CHAPTER III
Plans and Preparations for Hospitalization in Overseas Areas
Mobilization Planning
Planning for field hospitalization in the event ofmobilization involved determination of the numbers and types of medical unitsthat would be needed for the force anticipated, provision of up-to-date guidesfor their organization and equipment, and arrangements for furnishing them withpersonnel and supplies. Until the fall of 1940 the defensive nature of all WarDepartment mobilization planning combined with limitations upon available fundsto hold Medical Department activities in this sphere largely within the realm ofpaper work.
Determining the Number
of Medical Units Needed
Determination of the number of mobile medical units that wouldbe needed was governed primarily by the number of combat units authorized. Eachcombat organization such as a regiment or division had a standard structureconsisting of a specific number of units of the several arms and services,including medical, that were "organic" parts of the larger unit. Thusunits designed to provide emergency medical care and transportation for patientsin divisional areas of combat zones were automatically required along with theregiments and divisions of which they were a part. The organization of corps andarmies, though not strictly governed by tables of organization, was alsostandardized. On recommendation of The Surgeon General in the winter of 1939 a"type army" (that is, a standard army) was authorized 3 medicalregiments, 10 evacuation hospitals, 8 surgical hospitals, 1 convalescenthospital, 1 medical laboratory, and 1 medical supply depot. A corps wasauthorized either a medical regiment or a medical battalion. Other medical unitsvarying in kind and number might be authorized as a General Headquarters (GHQ)reserve force. In July 1940 the War Department Protective Mobilization Planlisted as mobile medical units, for an anticipated force of approximately1,150,000 men, 8 medical regiments, 5 "reinforcing" medicalbattalions, 1 horsedrawn ambulance company, 1 medical troop, 17 evacuationhospitals, 13 surgical hospitals, 1 convalescent hospital, 2 medi-
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cal laboratories, 2 medical supply depots, and certain other miscellaneousunits.1
There was no standard number of fixed medical units such as station andgeneral hospitals for given combat forces. To estimate the number needed theSurgeon General's Office again turned to Colonel Love's analysis of WorldWar I battle casualty experience. From this study some members of the Planningand Training Division believed that beds in fixed hospitals should equal 15percent of a theater's strength. Others believed a lower ratio would suffice.2The Surgeon General indicated in his Protective Mobilization Plan of 1939that 126,000 fixed beds would be needed by the end of the first year ofmobilization.3 The War DepartmentPlan provided for only 35,000-in 32 general hospitals, 4 station hospitals,and 2 hospital centers. The Surgeon General considered this provision"alarmingly inadequate" and attempted during 1940 to secure anincrease both in the number of beds authorized and in their scheduled rate ofavailability. In February he submitted a study showing that a minimum of 115,000fixed beds would be required, but because G-3 believed that the majority oftroops to be mobilized should be allotted to combat arms, The Surgeon General'srecommendations received only partial approval. On 6 August 1940 the GeneralStaff authorized an increase in the number of 1,000-bed general hospitals from32 to 102. The number of station hospitals and hospital centers remained asoriginally planned.4 (Table 1)
Revision of Tables of Organization
and Equipment Lists
As a part of its mobilization planning the Surgeon General's Officeundertook a general revision of tables of organization of all medical units andthe preparation of up-to-date equipment lists for them. Although these projectshad been started earlier, only the equipment list for medical regiments and thetables of organization for medical regiments and squadrons had been completed bythe fall of 1939. After the President declared an emergency this work was pushedto completion by the end of 1940.
Changes in the tables of organization of medical units thatsupplied emergency medical care and transportation for patients in combat zonesreflected changes in combat units to increase their mobility and flexibility.When the infantry division was "streamlined" and converted from a"square" to a "triangular" organization, its organic medicalunit was reduced from a regiment to a battalion and appropriate tables for thelatter were prepared. Likewise, the medical battalion eventually be-
1(1) Kent R. Greenfield, Robert R. Palmer, and Bell I. Wiley, The Organization of Ground Combat Troops (Washington, 1947), pp. 263-68, 275-80, in UNITED STATES ARMY IN WORLD WAR II. (2) 1st ind, SG to TAG, 11 Oct 39, on Ltr, TAG to C of Arms and Servs, 3 Oct 39, sub: Orgn of Army Troops. AG: 320.2(9-27-39)(l). (3) Ltr 320.3-1, SG to ACofS G-3 WDGS, 13 Jul 40, sub: Corps Med Units and Atchd Med, and Army Med Regts. HD: McKinney files. (4) War Department Protective Mobilization Plan, 1940, Annex No. 7, Pt. I. AG: Budget Div, WDGS files, A-45-7.
2Memo, GLM [Col Garfield L. McKinney] for Col [Albert G.] Love, 6 Feb 40. HD: McKinney files.
3SG PMP, 1939, Annex No. 29, Chart No 2.
4(1) Ltr, SG to TAG, 15 Feb 40, sub: Hosp under WD PMP 1939. AG: 381 (5-10-40) G-4/20052-134.
