CHAPTER XXIII
Providing the Means for Evacuation by Sea
Most of the patients evacuated from theaters of operations tothe zone of interior were transported in surface vessels. It is thereforeimportant to consider in the following discussion the types of vessels used,reasons for their employment, and problems encountered in suiting them to thetransportation of patients, along with difficulties in furnishing such vesselswith the supplies, equipment, and attendants required for the care of patientsen route.
Ships' Hospitals and Hospital Ships
At the beginning of 1939 the Army had four transports inwhich to return patients from overseas bases, such as Hawaii and thePhilippines. With the expansion of existing bases and the establishment of newones in the Atlantic during 1939 and 1940, additional transports were added tothe Army's fleet, and efforts were made to enlarge and improve their hospitalfacilities. These efforts were only partially successful, because funds for suchwork were limited. Furthermore, the ships themselves were too old to warrantextensive alterations, and the speed with which some were put into transportservice left no time for major changes.1 Inview of this situation as well as the probability that large numbers of patientswould be evacuated in subsequent months, the New York Port of Embarkationproposed in the fall of 1940 that the U.S. Army Transport Chateau Thierry shouldbe converted into a part-time hospital ship, to carry freight and troops onoutbound voyages and return with full loads of patients.2On recommendation of the chief of his Hospital Construction Subdivision,The Surgeon General disapproved, stating that the proposed transport was notsuitable for conversion, that its use would violate the terms of the
1The United States Army Transports U. S. Grant, St. Mihiel, Chateau Thierry, and Republic had been in almost continuous service since World War I. The Hunter Liggett, Leonard Wood, and American Legion were added in 1939. Others added to meet Army expansion needs were the Irwin, Kent, Munargo, Orizaba, and President Roosevelt (Joseph T. Dickman.) For their histories, see Roland W. Charles, Troopships of World War II (Washington, 1947), pp. 1-68. Information on problems of providing hospital facilities on these ships may be found in SG files: 560-69 (BB), 632.-1 (BB), 632.-2 (BB), 721.5-1 (BB) under name of transport; AG: 571, 573.27; TC: 571.4; and in surgeons' reports attached to voyage reports filed in TC: 721.1. Also see Chester Wardlow, The Transportation Corps: Responsibilities, Organization, and Operations (Washington, 1951), pp. 136-44, in UNITED STATES ARMY IN WORLD WAR II. 2(1) Ltr, Supt ATS NYPE to QMG thru CO NYPE, 27 Sep 40, with 1st ind. TC: 632 (Chateau Thierry). (2) Ltr, CG NYPE to QMG, 26 Nov 40, sub: Inadequate Hosp Fac on Trans. AG: 573.27 (11-26-40). (3) Ltr, Port Surg NYPE to SG, 29 Nov 40, sub: Inadequate Hosp Fac on Trans. SG: 632.-1 (Chateau Thierry)BB.
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Geneva and Hague Conventions,3 and that itsemployment in the evacuation of small numbers of patients from scattered areaswould be uneconomical. He recommended instead that "the idea of developinga hospital ship be given further study," and that the Army continue to usetransports for the evacuation of its sick and wounded from overseas areas.4
During 1941 the question of whether or not hospital ships would be providedremained unanswered. The question also arose of whether the Army or the Navywould be responsible for the evacuation of Army patients. Existing plans calledfor the control of all water transportation by the Navy beginning on M-Day(Mobilization Day), and during the early part of 1941, under policies announcedby the President, the Navy began to take over Army transports on which hospitalareas had been enlarged and improved. Disturbed by this loss to the Navy ofevacuation space and fearing a repetition of World War I experiences, when theNavy failed to evacuate patients to the satisfaction of the Army, the surgeon ofthe New York Port in October 1941 proposed that a hospital ship should beprovided for the Army.5 Reaction inWashington was mixed. Some officers in the G-4 Division of the General Staff, inthe Office of The Quartermaster General, and in the Surgeon General's Officewere favorably impressed; but the chief of the Surgeon General's HospitalConstruction Subdivision doubted "the wisdom and productivity of thisproposal."6 In transmitting it to the General Staff, TheSurgeon General asked for decisions as to the policy on evacuation and as towhether the Army or the Navy would be responsible for transporting the Army'spatients.7 The Japanese attack onPearl Harbor occurred before further action was taken on the New York Port'sproposal.
Basic Decisions on Water Evacuation in 1942
Entry of the United States into the war made necessary both immediate andlong-range plans for facilities for the evacuation of patients from theaters ofoperations. An agreement between the Army and Navy soon after Pearl Harbor forthe Army to continue to operate transports despite prewar plans to the contrarypartially solved this problem,8 forthe Army could continue to evacuate patients aboard them. Other questionsremained to be answered: (1) whether or not hospital ships would be
3The Geneva Conventions of 1864, 1906, and 1929 established principles for belligerents to follow in the care, treatment, and transportation of the sick and wounded of land warfare; the Hague Conventions of 1899, 1904, and 1907 adapted to maritime warfare the provisions of the Geneva Conventions. The Hague Convention of 1907 was signed by the representatives of forty-three countries, among them the United States, China, France, Great Britain, Germany, Italy, and Japan. In 1942 the Medical Department published an article on the Conventions, along with copies of their texts. Albert G. Love, "The Geneva Red Cross Movement: European and American Influence on its Development," Army Medical Bulletin, No. 62 (1942).
4(1) Memo, Lt Col John R. Hall, SGO, for Planning and Tng Div SGO, 10 Dec 40, sub: Conv of USAT Chateau Thierry into a Hosp Trans Ship. (2) 2d ind, SG to QMG, 28 Dec 40, on Ltr, CG NYPE to QMG, 26 Nov 40, sub: Inadequate Hosp Fac on Trans. Both in SG: 632.-1 (Chateau Thierry)BB.
5(1) Ltr, Surg NYPE to SG thru CG NYPE, 29 Oct 41, sub: Hosp Ships, with 4 incls. HRS: G-4/29717-100. (2) Memo, ACofS G-4 WDGS for ACofS WPD WDGS, 19 Nov 41, sub: Trf of ATS to Navy. HRS: G-4/29717-51.
6Memos, Col A[rthur] B. Welsh for Col [Howard T.] Wickert, undated; Col Wickert for Cols [Harry D.] Offutt and [John R.] Hall, 7 Nov 41, sub: Hosp Ships. HD: 560.2.
72d ind SGO 541.-2 (BB), SG to AG, 24 Nov 41, on Ltr, Surg NYPE to SG thru CG NYPE, 29 Oct 41, sub: Hosp Ships. HRS: G-4/29717-100.
8Wardlow, op. cit., pp. 200-201.
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used, and (2) if so, the extent to which they would be usedand whether or not the Army or Navy would control them.
Opinions on these points differed during the first half of1942. General Headquarters approved the use of both transports and hospitalships for evacuation, but believing that the enemy would not respect the termsof the Hague Convention granting hospital ships immunity from attack, GHQrecommended that all plans for evacuation should be prepared with thatprobability in mind. GHQ also recommended that a decision be sought on whetherthe Army or Navy would operate hospital ships.9Taking the position that transports could be used for evacuation fromareas with ample shipping, as demonstrated in World War I, The Surgeon Generalrecommended a continuation of that method for all large theaters; but because ofdisruption by the war of peacetime transport schedules, he now proposed that twohospital ships (one for the Atlantic and one for the Pacific) should be providedfor the evacuation of patients from small scattered bases. He made the latterrecommendation contingent upon respect by the Axis Powers for the terms of theHague Convention-the primary consideration, in his opinion, in any decision touse hospital ships. The Surgeon General also announced that he preferred toevacuate Army patients in ships operated solely under Army control. In any case,he wanted no division of responsibility. The agency responsible for operatingships for evacuation should be responsible also, in his opinion, for the medicalcare and administrative control of patients aboard them.10The Quartermaster General recommended the conversion of two Army transports intovessels that could be used either as hospital ships or as ambulance transports.If employed in the latter capacity they could be operated by the Army TransportService and would sail under convoy, carrying troops on outbound voyages andreturning full loads of patients to the United States.11A group of officers in G-4, most of whom were later transferred to SOSheadquarters and among whom was a Medical Corps officer (Maj. William L.Wilson), maintained that Convention-protected hospital ships-at least six-shouldbe used in addition to transports to evacuate Army patients from major theatersdespite uncertainty about the attitude of the Axis Powers toward the Convention.Furthermore, having ascertained that the Navy had no plans for providinghospital ships for the Army and being convinced by World War I history of thefutility of depending upon the Navy for evacuation, this group wanted the Armyboth to own and to operate the vessels procured for use as hospital ships.12
In the first half of 1942 the G-4 group pressed for approvalof its plans. After the Bureau of the Budget disapproved supplemental estimatesfor funds for six hospital ships submitted in January 1942, because the MaritimeCommission stated
9(1) Memo, Chief Surg GHQ for CofS GHQ, 9 Jan 42, sub: Return of Sick and Wounded from Foreign Theaters. HD: 541 (Trans). (2) Memo, GHQ for ACofS G-4 WDGS, 14 Jan 42, sub: Hosp Ships. . . . HRS: G-4/29717-100.
10(1) Memo, SG for ACofS G-4 WDGS, 5 Jan 42, sub: Plan for Water Trans for Sick and Wounded. SG: 541.2. (2) Memo, SG for JCS (Col [Russell I.] Vittrup), 6 Jun 42, with inclosed notes. SG: 560.-2.
11Ltr, QMG to TAG, 14 Feb 42, sub: Hosp Space on Army Trans. TC: 632 (Army Trans).
12(1) Memo, ACofS G-4 WDGS for TAG, 24 Jan 42, sub: Hosp Space on Army Trans. HRS: G-4/ 29717-100. (2) Memo, CG SOS for CofSA, 28 Apr 42, sub: Hosp Ships, with 9 incls. HD: Wilson files, "Book IV, 16 Mar 43-17 Jun 43." (3) The Medical Department . . . in the World War (1923), vol. I, pp. 357-71.
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that it would procure ships required by the Army, G-4requested the Commission on 12 February 1942 to procure six hospital ships,along with several vessels of other types, for the Army's use. When theCommission replied that hospital ships fell "properly under the cognizanceof the Navy Department," G-4's Transportation Branch disagreed andasked the Commission to reconsider its opinion. Receiving no reply to thisrequest by late April 1942, SOS headquarters (recently established andcontaining many officers formerly in G-4) pursued the matter further. Inletters prepared for the signature of the Secretary of War, it urged theMaritime Commission to procure six hospital ships for the Army, whether to beoperated by the Army or Navy, and called upon the Secretary of the Navy tosettle with the Army this question of jurisdiction. The administrator of therecently established War Shipping Administration, who was also chairman of theMaritime Commission, replied that he could not allocate vessels for use ashospital ships until the Army and Navy had agreed upon "strategicrequirements." Because of its close relation to other shipping problems,the Secretary of the Navy proposed that the whole question be referred to theJoint Staff Planners, a group working under the Joint Chiefs of Staff.13
The investigation conducted by the Joint Staff Planners andthe joint Chiefs of Staff covered not only the strategic shipping situation butalso other matters: the probability of enemy respect for the Geneva and HagueConventions, the British practice of evacuating patients by sea, and theestimated evacuation requirements for operations in the Pacific and for BOLERO(the build-up of American troops in the United Kingdom for an invasion of the European continent). The views of the Chief of theBureau of Medicine and Surgery of the Navy and of The Surgeon General of theArmy were also sought. The latter restated the position which he had takenearlier. The former believed that both Army and Navy patients should beevacuated by transports that were manned and operated by the Navy but weresupplied with enough Army officers and enlisted men to care for Army medicalrecords. If hospital ships should be used, he disapproved painting and markingthem as international conventions stipulated. Rather he proposed that they bepainted like transports for travel in convoy and reveal their identity ashospital ships only under "desirable" circumstances. In view ofagreement between the two medical services on the use of transports forevacuation and in the interest of economy in shipping, the Joint Chiefs of Staffannounced on 25 May 1942 that the normal means of evacuating patients from areaswith "more or less continuous transportation service" would be byreturning troop transports. Since the Army and Navy disagreed on the question ofhospital ships, the Joint Chiefs announced a compromise decision in June 1942.Three vessels would be procured and operated as hospital ships under the HagueConvention. They would be built according to plans supplied by the Army, wouldbe operated under the "general direction" of the Army, and would beprovided with Army medical complements, but would be converted under supervisionof the
13(1) Memo, ACofS G-4 WDGS for CofSA, 8 Feb 42, sub: Supp Ests "D," FY 1942. AG: 111 (1-31-42).(2) Ltrs, CofSA for US Mar Comm, 12 Feb, 7 Mar, 1 May 42; US Mar Comm to CofSA,24 Feb, 4 May 42. SG: 560.-2. (3) Ltr, SecNav to Sec War, 6 May 42, sub: Basisof Responsibility for Procurement and Opr of Hosp Ships. AG: 573.27 (5-6-42).
