CHAPTER IV
Changes in Organization and Responsibilitiesfor Hospitalization
Since most changes occurring early in the war in theresponsibilities of various agencies for hospitalization resulted from thereorganization of the War Department in March 1942, major outlines of the neworganization must be described briefly here.1In this connection one should understand that difficulties inhospitalization and evacuation resulting from the reorganization were aspects ofa larger problem involving activities of the Medical Department in general andthat similar problems were often encountered by other technical and supplyservices.
Reorganization of the War Department
Under the new setup the General Staff was relieved of some ofits administrative and operative functions in the zone of interior by thecreation of three major commands-Army Air Forces, Army Ground Forces, andServices of Supply (called Army Service Forces after March 1943). The divisionsof the General Staff were to devote themselves to planning, to the generalsupervision of matters for which they were traditionally responsible, and to thestrategic direction of forces in theaters of operations. The three majorcommands were all subject to the supervision and control of the General Staff,under the Chief of Staff, General George C. Marshall. War Department chartsplaced them all on the same level, but differences of opinion subsequentlydeveloped over whether or not they were actually coequal in authority.
The Army Air Forces, which had been established in June 1941and had attained a great deal of practical autonomy, had taken the lead andsupplied the drive for the reorganization as a means of protecting andregularizing its current position. Colonel Grant continued as the Air Surgeon.The Army Ground Forces comprised the arms (such as Infantry, Cavalry, andArtillery) and was responsible for
1Fuller discussions may be found in other volumes: (1) John D. Millett, The Organization and Role of the Army Service Forces (Washington, 1954), pp. 23-42, 93-97, 132-37, 148, 298-309, Ray S. Cline, Washington Command Post: The Operations Division (Washington, 1951), pp. 61-74, 90-95, 111-19, and Kent R. Greenfield, Robert R. Palmer, and Bell I. Wiley, The Organization of Ground Combat Troops (Washington, 1947), pp. 142-45, 268-71, all in UNITED STATES ARMY IN WORLD WAR II. (2) Wesley Frank Craven and James Lea Cate, eds., The Army Air Forces in World War II (Chicago, 1948), Vol. I, pp. 257-67. (3) Blanche B. Armfield, Organization and Administration (MS for companion vol. in Medical Dept. series). HD.
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preparing the ground army for combat. General Headquarterswas now liquidated and much of its personnel was transferred to AGFheadquarters. Colonel Blesse then became Chief Surgeon of the Army Ground Forces(or the Ground Surgeon). He remained in that position until December 1942, whenhe was succeeded by Col. William E. Shambora, and returned to it again in May1944 for the rest of the war.
To the Services of Supply were assigned the corps areas, thetechnical and supply services such as the Medical Department and theQuartermaster Corps, certain War Department administrative services, and some ofthe functions and personnel of G-4. Lt. Gen. (later General) Brehon B. Somervell,Assistant Chief of Staff, G-4, of the War Department General Staff since 25November 1941, became Commanding General, Services of Supply. Under hisjurisdiction was The Surgeon General, the head of the Medical Department.
The Surgeon General's New Position
Uncertainty developed about the effect the reorganizationhad or should have on responsibilities and authority for hospitalization andother medical activities. While General Magee recognized that there were"changes in the flow of control from the Secretary of War to the MedicalDepartment," he did not believe that the reorganization had altered theresponsibility of The Surgeon General for the health and medical care of theentire Army.2 Apparently he did notcomprehend at the outset the full impact on his office of the interposition ofan intermediate headquarters between himself and the General Staff. According toSOS doctrine General Somervell was responsible for all activities, includinghospitalization, within the Services of Supply and was at the same time staffadviser to-and in some instances spokesman for-the Chief of Staff onsupplies and services, including medical, for the entire Army.3In his new position, The Surgeon General was an adviser to GeneralSomervell. In this capacity the extent to which General Magee could dischargewhat he considered to be his responsibilities depended primarily upon the degreeto which General Somervell accepted his recommendations (1) regarding SOSmedical matters as the basis of command decisions and (2) regarding Army-widemedical matters as a basis for action or advice to the Chief of Staff. So far ashospitalization and evacuation in particular were concerned, it depended-partially,at least-upon the role of a medical section in SOS headquarters.
When SOS headquarters was established in March 1942 a medicalofficer, Lt. Col. William L. Wilson,4 was transferred from G-4along with General Somervell, Brig. Gen. (later Lt. Gen.) LeRoy Lutes, andothers. For several months he served in the Miscellaneous Branch of the SOSOperations Division under General Lutes. In July 1942, when SOS headquarters wasreorganized, a
2(1) Ltr, SG to CG SOS, 25 Mar 42, sub: Med Serv of Army. HD:321.6-1. (2) Cmtee to Study the MD, 1942, Testimony, p. 2055. HD.
3(1) Ltr, Gen Brehon B. Somervell to Col R[oger] G. Prentiss, Jr, ed, Hist of the MD in World War II, 13 Nov 50. HD: 314(Correspondence on MS) III. (2) Ltr, Lt Gen LeRoy Lutes to same, 8 Nov 50. Samefile. (3) The SOS viewpoint is explained in Millett, op. cit., pp. 143-47.