(2) Ltr, SG to TAG, 8 Jul 40, sub: Hosp under WD PMP, 1939, with 1st ind AG 381 (7-8-40)M-C, TAG to SG, 6 Aug 40. HD: 370.01-1. (3) Memo G-3/6541-Med-64, ACofS G-3 WDGS for Sec Gen Staff, 14 Apr 40, sub: Status of MD for War. AG: 381 (4-6-40) (1). (4) The War Department Mobilization Plan, speech by Lt Col Harry L. Twaddle, GSC, Chief Mob Br G-3 Div WDGS, 30 Sep 39. G-3 Course No 13 and 13A, AWC, 1939-40.
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Days of Mobilization | War Department Plan | The Surgeon General's Recommendation | ||||
Gen Hosp | Sta Hosp | Hosp Ctr | Gen Hosp | Sta Hosp | Hosp Ctr | |
M-Day | --- | --- | --- | --- | --- | --- |
M+10/11 | --- | --- | --- | 1,000 | --- | --- |
M+30/31 | --- | --- | --- | 8,000 | --- | --- |
M+60/61 | 3,000 | --- | --- | 32,000 | 1,000 | 2,000 |
M+90/91 | 3,000 | --- | --- | 36,000 | 2,000 | 2,000 |
M+120/121 | 22,000 | 1,000 | 2,000 | 43,000 | 3,000 | 4,000 |
M+150/151 | 32,000 | 1,000 | 2,000 | 52,000 | 3,000 | 5,000 |
M+180/181 | 32,000 | 1,000 | 2,000 | 72,000 | 3,000 | 5,000 |
M+210/211 | 32,000 | 1,000 | 2,000 | 84,000 | 3,000 | 7,000 |
M+240/241 | 32,000 | 1,000 | 2,000 | 92,000 | 3,000 | 9,000 |
M+270/271 | 32,000 | 1,000 | 2,000 | 96,000 | 3,000 | 10,000 |
M+300 | 32,000 | 1,000 | 2,000 | 99,000 | 3,000 | 10,000 |
M+330 | 32,000 | 1,000 | 2,000 | 101,000 | 3,000 | 10,000 |
M+360 | 32,000 | 1,000 | 2,000 | 102,000 | 3,000 | 10,000 |
Source: Study accompanying ltr, SG to TAG, 14 Feb 40, sub: Hosp under WD PMP 1939. AG: 381 (5-10-40) G-4/20052-134.
came the organic unit of a corps. Plans for the organizationof armored divisions required the preparation of tables of organization formedical units of that type of combat organization. In 1940 the tables of medicalregiments and squadrons were again revised. Generally there was a tendency toincrease the personnel in medical units of all sizes and to replace animal-drawnwith motor vehicles. Basically, none of the changes made altered the MedicalDepartment's long-established doctrine of hospitalization and evacuation incombat zones.5
Changes in tables of organization of hospital units reflecteda growth in specialized medicine. New tables published during 1940 listed forthe first time the specialists required as ward officers and chiefs of sectionsof professional services. They also allotted to hospitals more enlisted menhaving specialists' ratings and correspondingly fewer having only basicmilitary training. For the first time, they provided for civilian dietitians,physical-therapy aides, and dental hygienists. In many cases the total number ofofficers and enlisted men was increased. For example, in a 1,000-bed generalhospital the number of officers rose from 42, of whom 30 were physicians, to 73,of whom 55 were physicians, and of enlisted men from 400 to 500. These changes,the Surgeon General's Office believed, would enable military hospital units"to perform the necessary additional specialized medical
5(1) Documents on the revisions are in SG: 320.3-1, 1939 and 1940. (2) History of Organization and Equipment Allowance Branch [SGO], 1939-44. HD. (3) Ltr, Surg 4th CA to Corps and Div Surgs, 26 Mar 40, sub: Third Army Maneuvers. HD: McKinney files. (4) Memo, Capt Thomas N. Page for [Brig.] Gen [Albert G.] Love, 28 Dec 40, sub: Activities of the Planning Subdiv [SGO]. HD: McKinney files.