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Navy and would be operated by Navy crews.14Althoughauthorized in the middle of 1942, the first of these ships was not placed inservice until June 1944.
In the course of these protracted negotiations, the Army-believingthat the general problem of evacuating patients from ground operations inoverseas theaters was one for solution within the War Department-partiallytook matters into its own hands.15 In March 1942 the earlier proposal of TheQuartermaster General to convert transports into vessels that could be usedeither as hospital ships or as ambulance transports was revived by theTransportation Corps. The Surgeon General reversed his prewar position inopposition to the use of ambulance transports and in April supported thisproposal as a means of caring for immediate needs. Even if hospital ships shouldbe authorized, he pointed out, their construction would require at leasteighteen months.16 SOS headquarters approved, and late in May 1942the Acadia was withdrawn from regular transport service. From June toOctober it underwent conversion at the Boston Port of Embarkation, emerging witha capacity of approximately 1,100 troops outbound and 530 patients inbound.Making its first trip as an ambulance transport in December 1942, the Acadia continuedto sail as such until placed under the protection of the Hague Convention as ahospital ship in May 1943.17
Providing Facilities for Evacuation by Transports Early in theWar
In view of shipping shortages, uncertainty about the use ofhospital ships, and the decision for the Army to continue to operate trooptransports, the most obvious method of meeting immediate evacuation needs was the use oftransports. Existing regulations required each to have a hospital with bedsequal in number to 1 percent of its passenger capacity for cases of sickness enroute.18 Before the war the number of hospital beds on mosttransports had been increased to provide additional space for patients beingevacuated from overseas areas. In March 1942 the Office of the Chief ofTransportation proposed that the larger bed capacities be officially authorizedfor all transports-those to be procured as well as those already in service.Both the Surgeon General's Office and SOS headquarters approved, and in June1942 the higher ratios were authorized. Changes were made in the fall of thatyear in the proportion of beds for different types of patients, but not in thetotal number authorized. The first eight months of the year had shown that 75percent of the patients evacuated to the United States were mental cases. Toprovide more accommodations for them SOS headquarters on 8 September 1942directed the
14(1) JMTC 4/M, 9 May 42, Evac of Sick and Wounded from Overseas. SG: 704.-1. (2) JCS 52, 21 May 42; JCS 52/1, 29 Jun 42. Records and Admin Br, Off ACofS G-3 WDGS. (3) Ltr, Bu of Med and Surg USN to JPS, 4 Jun 42, sub: Evac of Sick and Wounded from Overseas. SG: 704.-l. (4) Memo, SG for JCS (Col Vittrup), 6 Jun 42. SG: 560.-2.
15Ltr, SecWar to SecNav, 1 May 42, sub: Evac of Army Sickand Wounded from Overseas. AG: 560.
16Memo, CofT for CG SOS, 13 Mar 42, sub: Hosp Space onArmy Trans, with 2d ind, SG to CG SOS, 8 Apr 42. SG: 632.-1 (BB). 17(1) Sailing Orders 82, Vessel: USAT Acadia, Outbound Voyage 5, 18 May 42. TC: 565.3 (Acadia). (2) Ltr, Surg NOPE to Col John R. Hall, SGO, 18 May 42, with reply dtd 20 May 42. HD: 560.2 "Hosp Cons Br SGO-Hosp Ships." (3) Memo, Chief Misc Br SOS for Gen [Le Roy] Lutes, 24 Jun 42, sub: Hosp Ships. HD: Wilson files, "Book I, 26 Mar-26 Sep42." (4) TC: 561-565 (Acadia); and OPD: 370.05.
18AR 30-1150, 19 Sep 41.
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Chief of Transportation to convert a portion of general wardbeds of each ship's hospital into beds for mental patients.19 Thus during 1942ratios (expressed in percentages) of hospital beds to troop berths wereauthorized for various types of transports as follows:
Percent Hospital Beds to Troop Berths | ||
Type of Ship and Patient | Mar 1942 | Sept 1942 |
Owned and permanently converted ships-total | 5.0 | 5.0 |
| Ward | 4.0 | 2.5 |
| Isolation | 0.5 | 0.5 |
| Mental | 0.5 | 2.0 |
Chartered and fully converted ships-total | 4.0 | 4.0 |
| Ward | 3.0 | 2.0 |
| Isolation | 0.5 | 0.5 |
| Mental | 0.5 | 1.5 |
Temporarily or hastily converted ships-total | 3.0 | 3.0 |
| Ward | 2.0 | 1.5 |
| Isolation | 0.5 | 0.5 |
| Mental | 0.5 | 1.0 |
Meeting standards set for ships' hospitals on vessels converted into troop transports depended upon the time available to ports for modifications and improvements. Throughout 1942 transports were hastened into service and sent out heavily loaded, sometimes with numbers of troops that exceeded ships' rated capacities by 10 percent.20 Changes in hospital areas of such vessels could be made only while they were undergoing initial conversions for the transport service or were in port between voyages for maintenance and repairs. Hence their hospital facilities varied. On some, completely new hospital areas were constructed. On others, existing hospitals were enlarged and improved. As a rule the Transportation Corps submitted to the Surgeon General's Hospital Construction Division for review the plans for hospital areas of vessels being converted. This Division sometimes approved plans that would not have been acceptable under ordinary conditions, but it disapproved others in part or in whole, and thus conversions were sometimes delayed. To prevent such delays and to standardize improvements made at different ports on different types of vessels, the Surgeon General's Office in November 1942 prepared a list of general specifications for ships' hospitals.21 Early in 1943 the Water Division of the Office of the Chief of Transportation sent it to all ports for use as a guide. Minimum standards thus established were as follows: a "suitable" surgical suite, minimal facilities for pharmacy and laboratory, adequate toilets for the hospital area with separate toilets for isolation wards, safety devices for wards for mental patients, a small X-ray unit with darkroom, berths of not more than two tiers, and beds equal in number to those authorized by SOS headquarters. Preferably, the hospital was to be located slightly aft of midship, not more than one deck below the uppermost "continuous weather deck," adjacent to cabins whose berths could be used for patients, and relatively close to lifeboats. It was to be well ventilated and lighted and was to
19(1) Memo, CofT for SG, 28 Mar 42, sub: Basic Plan for Evac of Sick and Wounded. HD: 705. (2) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: Opr Plans for Mil Hosp and Evac, with incl. HD: 705.1. (3) Memo, ACofS for Oprs SOS for CofT, 8 Sep 42, sub: Fac for Care of Mental Pnts on Trans. HD: 705 (MRO, Fitzpatrick Daybook).
20For example, see Memo, Oprs Off OCT for Water Div OCT,15 May 42, sub: Increased Trp Capacities. TC: 541.1.
21(1) Ltr, SG (Hosp Cons Div) for CofT, 26 Nov 42, sub: Gen Specifications for Hosp Areas on ConvertedTrans. SG: 632.-1 (BB). (2) Memo, Maj John C. Fitzpatrick for Chief Hosp and Evac Br Plans Div SOS, 17 Sep 42, sub: Rpt of Surv of Ships and Ships' Hosps. HD: 705 (MRO, Fitzpatrick Ref file). (3) Ltr, CofT to Supt ATS NYPE, 3 Oct 42, sub: Hasty Convs. SG: 632.-l (BB).
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have passageways wide enough for the removal of patients onlitters.22
Construction of new transports offered the possibility ofassuring suitable ships' hospitals provided there was effective coordinationamong the Surgeon General's Office, the Office of the Chief of Transportation,and the Maritime Commission. For a time, plans drawn by the Maritime Commissionwere not submitted to the Surgeon General's Office and the latter consideredhospitals on some of the new vessels unsatisfactory. After a series ofconferences early in 1943 the Maritime Commission agreed to submit its plansthereafter to the Transportation Corps and the Surgeon General's Office forreview and comment.23
Early in 1943 a significant change was made in accommodationsfor mental patients on transports. Until that time some berths had been enclosedwith wire cages, making spaces approximately 6 x 3 x 3 feet each in whichseriously disturbed mental patients might be placed to avoid endangeringthemselves and others. In January 1943 the New York Port surgeon proposed theelimination of such "unnecessary and inhumane" accommodations. Theneuropsychiatry section of the Surgeon General's Office supported thisproposal. It pointed out that advances in medical practice, such as the use ofsedation, hydrotherapy, and diversional activity, with minimum mechanicalrestraint, made it possible to care for mental patients in specially constructedwards. The Chief of Transportation therefore requested the Maritime Commissionto eliminate metal cages from future transports and directed port commanders toremove existing ones and provide suitable security-ward space instead on othertransports. Although surgeons of several ports argued that they would then be unable to care formental patients, especially on long voyages in tropical areas, theTransportation Corps and The Surgeon General remained firm.24 Toguide transport and port surgeons in caring for seriously disturbed patientswithout metal cages, they issued a memorandum on the care of mental patients ontransports in July 1943.25 Later in the war, as will be seen below, the Armyreverted to the use of individual cells for severely disturbed patients.
In the fall of 1942 British vessels, such as the liners QueenMary and Queen Elizabeth, which since early 1942 had been carryingAmerican troops overseas,26 were brought within the program forenlarging the patient-capacity of transports. Since the British did not movehelpless patients in transports, the Queens had inadequate laboratory andsurgical equipment and each had only 175 beds for patients. In October 1942 theArmy started arrangements for the installation of a 300-bed hospital on eachship. British officials in Washington were at first unsympathetic to
22Ltr, CofT (Water Div) to CGs PEs attn ATS, 26 Jan 43, sub: Gen Specifications for Hosp Areas onConverted Trans, with incl. TC: 632. 23Correspondence on ships' hospitals of troop shipsand reports of conferences with Maritime Commission representatives are found inSG: 632.-1 (BB) and TC: 632.
24(1) Ltr, Surg NYPE to SG (Col Tynes), 19 Jan 43, sub: Psychotic Pnts on Army Trans. TC: 632. (2) Memo, SGfor CofT 15 Feb 43, sub: Elimination of Cages for Care of Mental Cases on USArmy Trans. SG: 632.1 (BB). (3) Ltr, CofT to US Mar Comm, 27 Feb 43. TC: 632.(4) TC Cir 35, 1 Mar 43, Elimination of Cages for Mental Pnts. (5) Letters fromport surgeons at San Francisco and New Orleans containing objections to removalof cages are filed in SG: 632.-1 (BB) and TC: 632. 25Ltr, CofT (Mvmt Div) for CGs PEs, 10 Jul 43, sub: Careof Mental Pnts on US Army Trans. TC: 370.05 (Army Vessels).
26(1) Wardlow, op. cit., pp. 6, 222-24. (2)Charles, op. cit., p. 309.