4Colonel Wilson received his promotion from major tolieutenant colonel on 18 April 1942 but it was retroactive to 1 February 1942.This accounts for the fact that documents signed by him and cited in thefootnotes show him as a major until the middle of April.
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Hospitalization and Evacuation Branch was established inGeneral Lutes' office and Colonel Wilson was made its chief. This Branchgained additional medical officers and by October 1942 it had, in addition toits chief, one Medical Administrative Corps and three Medical Corps officers.Lt. Col. William C. Keller, a physician formerly with the Pennsylvania Railroad,was in charge of a railway evacuation section. Maj. (later Col.) John C.Fitzpatrick, who had had experience as a transport surgeon, was in charge of asea evacuation section. Maj. (later Lt. Col.) Henry McC. Greenleaf devoted hisattention to hospitalization. The administrative officer, Maj. (later Col.)Harry J. Nelson, was in charge of office administration.5
The SOS statement of the functions of this Branch-to reviewplans for, co-ordinate activities related to, and insure the means forhospitalization and evacuation-was subject to different interpretations.General Magee believed that his Office was best equipped to decide upon medicalmatters and that his advice should be given preponderant weight. Accordingly, inhis opinion any medical officer in a staff position of a higher headquartersshould be a representative of The Surgeon General and should receive hisinstructions and advice from the Surgeon General's Office. He interpretedestablishment of the Hospitalization and Evacuation Branch as representing adesire in SOS headquarters for a section to co-ordinate activities of variousArmy agencies in the transportation (or evacuation) of patients.6
The SOS viewpoint was different. In July 1942 General Lutesinformed corps area commanders that the "Hospitalization and EvacuationBranch lays down the policies to the Surgeon General on Hospitalization and Evacuation," and that it thenvisited their areas to see if "policies and plans as laid down to theSurgeon General" were satisfactory and were being followed.7ColonelWilson took the position that hospitalization and evacuation requiredsupervision by a higher headquarters than the Surgeon General's Office. Inexplaining his position as chief of the SOS Hospitalization and EvacuationBranch, he emphasized that he had no authority as a staff officer to makedecisions or to issue orders concerning hospitalization and evacuation (thatcould be done only by General Somervell or General Lutes) but that it was hisresponsibility to gather and evaluate information on such matters and to presentit, along with recommendations for action, to Generals Lutes and Somervell. Ifhis advice differed from The Surgeon General's, he stated, he gave the latter'sopinion as well as his own.8 In view of different conceptions oftheir respective responsibilities, it was perhaps inevitable that conflictswould develop between the SOS Hospitalization and Evacuation Branch and theSurgeon General's Office.9
5(1) WD Cir 59, Orgn Chart, SOS Orgn, 2 Mar 42. (2) Cmtee toStudy the MD, 1942, Testimony, pp. 1274-76. HD. (3) History of Planning Division, ASF, Vol. 1,p. 77. HRS.
6(1) Cmtee to Study the MD, 1942, Testimony, pp. 1973-2022. HD. (2) Verbatim transcription of notes employed by Maj Gen James C. Magee in conf in HD AML, 10 Nov 50. HD: 314 (Correspondence on MS) III.
7Rpt, Conf of CGs, SOS, 2d sess, 30 Jul 42, pp. 52-53. HD: 337.
8(1) Memo, Maj W. L. Wilson for Gen Lutes, 18 Apr 42, sub:Hosp and Evac Oprs, SOS. HD: Wilson files, "No 472, Hosp and Evac, 1941-42."(2) Cmtee to Study the MD, 1942, Testimony, pp. 1910-11, 1956-57. HD. See also pp.1869-1964, 1271-1339. (3) Memo, Col W. L. Wilson for Col R. G. Prentiss, Jr.HD: 314 (Correspondence on MS) III.
9See below, pp. 63-67, 151-60.
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The extent to which The Surgeon General could discharge hisresponsibility for the health and medical care of the Army depended also uponwillingness of commanders of the Ground and Air Forces to admit that theCommanding General, Services of Supply, or one of his subordinates, had anyauthority-even technical and professional-over matters for which they wereresponsible and upon which their own surgeons could advise them.
So far as hospitalization in the United States was concerned,this involved mainly the Air Forces. Since the Ground Forces were to occupy anduse stations operated by the Services of Supply, AGF headquarters readilyaccepted the dictum that the "Medical Department under the command of theCommanding General, Services of Supply," would furnish all of itshospitalization and evacuation in the United States except that provided byfield medical units operating under tactical control. On the other hand, it willbe recalled that the Air Forces already had a separate set of hospitals and thereorganization placed them, along with stations they served, under command ofthe Commanding General, Army Air Forces.