41
and surgical work required, in order to approach thestandards of medicine and surgery as practiced in first class civilianhospitals. . ."6
Although no new hospital unit was developed during theemergency period, a change in the surgical hospital indicated the MedicalDepartment's awareness of the problem of developing a highly mobile unit tocare for seriously wounded casualties near the front lines. The single-unit250-bed surgical hospital developed after World War I was replaced by a new400-bed surgical hospital to be organized under a table of organization issuedon 1 December 1940.7 Similar in some respectsto the "mobile hospital" adapted from the French auto-chir duringWorld War I,8 the new hospital comprised aheadquarters and three subordinate elements: a mobile surgical unit and two200-bed hospitalization units. Each of the latter had its own headquarters.Since each subordinate unit was capable of independent operation, the surgicalunit would be free to move forward, as soon as one hospitalization unit wasimmobilized with patients, to operate for the other hospitalization unit or tosupplement the facilities of other medical stations. Some of the surgical units,the Surgeon General's Office anticipated, would have complete operating,sterilizing, X-ray, and medical supply rooms permanently installed on bus-typeor van-type motor vehicles.9
Along with revised tables of organization, new equipmentlists were prepared. At the beginning of 1939 the only ones available wereshipping lists used during World War I. Like the medical supply catalog, theycontained many articles that were obsolete and lacked others that had beendeveloped in intervening years. To enable medical units to give modern medicaland surgical treatment, it was necessary to find out from manufacturers whatarticles were available and to analyze the functions and activities of eachunit, from reveille to taps, to determine which were needed. Another factor, thetransportation of units to theaters of operations, had to be considered. Toconserve shipping tonnage an attempt was made to include only indispensablearticles in equipment lists. This work was done by Colonel Offutt, assigned tothe Army Medical Center in January 1939 and later transferred to the SurgeonGeneral's Office. He collaborated with the Medical Field Service School(Carlisle Barracks, Pennsylvania), Walter Reed General Hospital, and The SurgeonGeneral's Supply Division and Planning and Training Division. The first listcompleted (in June 1939) was for the medical regiment. Others-including thosefor hospitals-followed during the remainder of 1939 and the first ten monthsof 1940. As rapidly as they were approved by the Surgeon General's Office theywere mimeographed and sent to the various medical supply depots. Concurrently,the table of basic allowances for the Medical Department was revised by TheSurgeon
6(1) The above paragraph is based largely on a comparison of the following T/Os: Gen Hosps, T/O 683W (6 Jun 32) with T/O 8-507 (25 Jul 40); Sta Hosp, T/O 684W (1 Jul 29) with T/O 8-508 (25 Jul 40) and Evac Hosp, T/O 283W (1 Jul 29) with T/O 8-232 (1 Oct 40). (2) See also Ltr, SG to TAG, 11 Jul 40, sub: Publication of T/O 8-508 and T/O 8-507. AG: 320.6 (Med) (4-18-40) (1).
7T/O 8-231 (1 Dec 40) superseded T/O 284W (1 Jul 29).
8The Medical Department . . . in the World War (1925), vol. VIII, pp. 184-91.
9(1) Ltr, Maj Frank B. Wakeman, SGO to Lt Col Guy B. Denit, MC, C&GS Sch, Ft Leavenworth, 11 Feb 41. SG: 322.3-1. (2) For documents on the experimental development of these vehicles see SG: 322.15-17.
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General's Planning and Training Division and was publishedon 1 November 1940.10
Efforts to Assure Availability of Equipment
and Personnelfor Units Planned
Revision of equipment lists emphasized the importance ofmodernizing World War I unit assemblages in storage. After the war in Europebegan, Surgeon General Magee requested funds for this purpose. In April andagain in May 1940 he informed the General Staff of the Medical Department'sunpreparedness for war, stating: "I have not at the War Department'sdisposal for any emergency one complete, modern 1,000-bed general hospital forinstant dispatch."11 Funds whichthe General Staff could secure were limited.12Moreover, believing that The Surgeon General failed to recognize thatincreases in industrial capacity since World War I would make procurement easierand faster, G-4 opposed "piecemeal action" which favored the MedicalDepartment alone. Hence the Staff only promised "consideration" ofMedical Department requirements along with those of other services, and it wasnot until the month before the passage of the Selective Service Act thatsubstantial funds for Medical Department equipment were included in the WarDepartment's budget requests.13
To provide professional staffs for hospitals included in theProtective Mobilization Plan, The Surgeon General early in 1940 began to arrangewith civilian medical institutions for the organization of authorized affiliatedunits. By June 1940 he requested an increase in their number, stating that theresponse of sponsoring institutions was more enthusiastic than he had expected.The next month the General Staff raised the numbers authorized to 68 general, 30evacuation, and 23 surgical hospital units. About a year later the SurgeonGeneral's Office reported success in the organization of affiliated units for41 general, 11 evacuation, and 4 surgical hospitals-approximately the numberoriginally authorized in 1939.14
Attempts to secure enlisted men for training in hospitalunits were only partially successful. Although draftees could be used to fillunits scheduled for activation during mobilization, trained cadres would berequired for each one and some units would have to be ready for action on M Day.Therefore some men needed to be trained in units before mobilization. Increasesin the authorized enlisted strength of the Army during 1939 and 1940 and in theauthorized strength of the Medical Department in May 1940 from 5 to 7 percent ofArmy's strength afforded some additional men. Since most of them were neededfor organic medical units of divisions or for expanding named hospitals,
10(1) Hist of Basic Equip Lists for Med T/O Orgns, incl 2, to Ltr, Brig Gen Harry D. Offutt to Col H. W. Doan, 10 Jun 48. HD: 322. (2) Memo, Capt Thomas N. Page for Gen Love, 28 Dec 40, sub: Activities of the Planning Subdiv [SGO]. HD: McKinney files.
11Ltrs, SG to TAG, 6 Apr and 10 May 40, sub: Status of the MD for War. AG: 381 (4-6-40) (1).
12Mark S. Watson, Chief of Staff: Prewar Plans and Preparations (Washington, 1950), pp. 156-66, in UNITED STATES ARMY IN WORLD WAR II.
13(1) Memo G-4/20052-134, ACofS G-4 WDGS for CofSA, 20 Apr 40, sub: Status of MD for War. AG: 381(4-6-40) (1). (2) Ltr, TAG to SG, 23 May 40, same sub. Same file. (3) Memo G-4/20052-134, Act ACofS G-4 WDGS for CofSA, 19 Aug 40, same sub. (Marked "not used.") AG: 381(5-10-40).