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the American plan for putting larger hospitals aboard, butchanged their attitude after American officials explained that shortages ofshipping and lack of hospital ships made it imperative to evacuate patients ontransports. Final agreement was that the United States would install a 300-bedhospital on each ship while in an American port. The proportion of beds ingeneral wards, isolation wards, and mental wards would be the same as thatalready established for hastily converted transports. When completed, eachhospital would be operated by American Army personnel. The construction of newhospital areas began early in November when the Queen Mary came intoport. Several months later work was begun on the Queen Elizabeth.27
Renewed Efforts to Get Army Hospital Ships, 1942 -43
Neither the policy announced by the Joint Chiefs of Staff inthe spring of 1942 nor efforts to supply evacuation facilities in compliancewith this policy silenced demands for Army hospital ships. As early as April1942 General Hawley (then Colonel), Chief Surgeon of the U. S. Army Forces inthe British Isles (later the European Theater of Operations), announced in aletter to The Surgeon General the policy upon which the European theater was toinsist: helpless patients would not be evacuated on ships subject to enemyattack (transports) but only on hospital ships plainly marked and operated underthe terms of the Hague Convention. Repeatedly thereafter the European theaterrequested hospital ships of the War Department, stating in August 1942 that fivewould be needed by April 1943 and five more by the following September.28 Tothese demands were added, in the fall of 1942, requests forhospital ships from ports in the United States that were responsible forevacuating patients from scattered island bases.29 Some bases werenot on the itinerary of regularly scheduled transports and hence needed othermeans of evacuation. The most logical seemed to be the use of hospital ships ona "pick-up" service. In response to these needs, the Surgeon General'sOffice in October 1942 recommended the procurement of three hospital ships, inaddition to the three already authorized by the Joint Chiefs of Staff. Theywould be used to collect patients from scattered island bases, to evacuatecasualties from large-scale landing operations, or to supplement transports inevacuating patients from the more distant and larger theaters.30 TheChief of Transportation referred this recommendation to the Joint StaffPlanners. Earlier, in August, a request for three Convention-protected shipswhich General Eisenhower
27(1) Memo, ACofS for Oprs SOS for SG, 6 Oct 42, sub: Med Equip and Sups for US Hosp Fac aboard HMT Queen Mary and Queen Elizabeth. SG: 475.5-1 (BB). (2) Memo, ACofS for Oprs SOS for CofT, 6 Oct 42, sub: Instl of US Hosp Fac on HMT Queen Mary and Queen Elizabeth. HD: 705 (MRO, Fitzpatrick Daybook). (3) Memo, SOS Hosp and Evac Br for ACofS for Oprs SOS, 2 Nov 42, sub: Add Hosp Fac on Two British Ships. SG: 705.-1 (BB).
28(1) Ltr, USAFBI (Chief Surg, Col Paul R. Hawley) to SG,25 Apr 42. SG: 560.2 (Gr Brit). (2) Rads CM-IN-4037 (11 Aug 42), CM-IN-6044(17 Aug 42), CM-IN-7813 (21 Aug 42), USASOS (London) to AGWAR; CM-OUT-5084 (16Aug 42), CMOUT-7479 (24 Aug 42), AGWAR to USASOS (London). OPD: In and OutMessages.
29(1) Diary, Misc Br SOS (Col [William L.] Wilson), 20 Jul 42,HD: 705 (MRO, Extracts from Hosp and Evac Br SOS Diaries). (2) Ltr, CG CPE to CofT, 25 Sep 42, sub: Hosp Ship for the CPE, with 2 inds. SG: 560.-2.
301st ind, SG to CG SOS, 23 Oct 42, on Memo, CG SOS for SG, 16Oct 42, sub: Rpt of Progress. SG: 632.-1 (BB).
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wanted by the end of September for the North African invasionhad also been referred to that group. In both instances, the Joint StaffPlanners, weighing the need for vessels to transport troops and cargoes againstthe need for hospital ships, decided that additional vessels could not be sparedfor the latter purpose and reaffirmed the existing policy of using transports asthe normal means of evacuation. On 12 November 1942 the Joint Chiefs of Staffdisapproved requests for additional hospital ships.31
Early in 1943 events caused a change in existing policy. Todemands of the European theater were added requests of the Southwest Pacific andNorth Africa for hospital ships not only for evacuation to the zone of interiorbut more particularly for intratheater use. In February 1943 the SouthwestPacific informed the War Department that it was converting a Dutch ship, the Tasman,into a hospital ship, and asked that it be certified under the terms of theHague Convention.32 The North African theater, like the European, hadadopted a policy of evacuating no helpless patients in transports. Early inMarch 1943 it refused to load litter patients on the Acadia, which wasmaking its second trip as an ambulance transport. Later that month this theatercabled Washington for two hospital ships for use in evacuating patients to theUnited Kingdom.33 Concurrently, evidence was accumulating that theenemy would respect the terms of the Hague Convention. Germany and Italypermitted British hospital ships to operate unmolested in the Mediterranean, andthey, along with Japan, had announced they were operating their own hospitalships. Furthermore, several Allied Governments, as well as the U. S. Navy, hadfollowed the lead of the British and placed hospital ships under Red Cross (Hague Convention) protection.34
Along with insistent demands of theaters for hospital shipsand growing evidence of enemy respect for the Hague Convention, it appeared inthe first half of 1943 that loss of transport and cargo space through conversionof vessels to hospital use was a less cogent reason than formerly for notauthorizing hospital ships. By that time the troop ship fleet had grown throughnew construction and the conversion of freighters. Moreover, British hospitalships were occasionally being used to transport American patients from theEuropean theater to the United States. A request by that theater in January 1943that medical personnel and equipment be
31(1) Memos, CofT for JPS, 21 Aug and 2 Nov 42, sub:Hosp Ships. TC: 564. (2) JPS 27/5/D, 24 Aug 42; JCS 52/2, 29 Aug 42. HD: 705 (MRO,Fitzpatrick Ref file, Aug 42-May 43). (3) JCS 52/3, 12 Nov 42. Records andAdmin Br, Off ACofS G-3 WDGS.
32Rad CM-IN-9207, SWPA to AG WAR, 18 Feb 43. HD: 705 (MRO, Fitzpatrick Daybook, Apr 42-Jun 43). Forconversion plans for these ships see HD: SWPA 560.2 (Tasman and Maetsuycker); forletters about certifying the Tasman see: TC: 561-565.1 (Tasman).33(1) Rpt, 204th Hosp Ship Co, USAT Acadia, voyage 2 (8 Feb-11 Mar 43). TC: 721.5 (Acadia). (2) Rad CM-IN-14498, NATO to WD, 27 Mar 43. SG: 560.-2 (N. Africa). (3) An Rpt Med Sec NATOUSA, 1943. HD.
34(1) Memo, CinC US Fleet, for JCS, 26 May 43, sub: Hosp Ships, incl A to [JPS] 360-9 (JCS 315/2) Memo, JPS for JCS. Records and Admim Br, Off ACofS G-3 WDGS. (2) See list of hospital ships (US Army and Navy, AlliedGovernments, and Axis Powers) in State Dept file 740.00117 Eur War 1-1648. ByMay 1943 Japan had 20 hospital ships, while Germany and Italy had 33. TheBritish Commonwealth of Nations had about 30 hospital ships for use in theAtlantic, Mediterranean, and Indian Ocean. The U.S. Navy had converted the Solaceinto a modern hospital ship, and it was at Pearl Harbor on 7 December 1941.It was designated as a Convention-protected ship on 31 October 1942. The Navyship Relief was likewise designated as a hospital ship on 5 February1943.
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transported by these ships on return trips led to a study ofthe legality of such action by the Army Judge Advocate General. In March 1943 heissued an opinion that hospital ships, whether British or American, might beused for the transportation of medical personnel and equipment without violatingthe provisions of the Hague Convention.35 This meant that space onhospital ships could be used for medical transport purposes to compensate, inpart at least, for the loss of vessels to ordinary transport service.
Still another factor influencing decisions about hospitalships early in 1943 was the tardiness with which the three ships authorized bythe Joint Chiefs of Staff in June 1942 were being made available. The delay wascaused largely by division of responsibility for them between the Army and Navyand subsequent misunderstandings over submission of plans and selection of typesof hulls. Even the most optimistic estimated in the spring of 1943 that theywould not be ready until mid-1944.36
In view of these circumstances The Surgeon General raisedanew the hospital ship question. He now proposed that hospital ships be providedfor the evacuation of all helpless patients. On 30 March 1943 he recommendedthat the Acadia should be registered immediately as a hospital ship underthe Hague Convention, "in view of the urgency of the situation in theAfrican theater"; that a second transport should be converted into ahospital ship as soon as possible; that completion of the three ships beingbuilt by the Navy should be "expedited"; and that five additionalvessels should be procured for use as hospital ships by 1 July 1944.37Subsequently, in April 1943, representatives of the Chief of Transportation, theSurgeon General's Office, and the ASF Hospitalization and Evacuation Branch discussed additional details of theproposed program. They agreed that vessels selected for conversion should besuitable for use as hospital ships but should also have some characteristics,such as excessively slow speeds, which made them undesirable for service astransports with convoys. They agreed also that the Army should procure andoperate hospital ships and that Army hospital ships should be provided withfacilities for emergency diagnosis and treatment only, rather than withelaborate facilities for definitive surgical and medical care as on Navyhospital ships. Finally, they decided that the first step in achievement of thisprogram would be to request the Joint Chiefs of Staff to amend the policy onevacuation facilities established in May 1942. Subsequently, Colonel Fitzpatrickprepared an impressive study for submission on 24 April 1943 to the GeneralStaff. Its crux was the recommendation that the Joint Chiefs of Staff (1) shouldapprove the use of Convention-protected hospital ships as the normal means, whenavailable, of evacuating the helpless fraction of sick and
35(1) Ltr, CG SOS ETO to CG SOS, 4 Jan 43, sub: Util of Hosp Ships for Trans Med Units and Sups, with 2 inds.HD: 705 (MRO, Fitzpatrick Daybook). (2) Memo SPJGW 1943/1760, JAG War Plans Div for JAG, 18 Mar 43, sub: Hosp Ships. SG: 560.2. 36(1) Memos, CG SOS for VCNO, 14 Jul and 10 Sep 42, sub: Hosp Ships for Evac of Sick and Wounded from Overseas. TC: 564. (2) Memo, Col A[chilles] L. Tynes for SG, 11 Sep 42, sub: Rpt on Conf on Cons of Hosp Ships. SG: 632.-1 (BB). Reports ofprogress in planning and converting these ships were made currently by OCT to SG and SOS. See files HD: 560.2 (Hosp Cons Br, Hosp Ships, Hope, Mercy, and Comfort). (4) Ltr, VCNO to CofSA, 18 Dec 42, sub: Procedure for Acquisition and Conv of USS Comfort (AH-6), USS Hope (AH-7), USS Mercy (AH-8). SG: 560.2. 37Memo, SG for ACofS OPD WDGS thru CG ASF, 30 Mar 43,sub: Hosp Ships, with 2 inds. SG: 560.-2.
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wounded, (2) should authorize steps to implement thisrevision of policy at the earliest practicable date, and (3) should approve theuse of hospital ships on outbound voyages for the transportation of medicalsupplies and personnel. The War Department General Staff approved thisrecommendation and forwarded it on 12 May 1943 to the Joint Chiefs of Staff.38
The provision of hospital ships for the North African theaterdid not await this recommendation. In response to North Africa's request fortwo hospital ships, the Operations Division of the General Staff offered on 7April 1943, after consultation with both the Chief of Transportation and TheSurgeon General, to convert the Acadia into a hospital ship if thetheater was willing to forego its use in the transportation of troops. Afterboth the Combined and Joint Chiefs of Staff had considered the theater'sacceptance of this offer, North Africa was notified on 22 April that the Acadiawould be converted into a hospital ship. A second ship, the Seminole, wasselected and approved for use as a hospital ship a week later.39 Bothships were stripped of armament and other belligerent features; their hulls werepainted white with a horizontal green band on each side; and red crosses, whichcould be illuminated at night, were painted on their sides, decks, and funnels.On 6 May the Secretary of War informed the Secretary of State of the designationof the Acadia as a hospital ship; four days later, of the Seminole. Structuralwork required in the conversion of the Seminole delayed her departureuntil September 1943, but the Acadia, which had already been fitted outas an ambulance transport, sailed from New York to North Africa on her maidenvoyage as a hospital ship on 5 June 1943.40
Six days later the Army received full authority to procureand operate its own fleet of hospital ships. On 11 June 1943 the Joint Chiefs ofStaff amended the earlier policy, announcing that the helpless fraction ofpatients would be evacuated in hospital ships if they were available. At thesame time they approved the use of hospital ships for the transportation ofmedical supplies and personnel on outbound voyages. To permit observance of theamended policy, the Joint Chiefs authorized the conversion of slow-speedpassenger vessels and of EC-2 cargo ships (Liberty ships) to provide a totalof 15 hospital ships by 31 December 1943, 19 by 30 June 1944, and 24 by 31December 1944. All but three-those already authorized for construction by theNavy-were to be procured, converted, manned, and operated by the Army alone.Since it had already sent the Acadia on its maiden voyage as a hospitalship and had begun the conversion of the Seminole, the Army thus hadauthority to place nineteen ad-
38(1) Ltr, CG ASF for ACofS OPD WDGS, 24 Apr 43, sub: Hosp Ships, with 9 incls. OPD: 573.27. (2) Memo, CofT for CG ASF, 11 May 43, sub: Hosp Ships. TC: 564. (3) Memo, CofSA for Secretariat JCS, 12 May 43, sub: Hosp Ships, with incl. OPD: 573.27.