Several documents issued after the reorganization purportedto clarify the respective responsibilities of the commanders of the Air andService Forces and the relationships of the Air Surgeon and The Surgeon General.A General Staff directive charged all commanders with "commandresponsibility for the operation of all medical facilities under their controland for future planning in connection therewith." It also charged theCommanding General, Army Air Forces, "with development and operation of airevacuation," and the Commanding General, Services of Supply, with providing"for the evacuation of sick and wounded delivered to hiscontrol," and with "administrative responsibility for the coordinationof the plans of all commands for evacuation of the sick and wounded to bedelivered to his control, and for coordination of plans for hospitalizationwithin the continental United States." An SOS directive on 18 June 1942charged The Surgeon General with "the initial preparation and themaintenance of basic plans for military hospitalization and evacuationoperations, and the coordination of the plans therefor of all commandsconcerned." An announcement of an agreement between the Air Surgeon and TheSurgeon General, approved by G-3, had stated earlier that the "routineconduct of medical activities with the Army Air Forces" was a"responsibility of each local surgeon acting under the Air Surgeon, who isresponsible to The Surgeon General for the efficient operation of MedicalDepartment technical activities with the Air Forces." It had also statedthat the Air Surgeon would not duplicate activities of the Surgeon General'sOffice, "with the exception of those procedures necessary for the propercontrol of Medical Department personnel and activities under the jurisdiction ofthe Army Air Forces."10
None of these documents specifically stated that the Servicesof Supply was to
10(1) Ltr, SG to CG SOS, 25 Mar 42, sub: Med Serv of Army. HD: 321.6-1. (2) Memo, CG SOS for ACofS G-3 WDGS, 26 Mar 42, sub: Med Activities under WD Cir 59, 1942, with Memo for Record. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42." (3) Ltr, CG SOS to all CA Comdrs and SG, 26 May 42, sub: Med Activities under WD Cir 59, 1942. SG: 020.-1. (4) Ltr AG 704 (6-17-42) MB-D-TS-M, TAG to CGs AGF, AAF, SOS, All Def Comds, All Depts, All Theaters, and All Sep Bases, 18 Jun 42, sub: WD Hosp and Evac Policy. HD: 705.-1. (5) 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. SG: 705.-1.
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exercise authority over AAF hospitalization and all of themwere sufficiently vague to permit a variety of interpretations. Difficultiesthat arose from Air Forces' resistance to SOS claims of authority and from theAir Surgeon's strivings for completely separate AAF hospitalization will bediscussed later.11
The division of responsibility for hospital units beingprepared in the United States for overseas service was clearer. This probleminvolved mainly the Army Ground Forces, for the Air Forces at that time had nosuch units and made no bid for them.12 Moreover, in February 1942General Magee had secured Staff approval of a policy of "providing over-allhospitalization for task forces, instead of attempting to provide separatehospitalization for the air and ground components thereof. . ."13While it wasclear that the reorganization placed medical units that were organic elements ofair and ground combat forces under AAF and AGF headquarters respectively,responsibility for nonorganic service units, such as hospitals, was left to be"directed by the War Department."14
The Ground Surgeon believed that medical units normally usedin combat zones in close support of ground troops should be assigned to theGround Forces and those normally used in communications zones, to the Servicesof Supply.15 Mindful of his position as chief medical officer of theArmy, The Surgeon General wanted all hospital units-those that served incombat as well as in communications zones-and certain other medical units thatnormally served as parts of field armies, such as medical laboratories anddepots, to be under the jurisdiction of the Services of Supply.16 Onthe recommendation of its Hospitalization and Evacuation Branch, SOS headquarters first requested that onlygeneral and station hospital units be placed under SOS control but later adoptedThe Surgeon General's position.17
After considerable investigation and study of the largerproblem of jurisdiction over service units in general, G-3 took a view thatcoincided with the Ground Surgeon's. On 30 May 1942 it announced that thethree major commands would, in general, train the nondivisional service unitswhich they used.18 On 8 July 1942 this principle was extended tocover acti-
11See below, pp. 106-09, 117-20, 173-76, 182-88.
12In March 1942 AAF Headquarters concurred in the SOSproposal that SOS have jurisdiction over general and station hospital units andAGF over all other field medical units. Memo, CG SOS for ACofS G-3 WDGS, 26Mar 42, sub: Med Activities under WD Cir 59, 1942. HD: Wilson files, "BookI, 26 Mar 42-26 Sep 42."
131st ind SGO 322.4-1, SG to TAG, 5 Feb 42, and 2d ind AG 320.2 (1-29-42) MSC-C, TAG to SG, 18 Feb 42, on Memo, C of Air Staff for SG, 29 Jan 42, sub: Expansion Program of AAF for Calendar Year 1942. HD:320.3 (Trp Basis).
14WD Cir 59, 2 Mar 42.
15Cmtee to Study the MD, 1942, Testimony, pp. 409-13. HD.
16(1) Memo, SG for CG SOS, 16 Mar 42. SG: 020.-1. (2) Memo, Act SG for Tng Div SOS, 31 Mar 42. SG: 322.3-1. (3) Ltr, SG to CG SOS, 28 Oct 42, sub:Recomds in Regard to Activation, Control, and Tng of Med Units, with 1 incl. SG:320.3-1.
17(1) Memo for Record on Draft Memo, CG SOS for ACofSG-3 WDGS, 26 Mar 42, sub: Med Activities under WD Cir 59, 1942. HD: Wilsonfiles, "Book I, 26 Mar 42-26 Sep 42." (2) Memo SP 020 (3-28-42),CG SOS (init WLW[ilson]) for ACofS G-3 WDGS, 17 Apr 42, same sub. Same file.(3) Memo, CG SOS for ACofS G-3 WDGS, 14 May 42, sub: Responsibility for Tng. HRS: G-3/353 (Only) vol. II. (4)For a discussion of the general problem, see Robert R. Palmer, Bell I. Wiley,and William R. Keast, The Procurement and Training of Ground Combat Troops (Washington,1948), pp. 499-511, in UNITED STATES ARMY IN WORLD WAR II.
