteration of ward and ward dressing cars and the procurementof 100 new cars. Additional ones would not be authorized, it was stated, untilmilitary requirements became "firmer."72 Contracts for alteringold cars and building new ones were let with the American Car and FoundryCompany in May 1944, and by late fall of that year cars of both types were readyfor trial runs.73
The new unit car was similar to the unit car of World War Iand to the rail ambulance car proposed in 1942 in that it had space for bothpatients and attendants as well as facilities for caring for patients and forfeeding all passengers. It was different in that it was built specifically as ahospital car, instead of being converted from existing rolling stock, and wasequipped "with every travel luxury." Ten feet longer than Pullmancars, its body was of steel and was mounted on easy-riding six-wheel trucks. Atone end was a stainless steel kitchen, with a refrigerator, an ice cream cabinet, a coalrange, sinks, a steam table, and a coffee urn. Both the press and the Armycalled this the "principal innovation in the new car." Next to thekitchen was a pharmacy and receiving room, with wide doors on each side forloading litter patients. This room could be used also as an emergency operatingor dressing room. Adjoining it were two sets of three-tiered berths that couldbe used for seriously ill patients, for mental patients, or for medicalattendants. This section was separated from the main ward by a sterilizer roomon one side of the car and a toilet and washroom on the other. The main wardsection had a row of five three-tiered Glennan-type berths on each side. Theycould be adjusted to provide seating space, or the two lower berths could beused for litter patients and the upper berth for ambulatory patients orattendants. Between the main ward and the vestibule were storage lockers and ashower bath on one side of the car, and a roomette each for an officer and anurse on the other. Each car was carpeted, equipped with special lightingfixtures, and air-conditioned.74 Although less luxurious and lackingspecific accommodations for doctors and nurses, hospital ward and ward dressingcars, after the installation of the kitchenettes in space made available byremoval of berths for four patients, could be used in much
72Memo, SG for CG ASF, 30 Mar 44, sub: Hosp Cars, ZI, with 4 inds. SG: 322.2-5 and TC: 453.9.
73(1) TC-3066, Specifications for Cons of Car, Hosp, 8 May44. Off file, Research and Dev Bd SGO, "Unit Car, New Type." (2) Memo, CofT (Reqmts Div) for CG ASF (Dir of Mat), 14 Jun 44, sub: Hosp Cars, ZI, with 3inds. SG: 322.2-5.
74(1) Railway Age, Vol. 117, No. 26 (1944), pp. 964-66. (2) American Car and Foundry Company, Report toWorkers, pp. 76-79. Lib Congress. (3) For details of development see files SG:453.1, TC: 531.4, and Off file, Research and Dev Bd SGO, "Hosp UnitCar."
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WARD IN NEW HOSPITAL UNIT CAR, 1944 (note adjustableberths).
the same way as the new unit cars. Thus by the end of thewar, the Medical Department had what were in effect only two types of hospitalcars: unit cars and kitchen cars.
With development of the new unit car and modification of wardand ward dressing cars, a change occurred in hospital train movements. Graduallythe practice developed of making up hospital trains for a number of destinationsand of including in them variable numbers of hospital cars in differentcombinations. Ordinarily, regardless of the inclusion of hospital cars withkitchen facilities, hospital kitchen cars were used for feeding all patients solong as a number of hospital cars remained attached to the train. This practicewas followed because it was more efficient to prepare food in one place than in many different places. Allcars of a hospital train did not proceed to the same destination. At"gateways" (railway junctions) separate cars were cut away from themain route and were attached to commercial trains to carry loads of patients todifferent destinations. After delivering initial loads, cars were often divertedto transport additional groups of patients from one general hospital to anotherbefore being used again as parts of a complete hospital train. Whenever carswere separated from hospital trains, their buffet kitchens were used to feedpatients.75 Thus the hospital cars
75(1) Rpts, Hosp Tn Conf, 15-16 Feb 45, Miller Fld,SI, N.Y.; 10-13 Jul 45, Presidio of San Francisco. HD: 531.4 (Conf). (2)Records of hospital train movements, filed in OCT, Tfc Control Div, form OCT145.
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RECEIVING ROOM IN NEW HOSPITAL UNIT CAR, 1944
finally in use in World War II possessed an adaptabilitywhich permitted them to be used along with other cars to make up a completehospital train or singly to transport small groups of patients on commercialtrains.