39(1) Rads CM-IN-14498 (27 Mar 43); CM-IN-6760 (12Apr 43); CM-IN-12911 (21 Apr 43), NATOUSA to WD. (2) Rads CM-OUT-3358 (8 Apr43); CM-OUT-5910 (14 Apr 43); CM-OUT-9291 (22 Apr 43); CM-OUT-12622 (30 Apr43), WD to NATOUSA. OPD: In and Out Messages. Under the CCS plan the Britishwould furnish 10 hospital ships and 6 hospital carriers, and the United Stateswould provide 2 hospital ships as soon as available.
40(1) Memo, ACofS OPD WDGS for CofS, 5 May 43, sub: Designation of USAT Acadia as Hosp Ship. OPD: 573.27. (2) Ltrs, SecWar to SecState, 6 and 10 May 43. Same file. For plans and problems of conversion seefile SG: 632.-1 (BB) and HD: 560.2 (Hosp Ships, Hosp Cons Br).
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ditional hospital ships in operation by the end of 1944.41
The Hospital Ship Program, 1943-45
Selection of vessels for conversion into hospital ships wasimportant to The Surgeon General because their basic characteristics largelydetermined the success of conversion. The width of a ship's beam determinedwhether passageways would be wide enough to permit the handling of litter cases.The size of its superstructure determined whether patients could be locatedabove the water line in areas that had natural ventilation and from whichpatients might be removed easily if it became necessary to abandon ship. Thecruising range of a vessel determined whether it was suitable for transoceanicservice, and its speed determined the number of trips per month and thus thenumber of patients it might evacuate. In June 1943, therefore, The SurgeonGeneral arranged with the Chief of Transportation for joint inspection ofvessels before selection for conversion.42
The ships chosen represented a compromise. In severalinstances, vessels were rejected by the Surgeon General's representatives,either because they had speeds of less than ten knots, had fewer than threedecks above the water line, or were of too narrow beam. On the other hand,despite its objection to their slow speed and low deck heights, the SurgeonGeneral's Office had to agree to the conversion of six EC-2 cargo ships. Theremaining fifteen ships (including the Acadia and Seminole) wereof varying ages and speeds. Seven had been built between 1901 and 1919; seven,between 1920 and 1926. Six had speeds of 10 to 12 knots; four, of 13 to 14knots; and five, of 15 to 16 knots. Some had been coastwise vessels only and later proved unsuitablefor use in the Pacific during stormy seasons.43(Table 18.)
All of the vessels selected were converted into hospitalships according to plans approved by the Surgeon General's HospitalConstruction Branch. Plans for the conversion of the six EC-2's were drawnby Cox and Stevens, naval architects in New York City; those for the remainder,by the Maintenance and Repair Branch of the Water Division, New York Port ofEmbarkation. A civilian architect from the Surgeon General's Office, assignedtemporarily in New York, represented the Medical Department in the initialstages of planning. Subsequently, completed plans were referred to the SurgeonGeneral's Hospital Construction Branch for final approval. In all planning,emphasis was placed on the number of patients' berths that could be providedrather than upon elaborate clinical facilities.44
A major problem in planning hospital ships was the locationand arrangement of the surgical suite and other professional rooms, wards fordifferent types of patients, and quarters for the ship's crew and
41(1)JCS 315, 13 May l943; JCS 315/1, 30 May 43. Records and Admin Br, Off ACofS G-3 WDGS. (2) Memo, JCS for ACofS OPD WDGS, 11 Jun 43, sub: Hosp Ships. OPD: 573.27. (3) Memos, Dir of Oprs ASF for SG and CofT, 18 Jun 43, sub: Hosp Ships. SG: 560.-2.
42Memo, Maj Gen Norman T. Kirk (SG) for Lt Col John C.Fitzpatrick, 30 Jun 43, sub: Hosp Ships. SG: 560.-2 (BB).
43For correspondence dealing with the hospital ship conversionprogram, inspection of and acceptance or rejection of certain transports (e.g., RobinAdair, Manuel Arnos, Utahan, William L. Thompson), revision and changes inplans for hospital areas, problems of construction, and Medical Departmentinspections during conversion, see TC: 564, SG: 632.1 (BB), SG: 560.2, and HD:560.2 (Hosp Ships, Hosp Cons Br). 44Tynes, Construction Branch, pp. 94, 113.
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TABLE 18-UNITEDSTATES ARMY HOSPITAL SHIPS IN WORLD WAR II
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medical complement. Experience in planning ships' hospitalsfor transports and in converting the Acadia and Seminole served asa guide at first. More satisfactory standards evolved as additional experienceaccumulated with later conversions. Normally the Surgeon General's Officepreferred to have the following located on decks above the water line: quartersfor officers, nurses, and medical attendants; the surgical suite; clinical andadministrative areas; and wards for litter patients, for patients who hadcommunicable diseases, and for those who were seriously disturbed mentally.Decks at the water line, or just below it, were considered suitable for wardsfor neuropsychiatric and ambulatory patients, for quarters for the ship'screw, and for galleys and mess rooms. Storerooms, the morgue, and the laundrywere placed in lower areas, including the hold. To achieve maximum stability,the surgical suite-consisting of two operating rooms, a sterilizing room, ascrub-up area, rooms for sterile and non-sterile supplies, and an X-ray anddarkroom-was preferably placed on the main deck slightly aft of center.To insure freedom from unnecessary traffic, isolation and mental wards wereconsidered best located when they were aft. Clinical and administrative areas,including the dressing room, pharmacy, laboratory, surgeon's office, medicalrecords office, chaplain's office, Red Cross office, transportation agent'soffice, post exchange, and commissary, were considered best located on the deckabove the water line near the forward gangway or side-port entrance, to permiteasy access when the ship was in port.45
Wards were provided on all ships for patients withcommunicable diseases, and for mental, medical, and surgical cases. Because of the large number of mental patients requiringevacuation, the Movements Division of the Transportation Corps proposed in thefall of 1943 to devote approximately half the capacity of each hospital ship toaccommodations for them. Wards for such patients were equipped for safety withconcealed radiators and pipes, shatterproof electric light fixtures, heavy doorswith viewing panels, locks which could be operated by a master key, andprotective bars over all portholes. For the care of acutely disturbed patientsthere were steel cells 3 to 4 feet wide and 7 feet long. For patientswith mild neuropsychiatric disorders, large wards with minimum security deviceswere used. Isolation wards for patients with communicable diseases wereseparated into rooms accommodating no more than eight (and preferably four)patients, and were equipped with separate bathrooms, diet kitchens, linenclosets, utility rooms, and scrub-up areas. All wards had two-tiered berths andwere provided with adequate administrative areas, such as utility rooms, dietkitchens, and offices.46 In the summer of 1945 mesh wire enclosureswere constructed on the decks of some hospital ships to provide areas wheremental patients could get fresh air and exercise.47
In addition to the general arrangement of hospitalfacilities, the Surgeon General's
45Letters dealing with recommendations made by the HospitalConstruction Branch are found in SG: 632.1 (BB), HD: 560.2 (Hosp Cons Br, Hosp Ships, Gen), andHD: 560.2 (Hosp Cons Br, file for each hosp ship). Blueprints and photographs ofeach hospital ship are located in above files.
46(1) Tynes, Construction Branch, pp. 101, 107ff. (2) Memo, CofT for SG, 9 Oct 43, sub:Hosp Ships. SG: 560.2. (3) Memo, SG for CofT, 4 Jan 44, sub: Mental Fac AboardHosp Ships. SG: 632.1 (BB).
47Memo, CofT for SG, 12 Apr 45, sub: Proposed Location ofMental Pnt Incls on Hosp Ships. SG: 632.1 (BB).
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SURGICAL WARD ON USAHS SHAMROCK
Office was also interested in features of construction thatpromoted sanitation and comfort. As a safety precaution and as a buffer againstnoise, it insisted that bulkheads should be of double-thick fireproof materialthat was easy to clean. White tile was considered necessary for the decks ofwashrooms, operating rooms, sterilizing and workrooms, dressing stations,cleaning gear rooms, utility rooms, diet kitchens, prophylactic stations,pharmacies, laboratories and autopsy rooms. For the rest of the hospital area adeck covering of cement composition or of heavy linoleum was consideredsatisfactory. Deckheads of a material similar to that used for bulkheads wereneeded as protection against dust in operating rooms, sterilizing rooms,dressing rooms, and smaller wards, and, in addition, as a safety measure-for covering exposed pipesand fixtures-in all mental wards.48
Numerous difficulties were encountered in converting thevessels into hospital ships. Lacking a suitable table of organization forhospital ship complements at the beginning of the program, the MedicalDepartment had to estimate the number of officers, nurses, and attendants forwhom quarters would be needed on each ship. Late in 1943, when The SurgeonGeneral revised the existing table of organization, some of the conversion plans
48(1) Tynes, Construction Branch, pp. 101, 106. (2) Memo, SGfor CofT, 26 May 43, sub: Steel Bulkheading in Hosp Ships. SG: 632.1 (BB). (3)Ltr, Water Div NYPE to CofT, 2 Nov 43, sub: Hosp Ships, with 4 inds. Same file.
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SURGICAL WARD ON USAHS LOUISA. MILNE
already prepared had to be modified to provide different setsof quarters.49 About the same time, the decision to devote 50 percentof each hospital ship's capacity to accommodations for mental patients causedfurther revisions in plans already drawn. Changes in the size of the merchantmarine crews, along with friction between maritime unions on the one hand andthe Transportation Corps and Surgeon General's Office on the other about thesize and location of crew quarters, tended to cause revisions in plans. In someinstances changes in approved plans were requested by representatives of theSurgeon General's Office (Maj. Howard A. Donald and Lt. Col. Achilles L. Tynes)as they inspected work in progress at various ports.50 Of perhaps evengreater importance were delays in shipyards. Some had difficulty in hiringenough workmen to keep conversion moving along rapidly. Others failed to getmaterials when they were needed. Still others, heavily committed to the Navy,devoted their workers and materials to naval landing craft with higherpriorities.51
As a result of these difficulties the entire
49For example, see Memo, Lt Col A. L. Tynes for SG, 27 Oct 43,sub: Rpt of Insp of SS Ernest Hinds. HD: 560.2 (Hosp Cons Br, Hosp Shipfile).
50(1) Tynes, Construction Branch, pp. 95-116. (2) Correspondence concerning conversions are filed in SG: 560.2, 632.1 (BB), and in HD: 560.2 (Hosp Cons Br, Gen), 560.2 (Hosp Cons Br, under name of each hosp ship).
51(1) Memo, SG for ASF Dir of Mat, 17 Feb 44, with inds. SG:632.1 (BB). (2) Memo, Col R. M. Hicks (Water Div OCT) for Howard Bruce, 23 Feb44, sub: Hosp Ship Convs. TC: 564.
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DRESSING STATION ON USAHS LOUIS A. MILNE
program was delayed. Only three Army hospital ships were inservice by the end of 1943. One per month was placed in service from Februarythrough May 1944, and one of the three ships being constructed by the Navy wascommissioned the next month. Thus by the end of June 1944 there were ninehospital ships serving the Army, instead of the nineteen anticipated. The nextmonth seven more were completed and in August and September two additional Armyhospital ships and the two remaining hospital ships being constructed by theNavy for Army use were ready for their first trips. The final two ships oftwenty-four authorized in June 1943 were placed in service in March and April1945. (Table 18) Meanwhile the Southwest Pacific had converted two vessels, the Tasman and Maetsuycker, forintra-theater use. Although controlled by the American Army, these vessels wereDutch hospital ships, sailing under Dutch registry and certified under the HagueConvention by the Netherlands Government.52
As Army hospital ships were readied for service, the problemof naming them arose. The Navy named its hospital ships for abstract qualitiesand hence designated the three ships it was building for the Army as the Comfort,Hope, and Mercy.