18Memo WDGCT 353 (5-30-42), ACofS G-3 WDGS forCGs AGF, AAF, and SOS, 30 May 42, sub: Responsibility for Tng. HRS: G-3/320.2"Activation, vol. I."
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vations also.19 As a result, for the rest of thewar the Services of Supply was responsible for activating and trainingcommunications zone units. Among them were fixed hospitals, such as general,station, and hospital center units, and certain evacuation units, such ashospital trains and hospital ship companies. The Army Ground Forces wassimilarly responsible for combat zone units, including surgical and evacuationhospitals as well as such units as medical regiments, medical battalions,medical detachments, and medical supply depots.
With division of responsibility for activating and trainingservice units, AGF headquarters assumed responsibility for recommending thenumber of mobile units to be included in the troop basis, while The SurgeonGeneral and SOS headquarters concentrated on units for fixed hospitals.Subsequently, responsibility for preparing tables governing the organization andequipment of hospital units was also divided. Since mobile hospitals weredesigned for use in combat zones, AGF headquarters felt that it should be freeto make such changes in personnel and equipment of these hospitals as it founddesirable for tactical reasons.
In September 1942 G-4 proposed that AGF headquarters shouldbe given responsibility for the preparation of tables for all AGF service units.20General Somervell feared that the chiefs of technical services, includingThe Surgeon General, might be bypassed if this proposal were adopted. On hisrecommendation, G-4 amended its original proposal to require AGF to consultwith SOS when preparing tables for service units.21 Thereafter,responsibility for the preparation of tables of organization, tables ofequipment, and tables of basic allowances for numbered hospital units was divided, as that for their activation andtraining had been earlier, between AGF and SOS headquarters.22
Even so, The Surgeon General retained considerable authorityover the medical equipment and supplies furnished all hospital units, mobile aswell as fixed, for one item in each table of equipment was the unit assemblage.It contained all items of medical equipment required for a hospital, was packedaccording to Medical Department equipment lists, and was issued by MedicalDepartment depots as a single item. While he customarily consulted with theGround Surgeon when revising equipment lists, The Surgeon General alone wasresponsible for their preparation and for the packing of unit assemblages.23
Further changes affecting the manner in which The Surgeon General could discharge his responsibility for the medical care of the Army occurred as a result of the reorganization of the Services of Supply in the summer of 1942. At that time corps areas were renamed service commands and authority formerly concen-
19Memo WDGCT 320.2 (Activation) (7-1-42), ACofS G-3 WDGS for CGs AAF, AGF, and SOS, 8 Jul 42, sub:Responsibility for Activation of Units. HRS: G-3/320.3 "Activation, vol.I."
20Memo WDGDS 809, ACofS G-4 WDGS for CG SOS, 21 Sep 42, sub:Prep of T/Os and T/Es. AG: 320.3(3-13-42)(5).
21(1)1st ind SPOPU 320.3(9-21-42), CG SOS to ACofS G-4 WDGS, 25 Sep 42, on Memo WDGDS 809, ACofS G-4 WDGS for CG SOS, 21 Sep 42, sub: Prep of T/Os and T/Es. AG: 320.3(3-13-42) (5). (2) DF WDGDS 867, ACofS G-4 WDGS to ACofS G-3 WDGS, 29 Sep 42, same sub. Same file.
22(1) AR 310-60, pars 8 and 16, 12 Oct 42. (2) WD Memo W310-9-43,22 Mar 43, sub: Policies Governing T/Os and T/Es. HD.
23(1) Memo, SG for CG SOS, 5 Nov 42, sub: Make-up of Hosp Unit Assemblies. SG: 475.5-1. (2) Rpt of [SGO]Bd for Determining Possibilities of Deleting Certain Items in a 400-bed EvacHosp [13 Nov 42]. SG: 475.5-1.
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trated in Washington was decentralized to them. Thus thecontrol of all general hospitals, except Walter Reed, was transferred from TheSurgeon General to commanding generals of service commands. For a while theformer retained authority to determine staff allotments for general hospitals,subject to SOS approval; but in April 1943, on the recommendation of the SOSControl Division, that function was also decentralized to commanding generals ofservice commands.24 The reorganization also diminished theauthority of service command surgeons and altered the Surgeon General'srelationship with them. They no longer occupied the position of staff advisersto their commanders but were now subordinated as chiefs of medical branches tothe chiefs of personnel or supply divisions of service command headquarters.Moreover, since command responsibilities were emphasized in the field, as inWashington, they could no longer be considered as field representatives of TheSurgeon General and could therefore exercise no authority over hospitals notunder service command control. Finally, The Surgeon General could-in theory atleast-communicate with service command surgeons and hospital commanders onlythrough command channels-that is, through General Somervell and thecommanding generals of service commands. This indirect method of intercourse wassomewhat offset by the practice of permitting informal direct communicationbetween the Surgeon General's Office and service command surgeons.25
Changes in responsibilities for hospital construction andmaintenance also occurred, but resulted only partially from the reorganizationsdiscussed above. In December 1941, in conformity with an act of Congress, all of The Quartermaster General'sconstruction and maintenance activities were transferred to the Chief ofEngineers.26 About five months later the War Departmentconcentrated in the latter responsibility which he had previously shared withThe Surgeon General for the maintenance of hospital plants.27 After the WarDepartment reorganization, recommendations of The Surgeon General forconstruction of new plants and for major alterations of existing plants weresubject to review by both the Hospitalization and Evacuation Branch and theConstruction Planning Branch of SOS headquarters. The former considered themfrom the viewpoint of medical needs; the latter, of Army-wide requirements. Bothbranches were guided by decisions and policies of the General Staff and bydirectives of the War Production Board. The selection of sites and the internalarrangements of new hospitals, as well as alterations of existing plants,continued to be a joint function of The Surgeon General and the Chief ofEngineers. Insistence of the
24(1) SvC Orgn Manual, 22 Jul 42, sec 403.02, in WD Hq SOS SvC (formerly CA) Reorgn, 22 Jul 42. HRS. (2) Memo, SG for Dir Control Div SOS, 1 Aug 42. SG: 020.-1. (3) Cmtee to Study the MD, 1942, Testimony, Statement of Col H. D. Offutt, pp. 214-15. HD. (4) AR 170-10, par 6a(l)(p), 10 Aug and 24 Dec 42. (5) Memo, Dir Control Div ASF for CofS ASF, 6 Apr 43, sub: Clarification of Prov of AR 170-10. . . . AG: 600.12(10 Mar 42) (1). (6) AR 170-10, C 2, 14 Apr 43.