Procurement of Additional Hospital Cars
In the winter of 1944-45 the Surgeon General's Officereviewed the anticipated patient load and re-estimated the hospital andevacuation facilities that would be required. On the assumption that V-E Daywould occur in June 1945, it was estimated in December 1944 that the number ofpatients returned to the United States each month from January through August1945 would range from 32,000 to 36,000 and would decrease thereafter.76 A drop in thepatient load would result in no less need for hospital cars, for after V-E Daythe major portion of patients would arrive at Pacific ports and a car operatingfrom one of them could make fewer round trips and carry fewer patients permonth, because of the greater distance to general hospitals, than could one froman Atlantic port. At the same time, railroads were finding it increasinglydifficult to supply the Army with enough commercial cars of the desired type. Toassure adequate numbers of hospital cars, the Surgeon General's Office on 19December 1944 asked for 100 additional unit cars as soon as possible. ASFheadquarters approved this request,
76See above, pp. 327-28.
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and contracts were let with the American Car and FoundryCompany in January 1945.77 Meanwhile, it became apparent that more kitchencars would be needed because the increasing number and changed type of hospitalcars permitted the operation of more than forty trains at one time. On 22January 1945, The Surgeon General requested the Transportation Corps to procuretwenty troop kitchen cars from the Defense Plant Corporation for use withhospital trains. This request was approved, and the twenty cars were deliveredwithin the next few months and put into use immediately, without significantalterations.78 (See Table 17.)
The peak of the patient load arriving from theaters ofoperations came before the second group of 100 unit cars was delivered. In May1945, when the greatest number of patients in any single month arrived, the Armywas using 120 old cars and 100 new unit cars, plus almost 60 kitchen cars.During that month, 47,044 patients were moved by train. This required the use of1,200 Pullman cars to supplement government-owned cars.79 Thereafter,the number of patients declined rapidly and by late August 1945, when the lastof the cars ordered in January had been delivered, the Medical Departmentdeclared surplus thirty-six modified ward and ward dressing cars. After V-JDay the decline in the patient load permitted the disposal of additional carsand by the middle of 1946 the Medical Department retained only 100 unit cars.80(See Table 17.)
Problems in Manning Hospital Trains
At the beginning of the war the Medical Department had atable of organization for a hospital train unit. Revised early in 1942, it was reissued in April as Table of Organization 8-520. It providedfor a self-sustaining unit to operate a complete hospital train with a capacityof 360 patients. To perform its own administrative, mess, and supply functionsas well as to care for patients, each unit was authorized 4 Medical Corpsofficers, 6 nurses, and 33 enlisted men.81 Eight such units wereorganized between June 1942 and June 1943, and for a short time there wasconfusion about their purpose both in SOS headquarters and among servicecommands. In September 1942, on recommendation of the Surgeon General'sOffice, SOS headquarters made it clear that such units were intended for servicein theaters of operations and were to be employed in the United States ontraining trips only.82
About the same time, there was concern about attendants for patients beingtransported by train in the United States. After the North African invasion,casualties began to arrive in increasing numbers. Furthermore, hospital carswhich the Army had ordered early in 1942 were delivered
77(1) History . . . Medical Regulating Service. . . , Tab 5, Hospital Trains. (2) Memo, SG for CG ASF (Planning Div) thru CofT, 19 Dec 44, sub: Hosp Cars, ZI, with ind. SG: 322.2-5. (3) Memo, ASF Planning Div for ASF Reqmts and Stock Control Div, 21 Dec 44, same sub. HRS: ASF Planning Div Program Br file, "Hosp and Evac."
78(1) Memo, SG for CofT (Rail Div), 22 Jan 45, sub: MD Kitchen Cars. SG:453.1. (2) Memo, Maj R. W. Tonning (OCT) for Rail Div OCT, 18 Jun 45, sub: Convof 20 Trp Kitchen Cars. TC: 531.4.
79Information supplied by Troop Movements and Records Section, Traffic ControlBranch, Passenger Division, OCT.
80(1) Memos, SG for CofT (Mil Ry Serv), 27 Sep 45, 27 Feb 46, and 2 Apr 46, sub: Release of Surplus Hosp Cars. SG: 453.
81T/O 8-506, 1 Nov 40; T/O 8-520, 1 Apr 42.