52For further information on these vessels, see TC: 565.l-DB (Tasman); HD: SWPA 560.2 (Tasman and Maetsuyker); and State Dept: 740.00117 Eur War 1939/1-1648 (Netherlands Hosp Ships). Also see WD Memo W40-21-43, sub: Use of SS Tasman as a Hosp Ship, 20 Oct 43, in AG: 560 (16 Oct 43).
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Trying not to trespass upon this system and at the same timetrying to designate Army hospital ships appropriately, the Surgeon General'sOffice proposed in July 1943 that they be named for flowers. TransportationCorps officials believed that this might complicate rather than simplify theiridentification as hospital ships. Since all of the vessels being converted werewell known in the world's shipping registers, an enemy encountering one couldidentify it, if designated as a hospital ship under its existing name, by itsascribed physical characteristics and silhouette. It was therefore decided toretain names that were not "entirely inconsistent" with the vessels'new mission and to name others for flowers. In the spring of 1944 the CoastGuard objected to this practice fearing that the Army's naming of hospitalships for flowers would cause confusion with Coast Guard ships carrying the samenames. As a result, at the suggestion of the Surgeon General's Office mosthospital ships commissioned thereafter were named for deceased Army medicalofficers and nurses.53 (See Table18.)
53(1) Memos, SG for CofT, 1 Jul 43; CofT for SG, 22 Jul 43, sub: Names for Hosp Ships. (2) Ltrs, USCG to CofT, 3 Mar 44; CofT to USCG, 9 Mar 44. (3) Memos, CofT for SG, 14 Mar 44, 8 Jan 45, sub: Names for Hosp Ships. All in TC: 569.61. (5) TC Cir 80-4, 5 Feb 44, with supp, 25 Mar, 30 May 44, and 10 Feb 45.
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Continuation of Efforts ToInsure Adequate Hospital Facilities on Transports, 1943-45
Although standards for ships' hospitals had beenestablished by the middle of 1943, meeting these standards continued to involvecertain problems. One was to obtain desired modifications of Maritime Commissionplans. In reviewing them the Surgeon General's Office sometimes found majorfaults: failure to comply with directives about the percentage of hospital bedsto be provided; unsatisfactory location of hospital areas, as for example in thestern two decks below the lifeboat loading deck, instead of nearer midship andone deck higher; improper arrangement of certain medical facilities, such as thecombination of the surgical suite and the dispensary; and failure to providesuch accommodations as utility rooms and dressing stations. Unless constructionof ships was too far advanced, the Commission generally made the revisionsrequested by the Surgeon General's Office.54
Less success was achieved in negotiations with the British toimprove hospitals on their transports. Normally they followed a policy of makingfew if any structural changes in ex-passenger vessels. In December 1943 thisproblem was referred to the Combined Military Transportation Committee and, asa result, the Transportation Corps and the Medical Department had to approvespecifications for hospital areas aboard British transports that wereconsiderably lower than those for American transports. For example, according toa decision of the Committee, British transports were not required to have wardsfor mental patients or separate operating and sterilizing rooms. Instead of thelatter, they had one room which served as a combination surgeon's office, records room,sterilization room, dressing station, and emergency operating room.55
Increases in the number of mental patients to be evacuatedand in the proportion of seriously disturbed cases required further changes intransports' hospitals. In the fall of 1943, on the recommendation of theSurgeon General's liaison officer, the Chief of Transportation directed thatcapacity for mental patients should be increased by 3 percent of the troopcapacity of each Army-owned and chartered transport. He also requested the WarShipping Administration to make similar changes on ships it operated for theArmy. This meant an increase in authorized accommodations for mental patientsfrom 2 to 5 percent of the troop capacity of Army-owned transports and from 1?to 4? percent of that of chartered transports. The percentage of berths forpatients of other types remained unchanged. In order to provide additionalaccommodations for mental patients without diminishing troop capacity,staterooms that were used on outbound voyages for officers and noncommissionedofficers were to be altered. "Potential weapons" were to be removedand electrical fixtures supplied with guards; suitable doors were to beinstalled
54(1) Tynes, Construction Branch, p. 117. (2) Ltr, SG to CofT, 16 Sep 43, sub: Gen Arrangement Plans for Hosp Sec on C4-S-B2 Mar Comm Trp Trans. (3) Memo, SG for CofT, 27 Sep 43, sub: Hosp Facs on US Army Trans, C-3 Type. (4) Ltr, Mar Comm to SG, 28 Sep 43, sub: C4-S-B2 Trp Trans, Hosp Spaces. All in SG: 632.-1 (BB).
55(1) Ltr, CofT to SG, 18 Dec 43, sub: Proposed Hosp RevisionAboard HMT Queen Mary. SG: 632.-1 (Queen Mary)BB. (2) Memo, SGfor CofT, 17 Feb 44, sub: Comments on Proposed Agreement Conc Minimum Standards Aboard Brit and Amer Trp Ships. SG: 560.-1 (Gr Brit). (3) Ltrs, CofT to CGsPEs, 15 Mar 44; CofT to CGs TofOpns, 19 Apr 44, sub: Minimum Standards on Britand Amer Trans, with Rpt CMTC, 18 Feb 44, 82d Mtg. TC: 337 (Trp Trans).
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and bars placed across portholes; and berths were to bemodified so that the lower two could be fixed by bolting or welding and the topone removed before the loading of patients.56
About a year later action was taken to provide more suitableaccommodations for severely disturbed patients. On 25 October 1944, theOperations Division, War Department General Staff, in a meeting withrepresentatives of the Chief of Transportation, The Surgeon General, and others,decided that transports should have locked cells for some patients and smallwards for others. Subsequently, the Transportation Corps announced thatindividual cells would be provided on transports sailing to the SouthwestPacific equal in number to .75 percent of their troop capacities and on thosesailing to other areas equal to .30 percent of their capacities. Approximatelyhalf the remaining accommodations for mental patients were to be in small lockedwards holding twelve or fewer patients.57
A study in the winter of 1944 of the anticipated patient loadindicated that, among other measures, fuller use would have to be made of theBritish Queens and "maximum loading" of certain transportswould have to be authorized. A series of conferences among Medical Department,Transportation Corps, and British representatives in the European Theater ofOperations and in Washington resulted in arrangements in January 1945 to use the QueenElizabeth and the Queen Mary on westbound trips primarily for theevacuation of patients. To increase their patient-carrying capacities to 3,500and 3,000 respectively (the number of patients who could be fed three meals aday from the ships' kitchens), additional pantries had to be installed,accommodations for more medical personnel provided, and facilities for patientsmodified. These changes were limited mainly to installing rails alongsidepatients' berths, furnishing additional bedpan washers and sterilizers, andproviding food carts for serving hot meals to patients unable to attend messformations.58
To permit the "maximum loading" of seventeen Armyand three Navy transports-that is, loading them with the maximum number ofpatients who could be properly fed and otherwise cared for regardless oflifeboat restrictions-similar changes had to be made aboard these vessels. InMarch 1945 the Chief of Transportation established the following standards forsuch changes: additional diet kitchens, food-serving pantries, and food cartsshould be provided to insure the serving of food in a palatable condition;sufficient bedpan washers and sterilizers should be installed to care for alllitter patients; additional mattresses and pillows should be provided; lee railsshould be attached alongside the berths of all litter patients and allambulatory patients who
56(1) Ltr, CG USAFFE to TAG, 24 Aug 43, sub: Evac of Psychotic Cases to US, with 2 inds. AG: 704.11. (2) Ltr, CofT to CGs PEs, 18 Nov 43, sub: Increase inMental Pnt Capacity on Trans. TC: 632 (Army Vessels). (3) Ltr, TAG to CGs AAF,AGF, ASF, Theaters, Def and Base Comds, etc., 8 Jun 44, sub: Procedure for Evacof Pnts by Water or Air from Overseas Comd. AG: 704.11 (3 Jun 44). (4) See pp.399-400.
57(1) Memo OPD 370.05, ACofS OPD WDGS for CG ASF, 27 Oct 44, sub: Evac of Mental Pnts from the SWPA. HRS: ASF Planning Div and Program Br file 370.05, "Hosp and Evac." (2) Memo, Mvmt Div OCT for Water Div OCT, 6 Nov 44, sub: Mental Accommodations on Trp Trans. SG: 705.
58(1) Rads CM-OUT-72113 (3 Dec 44); CM-OUT-76241(12 Dec 44), WD (prepared by Lt Col J[ohn] C. Fitzpatrick) to Hq ComZ ETO. SG:560.2. (2) Rpt, CMTC 67, 16 Jan 45, sub: Return of Pnts and Other Pers West-Bound on the Queen Elizabeth and Queen Mary. SG: 705.
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could not care for themselves without assistance; andadditional dispensaries and surgical dressing rooms should be constructed forthe routine dressings and emergency care patients might need en route.59 Thesechanges increased the capacities of seven transports to an average of more than1,300 patients each, including mental and litter cases.60
Additional Hospital Ships and Modifications for Pacific Service
In authorizing five additional Army hospital ships inDecember 1944 to help handle the patient load in 1945, the Joint Chiefs of Staffdirected that changes in vessels selected should be kept to the minimumnecessary to fit them as "ambulance-type hospital ships." Recognizingthe necessity of this policy, The Surgeon General agreed that existing deckstructures of these ships should be used to the greatest possible extent, butinsisted that each ship should have a proper surgery and X-ray department,adequate messing facilities for feeding bed patients, and suitable office space.61In this instance the Joint Military Transportation Committee selected thevessels to be used and once again the Surgeon General's Office collaboratedwith the New York Port of Embarkation in the preparation of plans forconversion. One of these ships was ready for service by April 1945; another, twomonths later; and the third, in September 1945.62 Work on the remaining two wassuspended after V-J Day and they were again placed in the transport service toreturn troops from overseas areas.
While plans were being made to put five additional Armyhospital ships in service, steps were taken to prepare those already availablefor Pacific duty. During 1944 the surgeons of some complained that ventilation of these vessels was so poor that patientsoften found the heat and odors almost unbearable. Early in 1945 representativesof The Surgeon General and the Chief of Transportation agreed that it would beideal to have hospital ships completely air conditioned, as were those of theNavy, but in view of shortage of time they decided that only portions of them,such as operating rooms, clinics, and certain wards, should be air conditionedand that efforts should be made to increase the exhaust ventilation of otherareas. This program was approved for the five newly authorized ships, and duringMay, June, and July 1945, at least eight others were routed to the New York Portof Embarkation for the installation of air-conditioning equipment.63
Medical Attendants for Service on Transports
Determining a Method of Supplying Personnel
The question of how medical attendants were to be supplied to care forpatients
59(1) Memo, CofT for Dir Nav Trans Serv, 22 Feb 45, sub: Pnt Capacity Mt. Vernon, Wakefield and West Point. (2) Rads, WD for CGs PEs, UK Base Sec, Hq ComZ ETO, POA, MTO, SWPA, 14 and 22 Mar 45. (3) Ltr, CG NYPE to CofT, 20 Apr 45, sub: Increase of Litter Capacityof Trp Ships. All in TC: 569.
60Total patient capacities of the vessels varied from 404 on the Borinquen to 2,618 on the George Washington. Seelist of maximum capacities in History . . . Medical Regulating Service . . . , sec6.
61(1) JCS 1199, 16 Dec 44, Hosp Ship Program; JCS 1199/1, 5Feb 45, same sub. (2) Memo, Col A[chilles] L. Tynes for SG, 21 Dec 44, sub:Plans for Proposed Conv of French Ships, Athos II and Colombie, intoUS Army Hosp Ships. Both in SG: 560.2.
62See Table 18.