25(1) Edward J. Morgan and Donald O. Wagner, The Organizationof the Medical Department in the Zone of the Interior (1946), HD, pp. 97-99.(2) Ltr, SG to CG SOS, 9 May 42, sub: Med Activities under WD Cir 59, 1942. SG:020.-1. (3) Memo, Chief Professional Servs [SGO] for Mr. Corrington Gill, 2Oct 42, sub: Supervision and Coord of Professional Care in Mil Hosps inContinental US. SG: 701.-1. (4) SOS Orgn Manual, 10 Aug 42, sec 403.02. (5)For a fuller discussion, see Armfield, op. cit.
26WD Cir 248, 4 Dec 41.
27(1) WD Cir 157, 23 May 42. (2) AR 100-80, 9 Jun 42. (3)See below, pp. 94-96.
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latter and of SOS headquarters upon decentralization to thefield of as much construction authority and activity as possible, in order tospeed construction, resulted by the end of 1942 (as will be seen later) in TheSurgeon General's loss of some authority he had previously exercised over theerection and alteration of hospital plants.28
The Wadhams Committee
Late in 1942 responsibilities and organization forhospitalization, along with many other aspects of Medical Department work, werethe subject of review and comment by a civilian committee appointed by theSecretary of War. This group, which called itself the "Committee to Studythe Medical Department" but which will be referred to hereafter for thesake of brevity as the Wadhams Committee (from the name of its chairman, Col.Sanford Wadhams, a retired medical officer), was constituted to "make athorough survey of professional, administrative, and supply practices of theMedical Department."29 It probed the relation between the Surgeon General'sOffice and the SOS Hospitalization and Evacuation Branch, and testimonypresented in that connection placed on record information summarized above whichmight not otherwise have been available.30 While some of theCommittee's recommendations dealt with the position of The Surgeon General inthe War Department, they appear to have had little influence on the authorityand responsibility of either the Surgeon General's Office or major commandsfor hospitalization. This subject, along with an account of the Committee'sbackground and investigation as a whole, is discussed fully elsewhere.31 Recommendationsof the Committee on policies and procedures for hospitalization hadsignificant effects and will be discussed at appropriate places in followingchapters.32
Changes in the Surgeon General's Office
During the early war years changes occurred in theorganization of the Surgeon General's Office as well as in higherheadquarters, but they affected the divisions most concerned withhospitalization less than others.33 On 21 February 1942 the HospitalConstruction Subdivision was raised in status to a division, reflecting therapid expansion of construction activities.34 The next month it was placed, alongwith the Hospitalization, Planning, and Training Divisions, in a newly formedOperations Service. In August, to describe its functions more accurately, theHospitalization Division's name was changed to Hospitalization and Evacuation.35
The Hospital Construction Division continued to exercise TheSurgeon General's advisory supervision over the construction, leasing, andmaintenance of all establishments for the care and treatment of the sick andwounded. Colonel Hall remained at its head. To handle wartime
28(1) Army Hosp Program in Continental US, extract from sec6, Analysis, Monthly Progress Rpt, data as of 31 Mar 43. SG: 632.-1. (2) Seebelow, pp. 92-93.
29SecWar Memo, 10 Sep 42. AG: 020 SGO (3-30- 43)(1).
30See above, p. 56, and also Cmtee to Study the MD, 1942,Testimony, pp. 1271-1339, 1690-94, 1869-1964, 1973-2022, 2039-49. HD.
31Armfield, op. cit.
32See below, pp. 93-94, 99, 118, 122-23, 127, 129, forexample.
33Morgan and Wagner, op. cit., pp. 9-25. Thesechanges will be considered in detail in Armfield, op. cit.
34(1) See above, pp. 24-26. (2) Memo, unsigned andunaddressed, 1 Dec 42, sub: Rpt on Admin Devs, SGO. MD: 024.-1.
35An Rpt, 1943, Oprs Serv SGO. HD.