82(1) An Rpt, Oprs Serv SGO, 1943. HD. (2) 2d ind, CG SOS to CG 4thSvC, 22 Sep 42, with Memo for Record, on Memo, CG 4th SvC for CG SOS, 29 Aug 42,sub: Hosp Tn. AG: 322.38.
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and in August the entire fleet of twenty-four were assignedto service commands.83 In discharging responsibility for manningthem, service commands encountered difficulty in determining how many doctors,nurses, and enlisted men were needed. SOS directives instructed them to use as aguide Table of Organization 8-520, but it applied to an entirely differentsituation. In the zone of interior hospital trains were to be composed of threehospital cars supplemented with such common-carrier equipment as Pullmans,diners, and baggage cars. They carried varying numbers of patients and dependedupon the railroads in the early part of the war for mess service. To supplyservice command surgeons with a more appropriate guide, SOS headquarters on 24December 1942 directed The Surgeon General to prepare a manning table for zoneof interior hospital trains. Submitted six days later, this table indicated that2 doctors, 1 nurse, and 14 enlisted men were needed for 100 patients; 2 doctors,1 nurse, and 16 enlisted men for 200 patients; 3 doctors, 1 nurse, and 19 enlisted men for 300patients; and 3 doctors, 1 nurse, and 21 enlisted men for 400 patients. Soonafterward SOS headquarters directed the Second Service Command-and presumablyothers-to use this guide in requisitioning personnel for use aboard hospitaltrains.84
As experience accumulated in transporting increasingly largenumbers of patients, ASF headquarters in August 1943 issued a new guide-Tableof Distribution 8-1520-which differed from the one prepared by the SurgeonGeneral's Office in December 1942. Whereas the old guide had covered groups ofpatients ranging by hundreds from 100 to 400, the new one covered groupsincreasing by twenty-fours from 118 to 358. This change reflected the growing tendency to send small groups of patients todifferent hospitals instead of making mass movements from a port to one or twohospitals only. The old guide had called for 2 doctors, 1 nurse, and 16 enlistedmen for 200 patients; the new one called for 3 doctors, 1 administrativeofficer, 3 nurses, and 11 to 16 enlisted men for 190.85 Despite a moderateincrease in personnel in the new guide, it proved inadequate, at least in oneservice command, and was not followed. During the period from 15 March 1944through 12 May 1944, seventeen hospital trains evacuated patients from StarkGeneral Hospital in the Fourth Service Command. Each carried an average of 190patients and had assigned as attendants an average of 6 doctors, 3administrative officers, 5 nurses, and 57 enlisted men.86 Presumablyother service commands also were free to use more attendants than the guidecalled for.
Another problem which service commands encountered was themanner in which train personnel should be handled administratively. Until themiddle of 1943 all commands assigned such personnel to station or generalhospitals. Difficulties caused by this procedure were illustrated by theexperience of the Second Service
83See above, pp. 349, 375.
84(1) Ltr SPOPH 322.15, CG SOS to CGs and COs of SvCsand PEs, and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs, with incl. AG: 704. (2)2d ind, CG SOS to SG, 24 Dec 42, with Memo for Record; 3d ind, SG to CG SOS, 30 Dec 42, with incl; and 4th ind, CG SOS to CG 2d SvC, 5 Jan 43, with Memo forRecord, on Memo, CG SOS for CG 2d SvC, 21 Nov 42, sub: Auth to Activate Two HospTns. AG: 320.2 (11-21-42).
85(1) T/D 8-1520, 12 Aug 43, Hosp Tn, ZI. (2) See pp.347-48.
86Memo, 1st Lt Theodore Kemp, Control Div [4th SvC] forMaj Maxwell, 5 Jun 44, sub: Pers Reqmts for Hosp Tn. HD: 531.4 (Pers Reqmts).There is no indication in the document cited as to the organization to whichMajor Maxwell was assigned.