14(1) Ltr, SG to Each Affiliating Inst, 16 May 40, sub: Affiliated Units, MD, USA. HD: 326.01-1. (2) Ltr, SG to TAG, 26 Jun 40, same sub, with 1st ind AG 381(6-26-40)M-A, TAG to SG, 22 Jul 40. Same file. (3) Annual Report . . . Surgeon General, 1941 (1941), p. 145. (4) John H. McMinn and Max Levin, Personnel (MS for companion vol. in Medical Dept. series), HD.
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the General Staff at first allotted none at all to nonorganicmedical units and numbered hospitals. Insisting upon the necessity of trainingmen in such units, The Surgeon General secured authority in June 1940 for theorganization, along with one medical laboratory and one medical supply depot, oftwo evacuation and two surgical hospital units at half theirtable-of-organization enlisted strength, but it was not until 1 August 1940 thatthe first of these was activated.15
Preparing Hospitalization for Overseas Areas During aPeacetime Mobilization
Mobilization of the Army for a year of peacetime trainingreversed the situation which had been anticipated in mobilization plans. Insteadof field medical units such as regimental medical detachments, medicalbattalions, medical regiments, and numbered hospitals to support combat forcesengaged in defensive operations, the greatest need was for named hospitals inthe United States. Hence, they had first call upon medical personnel andequipment. Moreover, since the United States was not at war, additionalhospitalization required in bases and possessions outside its continental limitswas provided on a peacetime basis-that is, in named hospitals. Nevertheless,medical units had to be organized and trained along with the combat forces theywere designed to support.
Activation of Field Medical Units
When mobilization began in September 1940 the Army had, asidefrom the medical units that were organic parts of existing divisions, only thefollowing field medical units: 2 surgical hospitals, 2 evacuation hospitals, 2medical regiments, 1 medical supply depot, and 1 medical laboratory.16Additional organic medical units would be activated and trained along withtheir parent units, such as infantry divisions. Their number depended upon thenumber of parent units that would be called into being by the General Staff. Thenumber of nonorganic units-those serving with armies, corps, and GeneralHeadquarters-that would be activated for training might differ from the numberneeded for combat operations. In anticipation of the passage of the SelectiveService Act, The Surgeon General had recommended in July 1940 the activation athalf strength of all such units in the Protective Mobilization Plan excepthospital centers, hospital trains, the auxiliary surgical group, and the generaldispensary.17 The General Staff partiallyadopted this recommendation in preparing the 1941 troop basis. In December 1940,it authorized the following corps, army, and GHQ medical units: 8 medicalbattalions, 8 medical regiments, 1 medical supply depot, 1 medical laboratory, 1general dispensary, 15 evacuation hospitals, 6 surgical hospitals, 22 generalhospitals, and 22 station hospitals.18 Approximatelyhalf of these
15(1) Memo, ACofS G-1 WDGS for TAG, 6 Nov 39, sub: Enl Pers, MD. G-1: 15081-Med. (2) Ltr AG 320.2 (5-13-40)M-D, TAG to SG, 14 May 40, sub: Adequacy of Serv Units as Contained in Proposed Trp Basis, with 1st ind, SG to TAG, 20 May 40. SG: 320.2-1. (3) Memo, SG for ACofS G-3 WDGS, 26 Jun 40, sub: Sta Lists. HD: McKinney files. (4) McMinn and Levin, op. cit.
16(1) Annual Report . . . Surgeon General, 1940 (1941), p. 175, and 1941 (1941), p. 153. (2) Unit cards of the 1st and 3d Evac Hosps, 6th and 7th Surg Hosps, 2d Med Lab, and 4th Med Sup Depot. HD.
17Ltr SGO 370.01-1, SG to TAG, 17 Jul 40, sub: Mob of MD Units in President's Tng Mob, PMP. AG: 381(1-1-40) Sec 3.
18Ltr AG 320.2 (11-15-40)M(Ret) M-C, to CGs of all Armies et al., 16 Dec 40, sub: Constitution and Activation of Units. AG: 320.2(11-15-40)(1) Sec 1.
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units were to be activated in February 1941 and the rest inJune. Early in 1941 the Staff revised the troop basis, and authorized anadditional medical battalion and two additional medical regiments. By the end ofJune 1941 all of the units authorized had been activated. The next month twoadditional station hospital units were provided when two provisional hospitals,organized but not needed for a task force, were redesignated as numberedhospitals. Although plans were made later in the year for additional units, nomore were authorized until after war came.19
Role of Hospital Units;
Their Personnel andEquipment
Confusion existed about the purpose of the hospital unitsactivated during this period. The character of the mobilization and the natureof the international situation were perhaps responsible for this. Under theSelective Service Act, Reservists and draftees could not legally be made toserve outside the United States except in its territories and possessions.Nevertheless, the Army being mobilized had to be prepared for action anywhere inthe event of a threat to the security of the country.