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workloads the number of officers in this Division wasincreased between December 1941 and December 1942 from 4 to 8; of civilianarchitects, from 4 to 7; and of civilian clerks, from 7 to 10. During1943, 1 officer, 1 civilian, and 2 clerks were dropped from the rolls, but acivilian real estate consultant was added, as the hospital construction programneared completion.36 Changes in the Division's branches reflectedshifts in construction policies and problems. In February 1942 there were threebranches: Planning and Estimates, Construction and Conversion, and Maintenanceand Repairs. In March, when increasing emphasis was placed upon the use ofexisting buildings, the Construction and Conversion subdivision was separatedinto two equal branches. Subsequently, the Conversion Branch was likewisesubdivided, becoming the Ground Troop Facilities and Air Corps FacilitiesBranches. This move was perhaps accounted for by the expansion and growingindependence of the Air Forces. In the late summer of 1942 the Planning andEstimates Branch was dropped from the Division, foreshadowing the transfer ofits activity to the Hospitalization and Evacuation Division. By August, then,the Hospital Construction Division consisted of the Maintenance and Repair,Civilian Facilities Conversion, Ground Troop Facilities, and Air CorpsFacilities Branches. This organization continued until July 1943.37
The Hospitalization Division, under Col. Harry D. Offutt,limited its activities largely to the development of hospitalization policies,the control of bed credits in general hospitals, and the maintenance of liaisonwith other divisions of the Office whose activities affected the functioning ofhospitals.38 The names of its subdivisions reflect this fact. InFebruary 1942, they were the following: Hospital Inspection, Bed Credits, andLiaison. In March, the inactive Inspection subdivision was dropped. In August,the two remaining subdivisions became the Bed Credits and Evacuation Branch andthe Miscellaneous Branch.39 During 1942 this Division gradually tookon another function, the periodic revision required by SOS headquarters of abasic directive for hospitalization and evacuation operations.40 InSeptember 1942 it also took over the job of estimating and planning for generalhospital beds that would be required in the future.41 Except forshort periods, in December 1942 and again in April 1943, the Division's staffwas limited to four officers and four clerks until the latter half of 1943.42At that time, the Division was enlarged and reorganized, under a new chief, toenable it to carry out the functions and activities which the war placed uponit.43
The Planning and Training Divisions continued to beresponsible for numbered hospital units. Col. Howard T. Wickert was chief of theformer. It made recommendations for the troop basis, for activation schedules,and for medical support for task forces and overseas theaters. It also preparedand revised tables of organi-
36(1) Tynes, Construction Branch, pp. 11-12. (2) Memo, Lt Col Seth O. Craft for Col R. W. Bliss, 8 Jul 43. HD: 319.1-2.
37Morgan and Wagner, op. cit., Orgn Charts VI, VII, IX,X, and XI.
38An Rpt, FY 1943, Hosp and Evac Div SGO. HD.
39Morgan and Wagner, op. cit., Orgn Charts VI, VII, andIX.
40An Rpt, FY 1943, Hosp and Evac Div SGO. HD. For thisdirective, see below, pp. 63-67.
41For example, the Hospitalization and EvacuationDivision prepared the following document: Memo, SG for CG SOS, 26 Sep 42, sub:Hosp, Gen Hosps. SG: 632.-2.
42Memo, Col H. D. Offutt for Chief Oprs Serv SGO, 8 Jul 43. HD: 319.1-2.
43See below, pp. 176-78.
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zation, tables of equipment, and equipment lists. Afterseparation of responsibility for nonorganic service units between AGF and SOSheadquarters, this Division limited itself primarily to SOS medical units butoccasionally extended its activities to others when called upon to participatein conferences with the Operations Division of the General Staff on theformation of task forces or the deployment of additional troops to establishedtheaters. After SOS headquarters was given responsibility for training SOSservice units, the Training Division (separated from the Operations Service inAugust 1942) established a Unit Training Branch to discharge itsresponsibilities in connection with the training of hospital and other medicalunits.44
A Dispute About General Planning for Hospitalization and Evacuation
Closely connected with the War Department reorganization andarising partly from differences of opinion between the Surgeon General'sOffice and the SOS Hospitalization and Evacuation Branch about their respectiveresponsibilities was a controversy over hospitalization and evacuation planningwhich developed early in 1942. Within three days after the establishment of theServices of Supply, Colonel Wilson reported to General Lutes on the results of atranscontinental inspection trip which he had undertaken while assigned to G-4and which he had initiated with a view to having G-4 exercise greatersupervision over hospitalization and evacuation. He stated that he had found nodefinite basic plan for hospitalization and evacuation within the United States,no plan or system of operations for evacuation from theaters, and no basic directive or system for activating, training, equipping, andusing numbered hospital units in the United States. He recommended that SOSheadquarters give further attention to the problem of numbered hospital unitsand overseas evacuation and that The Surgeon General be directed to submit basicplans for hospitalization and evacuation operations for the approval of SOSheadquarters and subsequent publication "for the guidance of allconcerned."45 General Lutes approved the proposal, and on 14 March 1942directed The Surgeon General to submit such plans.46 The SurgeonGeneral's Hospitalization Division conferred with the Office of the Chief ofTransportation and on 31 March 1942 submitted a plan for hospitalization andevacuation operations.47 Considering it unacceptable, ColonelWilson prepared another which he presented to General Lutes on 18 April 1942with the statement that its preparation had been necessary "because of theincomplete
44(1) An Rpts, SGO, FY 1942 and 1943, and An Rpt, OprsServ SGO, FY 1943. HD. (2) Morgan and Wagner, op. cit., pp. 9-23.