63(1) Memo SPTOM 560, Mvmt Div OCT for Water Div OCT, 31 Mar 45, sub: Surv of Ventilation Systs Aboard Hosp Ships. HD: 705 (MRO, Newman Staybacks). (2) Memo, Mvmt Div OCT for Gen R[obert] H. Wylie, 14 Jul 45, sub: Repair Status of US Army Hosp Ships. SG: 705.
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being evacuated by Army troop transport arose early in thewar. In January 1942, G-4 directed The Surgeon General and The QuartermasterGeneral to include in plans for sea evacuation operations recommendations aboutthe source and use of personnel for ships. In response The Surgeon Generalproposed the establishment of Medical Department pools at ports in the zone ofinterior and in theaters of operations. From such pools port commanders in thezone of interior could assign appropriate medical staffs to ships' hospitalson outbound transports and theater commanders could assign additional attendantsto care for patients on return trips. After completing voyage assignments, theattendants could return to theater pools by the first available ship. When noton transport duty, they could be used to supplement the staffs of hospitalslocated near ports either in the zone of interior or in theaters of operations.64
SOS headquarters at first partially approved The SurgeonGeneral's plan. On 18 June 1942 it authorized port commanders to establishpools of Medical Department personnel, under control of port surgeons, fromwhich to furnish complements for ships' hospitals. According to a guidesupplied by The Surgeon General, the permanent complement aboard each transportwas to consist of the ship's surgeon and twelve enlisted men. Before departureof a transport from the United States, a port surgeon was to estimate the numberof patients it would return from theaters and, according to a graduated table inthe guide, was to assign necessary attendants. In emergencies overseascommanders could supply additional attendants.65 This system provedinadequate, perhaps for several reasons. Ports in the United States had troublegetting enough medical personnel to operate the system. In the absence of alarge backlog of patients in theaters, it was impractical to estimate the numberof evacuees to be returned. Finally, port pools were difficult to keep inoperation because ships sometimes were diverted and did not return directly tohome ports.
The SOS Hospitalization and Evacuation Branch thereforesuggested a different plan in August 1942. Calling for the use oftable-of-organization units listed in the troop basis, it promised to insure theavailability of attendants at all times. Therefore SOS headquarters directed TheSurgeon General to prepare an appropriate table. It was to provide not only forunits to care for groups of 25, 50, 75, 100, 250, and 500 patients but also forunits to serve as permanent medical complements of transports. The latter wereto operate ships' hospitals on outbound trips and were to serve asadministrative and technical nuclei around which supplementary platoons couldfunction when patients were being returned to the United States. The SurgeonGeneral prepared the table as directed, but protested against its adoption.Because table-of-organization units were inflexible, he contended, they werewasteful of personnel when used in operations characterized by variable factors,such as ships' destinations, length of voy-
64(1) Memo AG 573.27 (10-29-41),TAG for SG, 26 Jan 42, sub: Hosp Space on Army Trans. HD: 541 (Equip for Trans). (2) Ltr, SG to TAG, 16 Feb 42, sub: T/O for Hosp Ship and Tabulation of Med Pers Reqmts for ATS to Evac from Overseas, with 5 incls. Same file. (3) Memo, SG to CG SOS (Dir of Oprs), 30 Apr 42. HD: 705 (Hosp and Evac, Col Welsh file).
65(1) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: Oprs Plans for Mil Hosp and Evac, with incls. (2) Ltr, SG to CGs all PEs, 29 Jun 42, sub: Opr Plans for Mil Hosp and Evac, with 3 incls. Both in HD: 705 (Hosp and Evac).
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ages, outbound loads, and the number and type of patients onreturn trips. Nevertheless, the General Staff supported SOS headquarters anddirected the activation of ten platoons in September. The next month, the tableof organization for "Medical Hospital Ship Platoons, Separate," waspublished. It provided for a permanent complement of medical personnel thatincluded one officer and twelve enlisted men for each transport, and forsupplementary platoons varying in size from seven to eighty-eight officers,nurses, and enlisted men to care for different numbers of patients.66
Publication of this table did not settle the questionentirely. In November 1942, when SOS headquarters was about to activate thirtyadditional platoons, The Surgeon General again objected to their use. Whetherbecause of this objection or for other reasons, SOS headquarters seems to havecompromised. Supplementary platoons were organized to serve aboard transportscarrying patients, but table-of-organization units to serve as the permanentmedical complements were never activated. Instead, SOS headquarters continued tosupply personnel for this purpose in allotments to port commanders.67
Measures to Conserve Personnel
Steady and large increases in evacuation in the latter halfof the war, along with other demands for shares of a limited supply of medicalpersonnel, especially doctors, intensified the problem of providing attendantsfor patients aboard transports. In the fall of 1943 the use of inflexibletable-of-organization units was questioned by the Surgeon General's PersonnelBoard and by ASF headquarters as being wasteful. The use of theater pools wasagain considered, but Lt. Col. John C. Fitzpatrick, liaison officer of The Surgeon General with theChief of Transportation, defended the use of platoons. They constituted thesurest way, he insisted, for ASF to discharge its responsibility for the care ofpatients after they left theater control. In October 1943 representatives of TheSurgeon General, the Chief of Transportation, the General Staff, and ASFheadquarters reviewed the entire question and decided that "platoons shouldbe modified and retained." They agreed also that maximum use should be madeof returning casual medical personnel to supplement the medical service ontransports. These measures, they expected, would promote manpower economy.68
Modifications were made not so much in platoons themselves asin their use. When the table under which they were organized was revised inOctober 1943, nurses were eliminated, as the Chief of Transportationrecommended. Thereafter they were to be furnished, if needed, by theatercommanders.69 Of more importance, the Office of the Chief ofTransportation in November 1943 developed a guide for theaters to use in placingplatoons aboard transports. This guide took account of the fact that variationsin types
66(1) Memo, ACofS for Oprs SOS for SG, 28 Aug 42, sub: T/O for Med Pers on Amb Ships and Trp Trans, with ind. (2) Memo, ACofS for Oprs SOS for Dir Mil Pers SOS, 1 Oct 42, same sub. (3) Memo, SG for CG SOS (Mob Br), 19 Oct 42. All in SG: 320.3. (4) T/O 8-534, 27 Oct 42.
67(1) Memo for Record, on Memo, CG SOS for TAG, 14 Nov 42,sub: Constitution and Activation of 30 Hosp Ship Plats, Sep. AG: 320.2 (1 Oct42) (3). (2) Memo, Hosp and Evac Br Plans Div SOS for Mob Br Plans Div SOS, 8Dec 42, sub: Med Pers on Army Trans. HD: 705 (MRO, Fitzpatrick Daybook, Aug 42-Jun43). (3) Memo, CG SOS for CofT, 4 Jan 43, sub: Almts for Ships' Complements. SG:320.3-1.
68(1) Rpt, SG Pers Bd Mtgs, 16 Sep-29 Sep 43. SG: 334.7-1. (2) Rpt, SC Pers Bd to Oprs Serv SGO, 28 Oct 43,sub: Study of MD Pers. HD: 334 (Kenner Bd).
69T/O&E 8-534, 21 Oct 43.
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of patients required variations in the number of attendantsprovided. For example, while two 100-bed platoons would be required to care for100 mental or litter patients, a 25-bed platoon was sufficient for a like numberof ambulatory or troop class patients. A 100-bed platoon could care for 150patients if 75 percent were either ambulatory or troop class. This guide, whichgeared the size of platoons to the type as well as number of patients, wasdesigned to permit a flexibility in use that would contribute to economy. InNovember 1943 it was sent to the European theater; the following March, to theNorth African. In June 1944 it was issued to all theaters in a revised directiveon evacuation operations.70
Another economy measure was the elimination of smallplatoons. With actual and anticipated increases in the patient load early in1944, it was unlikely that those with less than 100-bed capacity would beneeded. Small units-of 25-, 50-, and 75-bed capacities-were authorized oneMedical Corps officer each, as was the 100-bed unit. Thus the use of smallplatoons to attend groups of patients numbering 100 or more was wasteful ofMedical Corps officers. In April 1944 the Chief of Transportation requested ASFheadquarters to convert all platoons of 25-, 50-, and 75-bed capacities, a totalof 184, to 100-bed units. This action increased theirtable-of-organization capacity from 7,275 to 18,400 patients without anyincrease in the number of Medical Corps officers and with the addition of only1,964 enlisted men and 184 Dental Corps officers. With the eighty-seven 100-bedplatoons already organized, this gave a total table-of-organization capacity of27,100 patients.71 When additional platoons were required later, noneof less than 100-bed capacity was organized.
Another measure to supply attendants for patients evacuatedby transport was the use of medical personnel returning to the United States ina duty status. The number of enlisted men, officers, and nurses in this categoryincreased as the war lengthened and as they accumulated enough overseas serviceto return home on "rotation." Under an agreement reached in October1943, the War Department on 8 June 1944 directed theater commanders to form suchpersonnel into provisional medical hospital ship platoons and to return to theUnited States no Medical Corps officer below the grade of colonel and no nursewhatever without assuring the full use of his or her services en route.Subsequently, in the fall of 1944 and early in 1945, when the Chief ofTransportation requested the activation of additional platoons, The SurgeonGeneral disapproved, suggesting instead that theaters be directed to form moreprovisional platoons.72
Other measures were also necessary to
70(1) Ltr, CofT to CG ETOUSA 13 Nov 43, sub: Util of Med Hosp Ship Plat, Sep. HD: 705 (MRO, Fitzpatrick Stayback, 498). (2) Rad CM-OUT-7672, WD (Mvmt Div OCT) to CG NATOUSA, 18 Mar 44. SG: 322.8-1. (3) Ltr, TAG to CGs AAF, AGF, ASF, Theaters, Def and Base Comds, etc., 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comd, with incl 4. AG: 704.11 (3 Jun 44).
71(1) Ltr, CofT to CG ASF thru SG, 1 Apr 44, sub: Reorgn of Med Hosp Ship Plat (Sep). HD: 705 (MRO, FitzpatrickStayback, 1077). (2) Memo, CofT for CG ASF, 20 Apr 44, sub: Request forActivation of Add Med Hosp Ship Plats, Sep, with 10 incls. HRS: ASF Planning Div Program Br file, "Hosp and Evac. vol.3."
72(1) Ltr, TAG to CGs AAF, AGF, ASF, Theaters, Def and BaseComds, etc., 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air fromOverseas Comd. AG: 704.11 (3 Jun 44). (2) Ltr, CofT to CG ASF thru SG, 25 Oct44, sub: Request for Prov Med Hosp Ship Plats, Sep. HRS: ASF Planning DivProgram Br file, "Hosp and Evac." (3) Memo, CofT for CG ASF thru SG,24 Mar 45, sub: Request for Prov Med Hosp Ship Plats, Sep, with 2 inds. SG: 322(Plat).
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provide, within the amount of medical personnel available,sufficient attendants for patients on transports. Attempts were made to increasethe use of regularly organized platoons by reducing the time they spent in theUnited States and in returning to theaters. Although such units were assigned tothe Chief of Transportation, for a time the commanders of ports actuallycontrolled them while they were in the United States. In the fall of 1944 theircontrol was centralized in the Movements Division of the Office of the Chief ofTransportation. Knowing where platoons were needed as well as schedules of shipsleaving from all ports, this Division could arrange for the return of platoonsto theaters more quickly than could ports. Later, the War Department suggestedthat theaters might establish air priorities for them, in order to reduce thetime normally required for their return. Another measure taken in the fall of1944 was the deployment of platoons from "isolated theaters," such asthe Middle East, India, and South Pacific, to other more active theaters, suchas the European.73
Problems in the Use of Platoons
Questions arose about the control of platoons. The first tenwere assigned to the New York Port of Embarkation, but all others were assignedto the Chief of Transportation and were attached to ports. In December 1942 TheSurgeon General asked where and how they were to be placed aboard transportscarrying patients. Representatives of his Office, of the Office of the Chief ofTransportation, and of SOS headquarters subsequently decided that platoonsshould be attached to overseas theaters on a temporary duty basis and that theater commanders shouldbe responsible for placing them on transports as needed.74After attachment to theaters platoons came under the administrativecontrol of theater commanders. This step gave rise to complaints that theatersemployed them improperly when they were not escorting patients to the UnitedStates. One complained of being assigned to work in medical supply; another, ofbeing required to sort mail. Nevertheless the War Department followed a policyof not interfering with theater commanders in the control of platoons attachedto their commands and intervened only when the care of patients was affected.75When the Southwest Pacific failed to place sufficient attendants on transportsevacuating patients during 1944, the Movements Division of the
73(1) History . . . Medical Regulating Service. . . , sec 3. (2) Rad CM-OUT-69352, WD to CG USAF POA, 28 Nov 44. TC: 322 (Med Hosp Ship Plats). Similarmessages were sent to other theaters. (3) Memo for Record, on draft Rad, WD toSWPA and POA, 26 Nov 44. HD: 705 (MRO, Gay Stayback, 151). (4) Memo, CG ASF for CofT, 8 Dec 44, sub: Request for Prov Med Hosp Ship Plats, Sep. HRS: ASFPlanning Div Program Br file, "Hosp and Evac."