The Surgeon General seems to have regarded authorizedhospital units as primarily if not exclusively schools for tactical trainingthat would furnish cadres for other similar units or would provide trainedenlisted men as fillers for the hospitals that would be called up in case of war-thatis, the affiliated units. Along with shortages of personnel and equipment anddemands of named hospitals for both, this view undoubtedly influenced hisrecommendations and plans for supplying hospital units with these elements. Astactical training units, numbered hospitals would need-in The Surgeon General'sopinion-officers and equipment for unit administration and field trainingonly. Their enlisted members would be given technical training in namedhospitals or in enlisted technicians' schools. Moreover, full assemblages ofequipment and complete officer staffs were not available for numbered hospitals.Therefore, The Surgeon General planned to issue only field training equipment tonumbered hospital units and he recommended that few officers, from two to five,should be assigned to each.20
The General Staff considered the 1941 hospital units not astraining schools but as true hospitals which could operate in the United States(presumably on maneuvers) or in theaters of operations "in the event of anemergency." On 3 January 1941 it issued a letter to that effect.21Despite this view, the Staff adopted The Surgeon General's recommendation thathospital units be given only part of their personnel-perhaps because of theshortage of men and officers to meet various needs and demands.22Those formed dur-
19(1) Annual Report . . . Surgeon General, 1941 (1941), pp. 153-54. (2) An Rpt, 1941, Surg GHQ. HD. (3) Ltr AG 320.2(5-14-41)MC-C-M, TAG to CofS GHQ; CGs of all Armies, CAs, and Depts; C of Arms and Servs, etc, 22 Nov 41, sub: Revision of Trp Unit Basis, FY 1942. SG: 320.2-1. (4) An Rpts, 1941, 267th and 168th Sta Hosps. HD.
20(1) Ltr cited n. 17. (2) Annual Report . . . Surgeon General, 1941 (1941), p. 154. (3) lst ind SGO 322.15-17. (Ft Knox)N, SG to Surg Ft Knox, 10 Sep 40, on Ltr, CO 6th Surg Hosp to SG, 5 Sep 40, sub: T/O&E. HD: McKinney files. (4) Ltr, SG to TAG, 25 Feb 41, sub: Unit Assemblages, with 3 inds. SG: 475.5-1.
21Ltr AG 322.2(12-6-40)M-C-M, TAG to CofS GHQ CGs of Armies, et al., 3 Jan 41, sub: Purpose and Tng of Certain MC Units to be Activated with Sel Serv Men. SG: 322.3-1.
22Ltr AG 111 (12-23-40)M-C-M, TAG to CofS GHQ; CGs Armies, CAs, and Depts, 31 Dec 40, sub: Trp Basis, PMP, 1941. AWC: 160-93.
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ing 1941 received initially, in addition to cadres of RegularArmy enlisted men, from two to five officers each and only enough selectees-eitherfrom reception centers or from replacement training centers-to provide themwith about half of their table-of-organization enlisted strength.23
The position of the Staff on equipment differed from TheSurgeon General's. In December 1940 it announced a supply policy for all Armyunits-they would obtain complete issues of authorized equipment, exceptcontrolled items (that is, those in short supply and issued only on specialinstructions by the War Department), by submitting requisitions to corps areaheadquarters. Two weeks later it issued another directive making this policyapplicable specifically to Medical Department units,24but a shortage of supplies and equipment made compliance with thisdirective impossible when hospital units were first activated in 1941.25
Toward the middle of 1941 the views of The Surgeon General onthe purpose of hospital units began to coincide with those of the General Staff.By that time he had been required to provide medical complements for hospitalsbeing established in new overseas commands and to prepare medical support fortask forces being formed to occupy the French West Indies when it was fearedthat area might fall into German hands.26 Forthese purposes he drew personnel from named hospitals in the United States. InMay 1941 he informed G-3 that he was having considerable difficulty in providinghospitals for "task forces destined for early dispatch." Explainingthat he had to collect medical personnel from many scattered sources for thispurpose, he pointed out that this was not only a disorderly process but also athreat to the medical service of the hospitals from which personnel was drawn.He therefore asked G-3 to authorize full complements of officers, nurses, andenlisted men for seventeen of the hospitals activated earlier in 1941. Thiswould simplify the problem, he thought, of converting training units intofunctional units. At the same time he requested authority to withhold from suchunits all supplies and equipment, except training equipment, individualequipment, motor transportation, and controlled items, until their assignment tomissions involving medical care.27 Early inJuly the Staff approved sufficient increases in the personnel of eleven-butnot seventeen-units to bring their number of enlisted men up to almost fulltable-of-organization strength and of officers and nurses up to 50 and 75percent respectively. The Staff also approved The Surgeon General's proposalto withhold the issuance of full hospital equipment to these
23An Rpts, 1941, 4th, 6th, 10th, 11th, 15th, 19th, 23d, and 27th Evac Hosps; 28th, 33d, 48th, 61st, 62d, and 74th Surg Hosps; 1st, 5th, 7th, 10th, 11th, 12th, 22d, 47th, and 109th Sta Hosps; and 53d, 56th, 63d, 66th, 148th, 208th, 209th, 210th, 212th, 213th, and 214th Gen Hosps. HD.