45(1) Memo G-4/24499-178, Col W. M. Goodman, GSC, ChiefPlanning Br G-4 (init WLW[ilson]) for Gen Somervell, 20 Jan 42, sub: CurrentStatus of Hosp and Evac. MD: Wilson files, "Vol. I, 15 May 41-20 Jan42." (2) Memo Old G-4/24499-178, Maj W. L. Wilson for Gen [LeRoy]Lutes, 12 Mar 42, sub: Basic Plans for Hosp and Evac. HD: Wilson files, "No472, Hosp and Evac, 1941-42." (3) For an earlier interim report see:Memo, same for same, 8 Feb 42, sub: Recent Trip for Study of Hosp and Evac. Samefile.
46(1) Memo, CG SOS (signed Brig Gen LeRoy Lutes) for SG, 14 Mar 42, sub: Basic Plan for Hosp Oprs. SG: 704.-1. (2) Memo, same for same, 14 Mar 42, sub: Basic Plan for Evac of Sick and Wounded. Same file.
47Memo, SG for CG SOS, 31 Mar 42, sub: Basic Plan for HospOprs and Evac of Sick and Wounded, with incl. SG: 704.-1. The first three draftsof this document, as well as proposals submitted by the Chief of Transportation,are on file HD: 705 (Hosp and Evac Planning).
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nature and less understandable form of various planssubmitted by The Surgeon General."48 This draft was discussed with theSurgeon General's Office and then was sent to G-4 on 8 May 1942.49
On the same day General Lutes charged The Surgeon Generalwith having failed to prepare hospitalization and evacuation plans either beforeor after he was so directed.50 This charge, transmitted to TheSurgeon General with a statement by General Somervell that it was "ofcourse inexcusable not to have fully matured basic hospitalizationplans,"51 began a controversy which lasted for many months. GeneralMagee defended himself both in writing and in a personal conference with GeneralSomervell. He took the position that all contingencies to be covered by the plancalled for, except enemy raids and local disasters, had already arisen and hadbeen actually handled under existing plans. He believed, furthermore, that thedocument prepared by his Office was not only adequate but also preferable insome respects to the SOS draft.52 Later, when documents of the SOSHospitalization and Evacuation Branch emphasizing the lack of plans forhospitalization and evacuation were presented to the Wadhams Committee, GeneralMagee again defended his position, stating that if the allegations were true"it would indeed appear that chaotic conditions prevailed, but theseassertions are not supported by facts." Although Colonel Wilson insistedthat "there wasn't any planning" early in 1942 he now stated thatThe Surgeon General had not been "any more negligent than all the rest ofthe Army," including G-4.53 In its final report, theCommittee implied approval of The Surgeon General's position, but it made nodefinite statement clearing him of charges of lack of adequate planning.54
The real picture was neither as black as SOS headquarterspainted it nor as white as the Surgeon General's Office maintained. Plans formeeting normal hospital requirements for the zone of interior and theaters ofoperations were being made continuously by the Surgeon General's Office. Inview of the generous basis on which normal beds were authorized in the UnitedStates, together with the possibilities of expansion by setting up wards inbarracks (a method that was almost traditional with the Medical Department), itwould seem that emergency needs also were being sufficiently provided for. Since
48Memo, Maj W. L. Wilson for Gen Lutes, 18 Apr 42, sub: Hosp and Evac Oprs, SOS. HD: Wilson files,"No 472, Hosp and Evac, 1941-42."
49(1) Memo, Col H. T. Wickert, SGO for Col [W. L.] Wilson, SOS, 30 Apr 42, with incl Memo, SG for Dir Oprs SOS, 30 Apr 42. HRS: ASF Hosp and Evac Sec file, "Misc Classified Corresp from Off CG ASF to AGO." (2) Memo, CG SOS for ACofS G-4 WDGS, 8 May 42, sub: Hosp and Evac Oprs SOS. HRS: G-4 files, "Hosp and Evac Policy."
50Memo, Brig Gen LeRoy Lutes for Gen Somervell, 8 May 42, sub:Activities of SG. SG: 704.-1.
51Memo, Gen Somervell for Gen Magee, 8 May 42. SG: 704.-1.
521st ind, SG to CG SOS, 12 May 42, on Memo, Gen Somervell forGen Magee, 8 May 42. SG: 704.-1. The following note appears on thisindorsement: "Personally delivered by Gen Magee, 12 May 42." General Lutes prepared a reply to General Magee, pointing out errors in thelatter's defense and contending that there were no plans. ([2d ind SPOPG 370.05(Policy), CG ASF (init LL[utes]) to SG, 19 May 42, on Memo, Gen Somervell for GenMagee, 8 May 42. HRS: ASF Hosp and Evac Sec file, "Misc Classified Correspfrom Off CG ASF to AGO."]) Whether or not this reply was sent to GeneralMagee is uncertain. No copy of it has been found in SGO files. An ink noteattached to the copy cited states: "This is in reply to a formal indorsement written bySurg. Gen. in which he took exception to criticism of his lack of a suitableplan. He visited Gen Somervell on the subject. Gen S may want to know of thisreply. Lutes." In pencil on this copy is the following notation:"Suspend for Jun 3."