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Command. For example, officers, nurses, and enlisted men used to operate oneof its trains were assigned to Halloran General Hospital. This hospital assignedthem to ward duties, maintained their records, paid them, and considered themadministratively a part of the hospital staff. In consequence, nurses andenlisted men often worked on wards until the departure time of trains, withoutopportunities to rest and prepare themselves for trips. To get enlisted menreleased from ward duties for train trips, the train commander had to requestthe permission of the commanding officer of the hospital medical detachment who,in turn, had to request permission of the chief of the section for whom thesemen worked in the hospital. Officers who were assigned to wards lost contactwith patients they left behind while away on train trips. Working part of thetime in the hospital and part on hospital trains, officers and enlisted menfound it difficult to demonstrate to hospital authorities their fitness forpromotion and were often passed over when promotions were made. Enlisted men whowere absent from the hospital on paydays failed to receive their pay and, unlesspaid on a supplemental payroll, had to await the next regular payday a monthlater. The hospital considered this situation just as unsatisfactory as did thetrain commander because it had officers, nurses, and enlisted men upon whom itcould not always depend for hospital service. Nevertheless this system kept allpersonnel fully occupied in the intervals between train movements, and perhapssome of the problems connected with it could have been solved by minoradministrative changes. The Second Service Command however adopted a differentsolution by requisitioning additional personnel for train operations andassigning it, along with that already available, to a separate unit,the 1247th Service Command Service Unit.87
During 1944 other service commands followed this example. Theorganization of train units that were separate from hospital detachments wasdiscussed at a service commanders' conference in February 1944 and wasindorsed by the commanding general of the Service Forces. Afterward, in July1944, the First, Third, and Ninth Service Commands organized separate trainunits. At least one of them, the First, placed its train unit under the directcontrol of the service command surgeon in the spring of 1945. The Fourth ServiceCommand followed a different procedure. In September 1944 a receiving andevacuation detachment, consisting of litter bearers and clerks as well as trainpersonnel, was organized at Stark General Hospital.88 Theorganization of separate units, if their members were kept fully occupied, wassuperior to the use of hospital personnel for train service, since it simplifiedadministration in all respects.
Service command surgeons encountered difficulty in gettingadequate personnel allotments for train operations. Having estimates of thepotential patient load, the Surgeon General's Office attempted early in 1944to forestall this difficulty. In April it submitted to ASF headquarters anestimate of medical attendants needed by each service command during 1944 fortrain operations. ASF headquarters took
87(1) Rpt, Hosp Tn 1, Halloran Gen Hosp to CG 2d SvC ASF (Med Br Sup Div), 5 May 43, sub: Rpt of Hosp Tn Mvmt, HT 16-21-1-11, Main 24025, 27-28 Apr 43, with Supp. SG: 531.4. (2) An Rpt, 2d SvC, 1943. HD.
88(1) Rpt, Conf CGs of SvCs, Dallas, Tex, 17-19 Feb 44. HD:337. (2) An Rpts, 1st and 9th SvCs, McGuire and Stark Gen Hosps, 1944, HD. (3)GO 49, 14 Apr 45, Hq ASF, 1st SvC, Boston. HD: 531.4.
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the position that service commands should determine their ownneeds and should submit requisitions accordingly.89 Under thissystem, service command surgeons apparently failed to get the strength actuallyneeded for train operations. For example, at the end of 1944 the surgeon of theSecond Service Command had an allotment of 589 for assignment to hospitaltrains, but used 1,175. To make up the difference, he attached to trains 586persons from other medical installations in the command. The Surgeon Generaldiscussed this problem with the Chief of Staff at the end of 1944. As a resultservice commands got additional personnel. For example, the number assigned totrain service in the Second Service Command increased by May 1945 to 1,322-58physicians, 1 dentist, 75 other officers, 91 nurses, 1,053 enlisted men, and 44civilians.90
Supplies and Equipment for Hospital Trains
Equipment for the care and comfort of patients on hospitaltrains had to be planned for each hospital car developed, and consideration hadto be given to balancing the necessity of items for medical use against thelimited amount of space available. Hence, large items of equipment that werefixed parts of hospital cars, such as berths, instrument cabinets, storagelockers, instrument sterilizers, bedpan washers and sterilizers, cooking ranges,refrigerators, coffee urns, and the like, were planned along with cars in whichthey were to be installed and became a part of the specifications for theirconstruction. Builders of hospital cars normally procured and installed suchitems, but in some instances the Medical Department procured certain specialones, such as instrument sterilizers and operating tables, for installationby builders.91
Supplies and items of equipment that were not fixed parts ofhospital cars were listed in tables of allowances and in Medical Departmentequipment lists. The latter were the more important, because hospital carscarried few items supplied by services other than the Medical Department. By thefall of 1940, when procurement of the first two unit cars was approved, theSurgeon General's Office had developed an equipment list for cars of thattype. Like other Medical Department equipment lists, it included such items asdrugs and biologicals, gauzes and bandages, surgical instruments, linens, officesupplies, and mess equipment.92 Later, in 1942, when ward and warddressing cars
89(1) Memo, Dep Dir Plans and Oprs ASF for Dir PersASF, 26 Apr 44, sub: Reqmts for Med Pers to Cover Rail Mvmts . . . , with incl.HRS: ASF Planning Div Program Br file, "Hosp and Evac, vol. 3." (2)Memo, Dep Dir Plans and Oprs ASF for DepCofS for SvCs ASF, 8 May 44, sub: Est ofNumbers of Sick and Wounded Arriving from Overseas, with incl. Same file.