24(1) Ltr, TAG to CofS GHQ; CGs Armies, CAs, et al., 30 Dec 40, sub: Current Sup Policies and Procedure. AG: 475 (8-12-40) (1) Sec 1. (2) Ltr AG 320.2(11-16-40)M-D-M, TAG to same, 14 Jan 41, sub: Orgn, Tng, and Admin of Med Units. SG: 322.3-1.
25(1) Equipment for only three hospital units was available in medical supply depots in June 1941. Memo for Record on Memo, Act ACofS G-4 WDGS for TAG, 13 Oct 41, sub: Equip for Med Units. . .HRS: G-4/33344. (2) See An Rpts of numbered hosps cited above. HD.
26(1) See below, pp. 48 and 49. (2) An Rpts, 1943, 167th and 168th Sta Hosps. HD. These hospitals were originally organized as provisional hospitals, Station Hospitals A and B, for service with a task force being organized for the occupation of the French West Indies.
27Memo, SG for ACofS G-3 WDGS, 27 May 41, sub: Med Units, Task Forces. . . . AG: 320.2(5-27- 41)(6).
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eleven units, thus sanctioning, at least for this group, thepractice already followed. The next month, G-4 refused to grant The SurgeonGeneral's request to approve this practice as policy for all other numberedhospital units. Accordingly, when a "War Department Pool of Task ForceUnits" was formed in August 1941, raising the total number of hospitalunits earmarked for actual operations from eleven to thirty-one, differentsupply procedures prevailed for the two groups.28
In the fall of 1941 the difference of opinion about issuinghospital assemblages reached a crucial point when G-4 noted that only fourassemblages had been completed by October, that demands of the Philippine Armyand lend-lease aid might seriously interfere with the completion of others, andthat, according to its observers, hospital units participating in maneuversneeded full issues of equipment. Accordingly G-4 asked The Surgeon General forrecommendations on speeding up the equipment of units in the task force pool.29In reply The Surgeon General pointed to progress, stating on 5 November 1941that five hospital assemblages had been issued, that twenty others were readyfor issuance, and that still others were being packed. He attributed delays toslow deliveries by manufacturers and again requested permission to holdassemblages in depots until hospital units were assigned to missions involvingthe actual care of patients. In support of this request he argued that units intraining did not need full equipment, storage for it in the field wasinadequate, careless handling by unit members would cause breakage anddeterioration, and units would be unable to repack assemblages for shipment.30Maintaining its position but recognizing the possibility of warehousingshortages, G-4 began a survey of corps area storage facilities on 6 December 1941and directed The Surgeon General to earmark and hold all available equipment forspecific units until further notified.31
Training and Use of Hospital Units
In accord with The Surgeon General's plan-that members ofhospital units would receive tactical training in units but technical trainingin named hospitals-numbered hospital units were generally stationed near namedhospitals, but confusion existed about the command that was responsible fortheir training and use. With the separation of field forces from
28(1) Ltr, TAG to CGs 2d, 3d, 4th, 7th, 8th, and 9th CAs, and SG, 7 Jul 41, sub: Orgn of Med Units. AG: 320.2 (5-27-41) (6). (2) Ltr, SG to TAG, 17 Jul 41, sub: Sup of Med Units, and 1st ind, TAG to SG, 6 Aug 41. SG: 475.5-1. (3) Ltr, AG 381 (7-28-41) MC-E-M, TAG to CofS GHQ CGs of Armies et al., 20 Aug 41, sub: Units for Emergency Expeditionary Forces. SG: 322.3-1.
29(1) Memo, Act ACofS G-4 WDGS for TAG, 13 Oct 41, sub: Equipof Med Units for WD Pool of Task Forces, with Memo for Record. HRS: G-4/33344.(2) 1st ind, SG to TAG, 16 Oct 41, and 2d ind, TAG to SG, 27 Oct 41, on Ltr, TAG toSG, 14 Oct 41, sub: Equip of Med Units for WD Pool of Task Forces. AG: 320.2(5-27-41)(6). (3) Memo G-4/33344, Lt Col ClarenceP. Townsley, GSC, Chief Planning Sec [G-4] (init WLW[ilson]) for Col [Albert W] Waldron, [25 Nov 41], sub: Equip for Med Units for WD Pool of Task Forces. HD:Wilson files, "Vol. I, 15 May 41-20 Jan 42." (4) D/S, Act ACofS G-4WDGS for TAG, 25 Oct 41, sub: Equip for Med Units for WD Pool of Task Forces,with Memo for Record. HRS: G-4/33344.
30(1) Ltr, SG to TAG, 5 Nov 41, sub: Equip for Med Units in WD Pool of Task Forces. SG: 475.5-1. (2) Memo, SG for ACofS G-4 WDGS, 19 Nov 41, sub: Comments on Draft of Ltr "Current policies and Procedures for Classification, Storage, and Issue of Sup." Same file.
31(1) Memo, Act ACofS G-4 WDGS for TAG, 27 Nov 41, sub: Equip for Med Units for WD Pool of Task Forces, with Memo for Record. HRS: G-4/33344. (2) 1st ind, TAG to SG, 6 Dec 41, on Ltr, SG to TAG, 5 Nov 41, same sub. AG: 320.2 (5-27-41) (6). (3) Ltr, TAG to CGs of CAs, 6 Dec 41, same sub. Same file.