74(1) Ltr, TAG to CGs NYPE, 1st, 4th, 5th, and 8th SvCs and toSG, 30 Sep 42, sub: Constitution and Activation of 10 Plats. AG: 320.2 (9-30-42)(10). (2) Ltr, TAG to CGs NYPE, 1st, 4th, 5th, 7th, and 8th SvCs and to SG and CofT, 16 Nov 42, sub: Constitution and Activation of 30 Plats (Sep) Ship Hosp.AG: 320.2 (1-10-42) (3) Sec 15. (3) Memo, CG SOS for TAG, 5 Jan 43, same sub.AG: 320.2 (11-21-42). (4) Memo, SG for Hosp and Evac Br Plans Div SOS, 21Dec 42. SG: 200.3-1 (BB). (5) Diary, SOS Hosp and Evac Br, 22 Dec 42. HD:Wilson files, "Diary." (6) Memo for Record, on Memo, CG SOS for SG, 24Dec 42, sub: Med Hosp Ship Plat, Sep. HD: Wilson files, "Book 2, 26 Sep-31Dec 42." (7) Memo, CofT for CGs PEs, 17 Jun 43, sub: Mvmt Orders, Med HospShip Plats, Sep. TC: 322 (Med Hosp Ship Plats).
75(1) Ltr, CO 584th MHSP, HRPE to SG, 28 Jan 44, sub: Duties Performed by a Med Hosp Ship Plat Overseas. HD: 705 (Hosp Ship Plats). (2) Memo, MRO (Gay) for Col J[ames] T. McGibony, 15 May 45, sub: Misuse of Med Pers. HD: 705 (MRO, Newman Stayback,159).
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Office of the Chief of Transportation initiated a WarDepartment cablegram to that theater calling attention to "repeatedreports" that it both overloaded transports and supplied insufficientmedical personnel, even though platoons were available. This message pointed outthat the Army would suffer serious criticism unless such practices werecorrected.76 In 1945 reports reached the Surgeon General's Officethat nursing care on transports returning from the Pacific was below"desirable standards." Believing the cause of this situation to be aninclusion in provisional platoons of enlisted men not technically qualified tocare for patients, the Chief of Transportation had a War Department message sentto the Pacific urging greater selectivity in choosing men for provisionalplatoons.77
The medical hospital ship platoon, a wartime development,seems to have justified its existence. On V-E Day 176 regularly organizedplatoons were being used to attend patients returning from the European theater,and several months later there were 116 in the Pacific. Altogether there were332 platoons in service in August 1945.78 Officers familiar with their workagreed generally that they performed excellently, in view of the difficultmission and adverse conditions-long hours, arduous tasks, and a minimum ofleave and recreational opportunities. Moreover, although some felt thatdentists, pharmacists, and laboratory technicians were not really needed in suchplatoons, representatives of the Surgeon General's Office agreed in May 1945,in reviewing experience with such units, that their table of organization neededno change. After the war the Medical Regulating Officer proposed only one change-the second officer in each platoon mightbe of any branch of the Medical Department instead ofspecifically of the Dental Corps.79
Hospital Ship Complements
Although the Army had no hospital ships in the first part ofthe war, as already pointed out, efforts were made to get them and the SurgeonGeneral's Office drafted a table of organization for a medical hospital shipcompany early in 1942. Published in April, it provided for a unit of 14officers, 35 nurses, 1 warrant officer, and 99 enlisted men to care for 500patients, and for supplementary units of 2 officers, 4 nurses, and 11 enlistedmen for each additional group of 100.80 The approval in May 1942 of theconversion of the Acadia into an ambulance transport and a request inAugust 1942 by the European theater for three hospital ships made it appear thatunits organized under this
76Draft Rad, WD (Mvmt Div OCT) to CinC SWPA, 9 Oct44, sub: Evac of Pnts from Milne Bay. HD: 705 (MRO, Fitzpatrick Stayback, 1495).
77Draft Rad, WD (Mvmt Div OCT) to CinC AFPAC, CGs SFPE, SPE,LAPE, 20 Jul 45. HD: 705 (MRO, Newman Stayback, 195).
78Reports of locations, assignments, and movements ofplatoons were kept from March 1943 until their inactivation in 1945-46. Seemonthly reports in TC: 322 (Med Hosp Ship Plats); in HD: 705 (MRO, Staybackfiles: Fitzpatrick, Jun 43-Apr 44; Zolnaski, Mar-Nov 44), and in SG: 705,Plats, weekly Status Rpts, beginning in Mar 44.
79(1) History . . . Medical Regulating Serv . . . , secs 3.7 and3.8. (2) Memo for Record, Resources Anal Div SGO, 7 May 45, sub: Mtg of T/O Rev Cmtee for Redeployment. HD: 705 (MRO, Newman Stayback, 151). (3) Memo, MRO for Dir Hosp and Dom Oprs SGO, 23 Nov 45, sub: ASF MD T/O&E. HD: 705 (MRO, Hodge Stayback, 514). (4) George F. Jeffcott, A History of the United States Army Dental Service in World War II, Ch. X, pp. 35-42. HD.
80(1) Ltr, QMG to TAG, 14 Feb 42, sub: Hosp Space on ArmyTrans. AG: 573.27. (2) T/O 8-537, 1 Apr 42.
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table would be needed. SOS headquarters therefore directedThe Surgeon General to plan to supply personnel for them.81 As aresult, four hospital ship companies were activated in October and November1942. One was placed on the Acadia when it became an ambulance transportin December 1942. The other three were not used until the first of the Army'shospital ships went into service in the summer of 1943.82
After the Army began to select transports for conversionunder the 24-hospital-ship program, the table of organization for hospital shipcompanies had to be revised. It was designed to supply personnel for ships with500 or more beds, but those to be converted were to have varying capacities,ranging from about 300 to 700. Moreover, experience aboard the Acadia returningpatients from North Africa had revealed certain inadequacies in the old table.Furthermore, Army hospital ships were to be manned by both civilians andsoldiers-the former to operate vessels and the latter to care for patients.But there were some services which might be performed by either group. Hence adecision had to be made as to which services each was to perform and militarypersonnel had to be provided accordingly.83
The division of responsibility for borderline services cameup in July 1943 when plans were drawn for the conversion of the transport Agwileoninto the hospital ship Shamrock. The Surgeon General's HospitalConstruction Branch discovered that the New York Port of Embarkation had devotedmuch space considered desirable for litter patients-almost an entire decklocated above the water line-to quarters for the merchant marine crew. Toincrease this vessel's capacity for litter patients, the Water Division of the Office of the Chief of Transportationdirected reduction of the area occupied by the civilian crew by cutting downboth the size of the crew and the space allowed each of its remaining members.The steward's department was then cut from seventy to thirty-five. Despitesome reduction in original space allowance for individual members of thecivilian crew, they continued to be provided with more commodious quarters thanthe Army allowed enlisted men. As a result, The Surgeon General and the Chief ofTransportation agreed to use enlisted men as much as possible in order to savespace for patients.84 During the fall of 1943 the respective dutiesof the civilian and military crews were agreed upon and the table oforganization for hospital ship companies was revised. It was published on 7December 1943 as Table of Organization and Equipment 8-537T, Hospital ShipComplement.85
While the new table provided for complements to serve onships ranging in capacity, by hundreds, from 200 to 1,000
81(1) Memo, CG SOS for SG, 22 Aug 42, sub: Add Hosp Ships.SG: 560.-2. (2) Memo, SG for CG SOS, 24 Aug 42, sub: Request for Auth andActivation of Certain Req SOS Med Units. SG: 320.3-1.
82(1) Memo, CG SOS for ACofS G-3 WDGS, 10 Oct 42, sub:Deletion of 107th Gen Hosp from Current Trp Basis, with Memo for Record. AG:320.2 (10-10-42). (2) Diary, SOS Hosp and Evac Br (Fitzpatrick), 31 Dec 42.HD: Wilson files, "Diary." (3) See pp. 398, 403-04.
83(1) Ltr, CO 204th Hosp Ship Co to CG NYPE thru Surg NYPE,8 May 43, sub: Request for Change in T/O. TC: 320.3 (Acadia). (2) HaroldP. James, Transportation of Sick and Wounded [1945]. HD.
84Memo, Lt Col A[chilles] L. Tynes for SG, 3 Jul 43, sub: Revised Plans for Hosp Ship Agwileon. HD: 560.2.
85(1) Memo for Record, by Maj Howard A. Donald, SGO, 27 Sep 43, sub: T/O for Hosp Ship
Cos. SG: 320.3-1. (2) Rpt of Conf, Med Hosp Ship Complement, 30 Sep 43. SG: 560.-2. (3) Memo, SG for CG ASF, 13 Nov 43, sub: T/O 8-537, Hosp Ship Complement. AG: 320.3 (20 Nov 43) (2).
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beds, it differed from the old primarily in the number ofenlisted men authorized for nonmedical duties. A comparison of the complementauthorized for a 500-bed ship under the new table with that for a vessel of thesame capacity under the old one illustrates the changes made. The number ofdoctors-eight-remained the same. While the number of nurses was reduced fromthirty-five to thirty-four, a hospital dietitian was added. The number ofdentists was reduced from two to one, but Medical Administrative Corps officerswere increased from two to three. One Sanitary Corps officer and one chaplainwere added to the commissioned staff. Although the number of technicians wasreduced by one, the number of medical supply and administrative men wasincreased from twelve to seventeen. Greatest changes affected enlisted men inthe non-medical services and were governed by the division of duties betweencivilian and military crews announced by the Transportation Corps in December1943.86 Because the civilian crew was to prepare food for all persons aboard, withthe exception of special diets for patients, the seventeen military cooksformerly authorized were reduced to one. Since the military crew was to furnishcooks' helpers, the latter were raised in number from ten to twelve. Inaddition, the military crew was to supply guards for certain sections of theship (primarily those occupied by patients), operate the laundry, and supplydining room service for assigned enlisted men, patients, and both civilian andmilitary personnel authorized to eat in the saloon mess. It was also to provideroom service for all patients and military personnel. For these purposesforty-seven enlisted men were added. To permit them to serve in wards when notengaged in non-medical duties, thirty-one were to be trained and classifiedas ward orderlies.
Division of responsibilities between military and civiliancrews in the fall of 1943 did not eliminate all problems involved in using bothcivilians and enlisted men on hospital ships. In February 1944 the crews of twothreatened to strike unless civilians were placed in some of the jobs filled byenlisted men. To avoid an interruption in evacuation operations, The SurgeonGeneral and the Chief of Transportation agreed to a compromise.87Responsibility for furnishing dining room service in the saloon mess (for boththe civilian and military personnel eating there) and for supplying cooks'helpers was transferred to the civilian crew, and the average number ofcivilians in the steward's department was increased from about thirty-five toabout forty-five. This change removed enlisted men from their point of greatestcontact with the civilian crew and was expected to reduce friction between thetwo groups. While it was not reflected in a reduction of the military crew untilearly in 1945, the change did affect plans for the conversion of transports intohospital ships, for the drawings already made had to be modified to providequarters for the additional civilians. Thereafter, the Chief of Transportationsupplied the Surgeon General's Office with manning tables for each of thehospital ships being provided, so that accom-
86OCT Cir 164, sub: Div ofResponsibility Aboard US Army Hosp Ships, 10 Dec 43, (revised 15 Mar 44). HD: 705 (MRO,Fitzpatrick Staybacks, 840, 970).