90(1) History, Office of the Surgeon, Second Corps Area andSecond Service Command From 9 September 1940 to 2 September 1945. HD. (2) Notesfor Gen Kirk on Conf with Gen Marshall, Summary: 25 Dec 44. HD: 024 (ResourcesAnal Div, Jul-Dec 44).
91(1) Gen Specifications for Hosp Unit Cars for WD, 4 Jun 40. TC:453. (2) Rpt of MD Bd, Med Fld Serv Sch, 27 Aug 40. SG: 453.-1. (3) 1st ind, SGto MSO Carlisle Barracks, Pa., 10 Apr 41, on Ltr, MSO Carlisle Barracks, Pa., to SG, 7 Apr 41, sub: Car, Railroad, Hosp Unit, Unit Car No 2. Off file, Researchand Dev Bd, SGO, "Hosp Unit Cars." (4) Specifications for Remodeling18 Pullman Parlor Cars to Hosp Ward Cars for the WD, 30 Jan 42. Off file,Research and Dev Bd, SGO, "Hosp Ward Car." (5) TC US ArmySpecification No TC-3066, 8 May 44, Construction of Car, Hospital. Off file,Research and Dev Bd, SGO, "Unit Car, New Type." (6) Ltr, SG to CO HospTn SCSU 1247, 27 Jun 45, sub: Sterilizers for Hosp Ward Cars. SG: 453 (2d SvC)AA.
92(1) Memo, [Col] A[lbert] G. L[ove] for Lt Col [FrancisC.] Tyng, 10 Oct 40, sub: Hosp Unit Car. Off file, Research and Dev Bd, SGO,"Unit Car." (2) Med Equip for Hosp Unit Car, Oct 40. Same file.
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were developed, equipment lists were prepared for them also,and when their delivery was expected in the spring of that year the SurgeonGeneral's Office requested SOS headquarters to approve the inclusion ofassemblages, packed according to these lists, as authorized items in tables ofallowances for hospital cars. Approval was given, and these lists became theofficial basis for the issuance of equipment and supplies to ward and warddressing cars when they were first delivered to the Army in the late summer of1942.93
These early equipment lists were necessarily theoretical innature, because the Medical Department had had no experience, when they wereprepared, in operating hospital cars of the types developed during World War II.In 1943 they were revised. Subsequently, as experience accumulated, hospitaltrain commanders proposed further revisions. Their recommendations were atvariance with one another, and the Surgeon General's Office had difficulty indeciding which to accept.94 Hence, at a hospital train commanders'conference in February 1945, a representative of the Surgeon General'sTechnical Division distributed a tentative equipment list, based uponrecommendations already submitted, for consideration by officers who wereresponsible for the care of patients aboard hospital trains. After discussingthe items listed, train commanders and The Surgeon General's representativeagreed upon which should be retained, deleted, or added.95 Newequipment lists for ward, ward dressing, unit, and kitchen cars were thenpublished in March 1945.96 Several months later it appeared that traincommanders were dissatisfied with the supplies and equipment agreed upon and ata conference in July 1945 they proposed changes. Some, such as in thesubstitution of twelve bath towels for twelve hand towels, the Surgeon General'sOffice approved. Others it refused to authorize because The Surgeon Generalinsisted upon retaining in all hospital cars enough equipment of certain types,such as surgical instruments, to provide for emergencies or accidents that mightoccur as well as for the routine care of patients en route.97
In addition to revising equipment lists, the Surgeon General'sOffice either developed new items or permitted hospital train commanders to doso. For example, upon a recommendation of the Fourth Service Command, theSurgeon General's Office in 1944 developed a better mattress of a differentsize for use on hospital trains.98 Accepting a suggestion from theSecond Service Command, it soon afterward developed an adjustable back rest.This item contributed to the comfort of patients by enabling them to changepositions while
93(1) Memo, Lt Col Thomas N. Page for Lt Col Griffin and LtCol Hays, 20 Apr 42. Off file, Research and Dev Bd, SGO, "Hosp WardCars." (2) Ltr, SG to Reqmts Div SOS, 10 May 42, sub: Med Equip for Hosp Tn,with ind. SG: 453.-1. (3) Memo, CG SOS for CGs 2d, 4th, 6th, 8th, and 9th SvCsand for SG, 26 Aug 42, sub: Control of Hosp Tns. HD: 531.4.