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corps areas late in 1940, the General Staff, it will berecalled, either assigned or attached to the four field armies all numberedmedical units, including station and general hospitals that did not normallyserve under the jurisdiction of field armies. At the same time, the Staffdirected corps area commanders to make their medical facilities available forthe training of hospital units, and it forbade army commanders to assume controlover such units without the approval of corps area commanders. Furthermore,while one directive stated that the personnel and units of field forces on dutywith corps areas would be controlled entirely by corps area commanders, anotherforbade the same commanders to assume jurisdiction over field force unitsundergoing training in corps area installations.32 As a result,neither GHQ nor the Surgeon General's Office exercised any very direct controlover numbered hospital units, and the units themselves were sometimes confusedas to whether they were subject to army or corps area command.33
Without close supervision from higher authorities thetraining which hospital units received depended primarily upon the attitudes oflocal surgeons and unit commanders. In some instances, well-planned on-the-jobtraining programs were established in named hospitals and were co-ordinated withunit field training. In others, the commanders of named hospitals assigned menfrom numbered units to vacant jobs regardless of their training value. In suchcases technical training suffered because many men did only menial work, andcontroversies developed between hospital commanders responsible for post medicalcare and unit commanders responsible for the technical as well as the fieldtraining of their men.34
Confusion about the control of hospital units also affectedtheir use on maneuvers. Explaining his lack of authority over hospital units,The Surgeon General suggested that the personnel of some should be used toaugment the staffs of named hospitals and to assist medical detachments,battalions, and regiments engaged in maneuvers. He proposed that other unitsshould be employed in giving medical care as they would in theaters ofoperations.35 Their use in this manner was limited by incompletestaffs and lack of equipment. In some instances evacuation hospitals borrowedenough personnel and equipment from other medical units and from corps areas toenable them to provide limited hospitalization for troops in the field. Afterthey were set up, such hospitals tended to become stationary. Army commandersthen had to improvise mobile hospitals by using personnel and equipment ofmedical regiments. Generally armies had to rely upon corps areas for
32(1) Ltr AG 320.2(9-27-40)M-C, TAG to C of Arms and Servs, CGs of Armies, Army Corps, Divs, CAs and Depts, etc., 3 Oct 40, sub: Orgn, Tng, and Admin of Army. SG: 320.3-1. (2) Ltr, TAG to same, 4 Nov 40, sub: Units Asgd and Atchd to GHQ, Armies, Corps. . . . AG: 320.2(8-2-40) (4) Sec 3. (3) Ltr AG 320.2(11-16-40)M-D-M, TAG to same, 14 Jan 41, sub: Orgn, Tng, and Admin of Med Units. SG: 322.3-1. (4) Ltr, TAG to same, 8 Apr 41, sub: Asgmt and Atchmt of Fld Force Units to GHQ, Armies, Army Corps. . . . AG: 320.2(8-2-40)(4) Sec 3A, Pt 1.
33(1) Memo 2, incl to Ltr, Col Daniel J. Sheehan, MC, to Col Roger G. Prentiss, Jr, MC, 10 May 51. HD: 314 (Correspondence on MS) III. (2) An Rpts, 1940 and 41, 222d, 213th, 215th, and 183d Gen Hosps. HD.
34(1) Memo, Lt Col T. E. Huber for Historian, Tng Div SGO, 4 Jun 45, sub: Unit Tng, ASF, World War II. HD: 353. (2) Memo 2, incl to Ltr, Col Daniel J. Sheehan, MC, to Col Roger G. Prentiss, Jr, MC, 10 May 51. HD: 314 (Correspondence on MS) III.
35Rpt, Conf of SG with CA Surgs, 10-12 Mar 41. HD: 337.
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hospitalization of troops on maneuvers. To assist corps areahospitals and at the same time to give members of numbered units some experiencein the actual operation of hospitals, station, general, evacuation, and surgicalhospital units were attached to named hospitals in maneuver areas. Because theirmembers were usually integrated with the staffs of corps area hospitals, suchunits not only tended to lose their identities but also failed to acquireexperience as functioning organizations.36
Furnishing Hospitalization
for Overseas Areas
Even before war actually began, additional hospitalizationhad to be supplied for troops in garrisons in territorial possessions of theUnited States and on island bases leased from the British in September 1940. Inthe Hawaiian and Philippine Islands, the Panama Canal Zone, Puerto Rico, andAlaska, hospitals were expanded as in the United States and additionalincrements of supplies and personnel were sent to care for the expansion.37According to War Department plans, the Atlantic bases were to be garrisoned andoperated on a peacetime basis. The Surgeon General's Office therefore plannedhospitalization for them in the same way as for posts in the United States.After computing bed requirements on a 5 percent ratio, the Hospital Constructionand Repair Subdivision collaborated with the Chief of Engineers (who was chargedwith the construction of those bases) in drawing plans for permanent orsemipermanent hospital buildings of appropriate sizes. Meanwhile, other groupsin the Office planned shipments of supplies and equipment and earmarked personnel to be drawn from existinginstallations for new hospitals.38
Implementation of the plans to garrison the Atlantic basesgot under way early in 1941 before construction was completed. In January a fewmedical officers and a small detachment of enlisted men sailed with troops beingsent to St. John's, Newfoundland. They operated a 40-bed hospital aboard thetransport Edmund B. Alexander until it was ready to return to the UnitedStates about the middle of June. Then they moved into a rented estate atNorthbank.39 In April, a second group of medical personnel,consisting of 21 medical officers and 164 enlisted men, accompanied the garrisonsbound for Trinidad and Bermuda. The detachment which accompanied the Trinidadbase force established a hospital in a temporary, single-building structure. Theone which went to Bermuda set itself up, along with base headquarters and otheractivities, in a hotel building. In other bases medical officers with smallstaffs operated dispensaries and arranged for the hospitalization of patientsneeding further treatment either
36An Rpts, 1941, Surg GHQ First Army, Second Army, ThirdArmy, Fourth Army, and 1st, 4th, 6th, 10th, 11th, and 23d Evac Hosps, 166th Sta Hosp, and Ft Bragg Sta Hosp. HD.