87(1) Memo, Dir Hosp Admin Div SGO for Chief Hosp Cons Br Hosp Div SGO, ca. Feb 44, sub: Qtrsfor Civ Crews, Hosp Ships. HD: 560.2 (Hosp Ships, Hosp Cons Br). (2) Memo, SG (Fitzpatrick) forCofT (Water Div), 22 Feb 44, sub: Full Civ Crews Aboard Army-Opr Hosp Ships. HD: 705(MRO, Fitzpatrick Stayback, 848).
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modations for the civilian crew might be planned and, at thesame time, as much space as possible be saved for patients.88
Early in 1945 the table of organization for hospital shipcomplements was revised. Two of the five additional hospital ships authorized inDecember 1944 were to have capacities exceeding 1,000 beds each. The revisedtable took this situation into account, providing for a complement for a1,500-bed ship. It also reflected the shift of responsibility for providingcooks' helpers from the military to the civilian crew by reducing the numberauthorized for a 500-bed ship from ten to two. These two were kept to assist onemilitary cook in the preparation of special diets for patients. The number of"basic" soldiers was also reduced-from twelve to seven.Nevertheless, the total number of enlisted men in the complement for a 500-bedship was reduced by only five, because two men were added to perform nonmedicalfunctions, the number of technicians was increased from forty-four toforty-eight, and four men were added to conduct educational and physicalreconditioning programs. One nurse was eliminated. Otherwise the number ofcommissioned officers remained the same. The new table also reflected a functionnot originally anticipated for Army hospital ships-hospitalization ofcasualties resulting from the initial phases of landing operations. Unlike Navyhospital ships, which were fitted for definitive medical and surgical treatmentat sea, Army hospital ships were planned and staffed to transport patients whohad already received treatment in shore installations and needed only a minimumof medical and surgical care en route. After some had been used in support ofamphibious operations, the suggestion was made that the tables of organizationof complements of such ships should be revised to include anappropriate concentration of specialists. The Surgeon General's Officebelieved that the sporadic use of Army hospital ships for amphibious operationsdid not justify such action. Therefore the new table authorized thereinforcement of normal complements with special medical professional serviceteams when hospital ships were used in support of amphibious landings.89
Since a hospital ship complement was assigned to each ship,the activation and training of complements was keyed to the program ofconverting transports to hospital ships. From the time the first four wereactivated in the latter part of 1942 until the end of January 1945, twenty-fiveadditional complements were organized and trained. Three were used on the Hope,Comfort, and Mercy. Twenty-four were used on hospital ships operatedby the Army, while two were never used because completion of the ships for whichthey had been organized was suspended when the war ended.90
Problems in Providing Supplies and Equipment for Hospital Ships and Transports
Furnishing medical equipment and supplies for patientsevacuated by sea depended upon many variable factors.
88(1) Tynes, Construction Branch, pp. 96-100. (2) Ltr SPTOW 231.81, CofT to SG, 7 Mar 44, sub: Auth Manning Scales Aboard US Army Hosp Ships. SG: 320.4-1. (3) For other manning tables, see HD: 560.2 (Hosp Cons Br, under name of ship).
89(1) T/O&E 8-537, 3 Mar 45. (2) Memo, MRO for SG (Orgnand Equip Allowance Br), 16 Jun 45, sub: Recomd Changes in T/O&E. HD: 705 (MRO,Hodge Stayback, 361).
90History . . . Medical Regulating Service . . ., sec 4.21,with incl.
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Among them were the type of ship (troop transport, ambulanceship, or hospital ship), the size and patient capacity of each, the kinds ofpatients carried (litter, mental, and ambulatory), and the number of days at sea(determined by the speed of each vessel and the length of its voyage). For thisreason the initial issue of medical items, as well as replacement issues aftereach voyage, required individual consideration by port surgeons and medicalsupply officers. Before the war they collaborated locally with transportsurgeons in determining the needs of each transport and in supplying initial andreplacement allowances of medical items.91 In connection with more generalplanning for sea evacuation operations early in 1942, The Surgeon Generalproposed that this system be continued, but that port surgeons be guided bylists of equipment to be supplied by his Office. SOS headquarters announced itsapproval of this proposal on 18 June 1942.92 Meanwhile in collaboration withtransport surgeons, the medical supply officer of the New York Port had preparedtypical requisitions for use in making initial issues of equipment and suppliesto transports hurriedly placed in service after the war began.93
The Surgeon General's guide, distributed at the end of June1942, contained lists of equipment and supplies for 60-day voyages for 500-bedhospital ships, 500-bed ambulance ships, and transports carrying outbound troopsin multiples of 1,000 and inbound patients in multiples of 100. Among the items included in each list were drugs andbiologicals, surgical gauzes, surgical instruments, dental supplies andequipment, laboratory supplies and equipment, X-ray supplies and equipment,operating room equipment, and the like.94 In the fall of 1942 theSurgeon General's Office revised these lists and in December issuedthem in a new form.95
The problem of equipping and supplying hospital ships assumednew importance after the Army was authorized to provide and operate its own.Vessels selected for conversion under this program were to have patientcapacities varying from about 300 to 700. It was therefore necessary for theSurgeon General's Supply Division to prepare individual equipment lists, atleast for the first few ships converted.96 After they were preparedthe Transportation Corps was informed of fixed equipment and its dimensions, sothat plans could be made for its installation, and medical depots wereinstructed to make initial issues of supplies and equipment to each hospitalship.97 In the winter of 1943-44 the Surgeon General's Officedeveloped standard equipment lists for hospital ships with 200-, 500-, and1,000-bed capacities and for 100-bed expansion
91For example, see Ltr, Port MSO NYPE to SG, 30 Mar 42, sub:Med Equip of Trans. HD: 541 (Equip for Trans).
92(1) 2d ind, Act SG to CG SOS (Dir Oprs), 8 Apr 42, on Memo, CofT for CG SOS, 13 Mar 42, sub: Hosp Space on Army Trans. SG: 632.-1 (BB). (2) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: Oprs Plans for Mil Hosp and Evac, with incl. AG: 704.
93Ltr, Surg NYPE to SG thru CG NYPE, 18 Mar 42, sub:Standardized Initial Med Sups for Army Trans, with 2 inds. HD: 541 (Equip forTrans).
94Ltr, SG to CGs PEs, 29 Jun 42, sub: Opr Plans for Mil Hosp andEvac, with 3 tables. HD: 705 (Hosp and Evac).
95(1) Memo, ACofS for Oprs SOS for SG, 22 Aug 42, sub: Basic Equip Lists for Hosp Ships and Ships' Hosps. AG: 573.27 (8-22-42). (2) Instructions for Transport Surgeons, NYPE, 1943. HD: 560.2 (NYPE).
96For example, see (1) Ltr, SG to SPE, 3 Nov 43, sub: Conv ofS.S. President Fillmore into a Hosp Ship. HD: 560.-2 (Hosp Ships). (2)Ltr SPMC 632.-1 (BB), SG to SFPE, 3 Nov 43, sub: Conv of S.S. Ernest F.Hinds into a Hosp Ship. Same file.
97Memo, SG for CofT, 26 Nov 43, sub: Med Equip for Ships. SG:475.5 (BB).
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units.98 These lists were revised, along withthose for transports, in March 1944 and again in April 1945.99
In addition to medical items ships needed other supplies andequipment. Medical Department units serving on ships needed certainorganizational equipment. To meet this need, tables of equipment were issuedearly in 1943 for medical ambulance ship companies and for medical hospital shipcompanies.100 Certain housekeeping items, such as mess equipment, beds,mattresses, and blankets, were required for ships' operating crews as well asfor medical staffs and patients. During 1942 the Medical Department and theTransportation Corps worked out a division of responsibility for supplying them.In general the Transportation Corps agreed to furnish all nonmedical items andall mess equipment, beds, mattresses, blankets, and linens not used for"strictly medical" purposes.101
In planning to equip the Hope, Comfort, and Mercy, theArmy and the Navy encountered difficulty in dividing items for which each wasresponsible. The Army understood that the Navy and its contractors were tosupply all medical equipment that was fixed, or attached, to these ships andthat the Army was to furnish all portable medical equipment. It turned out thatthe Army had to supply all, including fixed medical equipment, such as dentaloperating chairs, operating tables, and X-ray machines.102Uncertaintyexisted for a while, also, over whether the Army or the Navy with itscontractors was to supply housekeeping items. This matter was clarified in anagreement by which the Navy was to supply all portable messing equipment,linens, and blankets, and its contractors were to furnish all mattresses andpillows except those furnished by the Navy for enlisted crews employed in ships'operations.103
During the first half of the war other problems developed inconnection with the equipment of ships. The Surgeon General's Office believedthat adjustable berths similar to beds used in hospitals were needed forseriously ill patients. As a result, a particular type of adjustable berth,known as a "gatch bed," was developed for use on Army hospital ships.104Alternating current (AC) electrical equipment, which the MedicalDepartment had in stock and procured in the early part of the war, wasunsuitable for use on ships which had direct current (DC) systems. To solve thisproblem direct current equipment was procured in a few instances, but generallyconverters were placed on ships so that equipment in stock could be used.Because of the possibility of creating signals that would reveal ships'positions to enemy naval craft, the use of electrotherapeutic equipmenton transports was limited.105
98Equip Lists Nos 97239-05 (200 bed); 97239-10 (500 bed); 97239-15 (1000 bed); 97239-20 (100 bed expansion units), in ASF Med Sup Catalog MED 3, 1 Mar 44. 99(1) ASF, MD Consolidated Equip List No 3, 5 Mar 44.(2) ASF Med Sup Catalog MED 10-4, Apr 45.
100T/E 8-538, 20 Jan 43; T/E 8-537, 10 Apr 43.
101Memo, SG (Tng) for CofT (Water Div), 14 Sep 42, sub: Med Equip for Hosp Ships, Amb Ships and Trans Ships. SG: 475.5-1 (BB).
102Tynes, Construction Branch, p. 92.
103See SGO (Hasp Cons Br) correspondence with Cox and Stevens, New York City and with the Navy (BuShips) in HD: 560.2 (Hosp Cons Br, Hosp Ships Hope, Mercy, and Comfort).
104Ltr, SG (Tynes) to CofT (Water Div), 17 Nov 42, sub: Plans for Double Deck Hosp Berth With Gatch BottomBerth. SG: 427.-4 (BB).
105(1) Ltr AH6/S63(665-517), AH7/S63, AH8/-S63, BuShips to SupShip NY, and San Pedro, Calif, 28 Jun 43, sub: Hosp Ships, AH6 to 8, A.C. Power Sups for I.C. Sys. TC: 632 (Hosp Ships). (2) Memo, CG SOS (Lutes) for CofT, 8 Oct 42, sub: Electrotherapeuticand X-ray Equip Aboard US Army Vessels. HD: 705 (MRO, Fitzpatrick Daybook).
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A significant development occurred in the latter half of thewar in connection with the laundries of hospital ships. Laundries aboard shipswere necessary if the quantities of linens carried were not to be inordinate.Yet laundry operations consumed a tremendous volume of fresh water, and whilehospital ships could not afford to curtail laundry operations it was imperativethat fresh water for other uses receive higher priority. To solve this problemthe Surgeon General's Office developed a salt-water washing process. In thesummer of 1944 successful tests at the Naval Receiving Station and the Army Medical Center (both in Washington, D. C.) demonstrated thatsalt-water washing was both safe and efficient. The process that was developedinvolved the use of salt water and certain detergents for suds and first rinsesand of fresh water for the final rinse and sour. This process, ultimately usedon all Army hospital ships, reduced by about 80 percent the amount of freshwater ordinarily needed for laundry operations.106
106(1) Historical Record, Laundry Section, HospitalDivision, [SGO], 1 July 1944, pp. 22-25, and exhibit 27. HD: 024. (2) Diary, Hosp and Dom Oprs SGO, 18 Aug 44, par 6, Laundry Sec. HD: 024.7-3.