94(1) Ltr, CO 2d SvC Hosp Tns 1247th SCSU to SG, 2 Oct 43, sub: Changes to Med Equip, Ward and Unit Cars. SG: 453.-1. (2) Diary, Tec Div SGO, 25 Nov-1 Dec 44. HD. (3) Memo, Post Sup Off [Stark Gen Hosp] to SG, 21 Jan 45, sub: Mess Equip on Hosp Cars, with 2 inds. SG: 453.
95(1) Transcript of Proceedings, Hosp Tn Conf, 15-16 Feb 45.(2) Diary, Tec Div SGO, 17-23 Feb 45. HD.
96ASF Catalog Med 10-14, Med Equip List, 27 Mar 45.
97(1) Transcribed Mins of Hosp Tn Unit Comdrs' Conf, 10-13Jul 45. HD. (2) Memo, Capt George R. Allen for Dir Tec Div SGO, 30 Jul 45. Offfile, Research and Dev Bd SGO, "Unit Car, New Type."
98(1) Diary, Tec Div SGO, 3-9 Jun 44, 25 Aug-1 Sep44. HD. (2) Transcript of Proceedings, Hosp Tn Conf, 15-16 Feb 45. HD.
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in train berths.99 Another example of newequipment was the bath tray. Fitting on the sides of hospital berths, this traysimplified the work of nurses in bathing patients in bed. It was first put inuse by the Second Service Command in the latter part of 1944. The SurgeonGeneral's Office adopted the idea and began a development project for such atray but the war ended before it was standardized.100
Items included in the equipment lists of hospital cars wereconsidered to be the minimum in type and quantity that should be kept aboard atall times. Hence, hospital car commanders were authorized to draw equipment andsupplies, to replace those used, from any medical supply officer in the UnitedStates. Normally, however, home stations made replacements.101 To avoidbookkeeping, linen was exchanged on an item-for-item basis. Regulations early inthe war required hospitals to exchange linen with hospital trains when patientswere transferred to their control. It happened frequently that such exchangeeither delayed train schedules or was not made at all. At the train commanders' conferencein February 1945, therefore, it was decided that the exchange of soiled forclean linen would normally be deferred until the end of a trip or until pointswere reached at which trains stopped for lengthy periods. In cases where soiledlinen was not replaced by one of the hospitals to which patients were delivered,that hospital furnished a receipt for the linen it received so that traincommanders could draw clean linen from general hospitals at the ends of trips.102
99(1) Ltr, SG to CO 2d SvC Hosp Tns 1247th SCSU, 11 Sep 44, sub: Back Rests. SG: 442.7 (2d SvC)AA. (2) Diary, Tec Div SGO, 28 Apr-4 May 45. HD.
100(1) Ltr, Chief Hosp and Evac Br 2d SvC to CG ASF attn SG, 14 Oct 44, sub: Hosp Tns, with incl. SG: 700.7-2. (2) Ltr, SG to CO 2d SvC Hosp Tns 1247th SCSU, 2 Dec 44. SG: 453 (2d SvC)AA. (3) Diary, Tec Div SGO, 21-27 Jul 45. HD.
101(1) Diary, Tec Div, SGO, 17-23 Feb 45. HD. (2) ASFCirs 286 and 401, 1 Sep and 9 Dec 44.
102(1) Ltr, CG Lovell Gen Hosp to SG, 8 Feb 45, sub:Linen Exchange for Hosp Cars, with 2 inds and Memo for Record. HRS: Hq ASFPlanning Div Program Br file, 370.05 "Hosp and Evac." (2) Transcriptof Proceedings, Hosp Tn Conf, 15-16 Feb 45. HD.