37(1) An Rpts, 1941, Surg Hawaiian, Puerto Rican, and PanamaCanal Depts. HD. (2) HD: 322, Welsh file.
38(1) Memo, Lt Col H. D. Offutt for Maj Welsh, 8 Feb 41. HD:Atlantic Bases file folder. (2) Ltr, SG to CofEngrs, 25 Feb 41, sub: Floor Plansfor MD Fac at Antigua, Bahama, British Guiana, and Saint Lucia. SG: 632-1. (3)Memo, SG for Maj [Henry I.] Hodes, G-3, 28 Nov 40, sub: MD Pers for AtlanticBases. HD: Atlantic Bases file folder. (4) Ltr, SG to CofEngrs, 10 Mar 41, sub:Med Sups and Equip . . . , and 1st ind, CofEngrs to SG, 31 Mar 41. Same file.
39An Rpt, 1941, Sta Hosp. Newfoundland Base Comd. HD.
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in hospitals established by the Engineers for civiliansworking on Army construction or in hospitals operated by the British.40
In the fall of 1941 the first numbered hospital units weresent overseas. Under an agreement with the Icelandic Government, the UnitedStates established a force in Iceland as an outpost of defense. On 5 September1941 the second echelon of this force, "the first United States expeditionto depart with a complete plan and all means necessary to implement it,"41sailed from New York. The 11th, 167th, and 168th Station Hospitals accompaniedit. The last two were composed of Regular Army men drawn from named hospitals inthe United States and organized in mid-1941 as provisional Station Hospitals Aand B for service with an expedition (later canceled) to the French West Indies.The other was made up primarily of drafted men who converted themselves intoRegular Army soldiers by volunteering for three-year enlistments before sailing.Upon arriving in Iceland only one of these units actually operated a hospital in1941. On 24 September the 168th opened in a permanent three-story frame buildingat Camp Laugarnes. The 11th and 167th were attached to the 168th and served asmaintenance and construction forces on roads, utilities, and buildings.42
Plans and preparations for hospitalization in overseas areaswere limited during the emergency period by meager funds and the uncertainnature of the peacetime mobilization. For this reason the Medical Departmentencountered difficulty-as it would later for other causes-in securingauthority from the War Department General Staff to plan for and activate as manyhospital units as it considered desirable.
For estimating requirements the Surgeon General's Officehad only World War I experience to rely upon, and there were differences ofopinion as to how many fixed beds would be really needed. In order to enableunits to give modern medical care, the tables governing their organization andequipment were revised. Although personnel authorized by such revisions wasoften increased, the General Staff began a practice-to be carried to greaterlengths later-of requiring reductions in both personnel and equipment fortable-of-organization units. Affiliated units were organized and some regularunits were activated. The role of the latter was uncertain, but The SurgeonGeneral gradually tended to agree with the General Staff that some of them atleast would be used to give actual medical care. The rest would continue totrain fillers for affiliated units. While The Surgeon General and the GeneralStaff agreed upon the policy of providing hospital units with less than fullquotas of officers and enlisted men, they disagreed upon the question of whetheror not units in training should receive full issues of supplies and equipment.This dispute was to continue unabated during the first half of the war.
40(1) Memo, Maj A. B. Welsh for Brig Gen A. G. Love, 7 Apr 41,and Ltr AG 320.2(4-8-41)M-D-M, TAG to C of Arms and Servs, 8 Apr 41, sub:Immed garrison for Bermuda and Trinidad. . . . HD: Atlantic Base file folder.(2) A History of Medical Department Activities in the Caribbean Defense Commandin World War II, vol I, pp. 245-46, 281-82, 311, 314, and 320. HD. (3) AnRpt, 1941, Surg Bermuda Base Comd. HD.
41Greenfield et al., op. cit., pp. 22-23. For afull discussion of the agreement with Iceland and the force sent for itsdefense, see Stetson Conn and Byron Fairchild, Defense of the Americas, Vol. II,a forthcoming volume in the series UNITED STATES ARMY IN WORLD WAR II.
42An Rpts, 1941, 1943, 168th Sta Hosp; 1941, 1942, 167th Sta Hosp; 1941, 11th Sta Hosp; 1942, Surg IcelandBase Comd. HD.