53Cmtee to Study the MD, Testimony, pp. 1988-89, 1995-98,1919-23. HD.
54Cmtee to Study the MD, Rpt, p. 15, HD.
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no enemy attack or severe epidemic occurred, the latterstatement can be made with less certainty than the former. Moreover, the SurgeonGeneral's Office was collaborating with the Chief of Transportation inplanning facilities, personnel, and equipment for the evacuation of patientsfrom theaters of operations. But the Medical Department had not prepared a basicdirective for hospitalization and evacuation such as SOS headquarters required,nor was any one division in the Surgeon General's Office charged with thepreparation of comprehensive Army-wide plans for hospitalization and evacuation.Certainly confusion existed as to responsibilities under the new War Departmentorganization, but one may question whether, under the circumstances, it was anymore incumbent on The Surgeon General than on higher headquarters to definethose responsibilities and to require subordinate commanders to submit plans forhospitalization and evacuation.
The "plan" which Colonel Wilson drafted differedconsiderably from the one prepared by The Surgeon General's HospitalizationDivision.55 Perhaps this was caused as much by ambiguity of the SOSdirective requiring the preparation of a "plan" as by The SurgeonGeneral's lack of officers trained in planning, which SOS headquarterscharged. A comparison of the two drafts shows that Colonel Wilson accepted andincorporated most of the information, pertaining chiefly to established policiesand procedures, which The Surgeon General's draft contained. Greatest changewas the addition of statements outlining the responsibilities of variouscommanders for hospitalization and evacuation and requiring them to submitplans, in specified forms at specific times, to The Surgeon General, who in turnwas to review and co-ordinate them and then submit them along with hisown "plan" to SOS headquarters. Reviewing the SOS draft, G-4 calledit "an 'omnibus document' which undertakes to do a number ofthings," and suggested that two documents should be issued in its place:one, a statement of basic policies and procedures for hospitalization andevacuation; the other, a directive calling for "data and sub-plans from thefield."56 Subsequently, after collaboration between G-4 and SOSheadquarters, two documents were issued on 18 June 1942. One was a General Staffdirective stating in general terms the responsibilities of major commanders forhospitalization and evacuation. This remained unchanged for the balance of thewar. The other, revised later on, was an SOS letter with the SOS"plan" as an inclosure.57 Only the plans which these documentsrequired of subordinate agencies need to be considered here. Responsibilitieswhich they delineated and policies and procedures which the SOS "plan"announced will be discussed elsewhere in this volume.58
Subordinate agencies had to include in hospitalization planstabulations of beds for normal use, along with statements of
55(1) Memo, SG for CG SOS, 31 Mar 42, sub: Basic Plan for Hosp Oprs and Evac of Sick and Wounded, with incl 1. SG: 704-1. (2) Memo, Maj W. L. Wilson for Gen Lutes, 18 Apr 42, sub: Hosp and Evac Oprs SOS, with Tab A, same sub. HD: Wilson files, "No 472, Hosp and Evac, 1941-42."
56Memo, ACofS G-4 WDGS for CG SOS attn Oprs Div, 11 May42, sub: Hosp and Evac Oprs, SOS. HRS: G-4 files, "Hosp and EvacPolicy."
57(1) Ltr AG 704 (6-17-42) MB-D-TS-M, Sec War to CGs AGF, AAF, SOS, et al., 18 Jun 42, sub: WD Hosp and Evac Policy. HD: 705.-1. (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. Same file.
58See below, pp. 57-58, 81, 88-90, 114, 319-20,for example.
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shortages; reports of provisions made to double hospitalcapacities in emergencies by the use of existing buildings such as apartments,hotels, schools, and dormitories; and reports of relations established withother agencies, such as the Office of Civilian Defense, "under whichunilateral or mutual hospitalization support may be planned." Evacuationplans were to include estimates of persons of all types to be evacuated, bothnormally and in emergencies, along with statements about the status of personneland equipment required for the transportation and care en route of patientsbeing evacuated.
Hospital, port, and corps area commanders complied with thisdirective, and on 30 August 1942 The Surgeon General transmitted their plans,along with his own "comprehensive plan," to SOS headquarters.59 TheSurgeon General's "plan" was twofold. It contained a consolidationof the tables presented by corps areas and a draft of a "plan" basedlargely upon the SOS directive issued on 18 June 1942. The SOS Hospitalizationand Evacuation Branch considered this draft acceptable, but revised it beforepublication, adding statements to bring the compilation of policies andprocedures governing hospitalization and evacuation up to date and changing thewording to require The Surgeon General to submit a directive, rather than a"plan," thus making the terminology conform more closely with thefact. The revised edition of thehospitalization-and-evacuation-operations-planning directive was issued by SOSheadquarters in November 1942, although it was dated 15 September 1942.60 Tomake subsequent revisions as required, The Surgeon General on 7 November1942 appointed a board of officers, with Colonel Offutt as chairman.61Although it submitted a revised version on 12 February 1943, none was published untilthe end of 1943.62 That version appeared in the form of a War Departmentcircular.
An evaluation of the importance of the "plan" ordirective, as issued in its various versions, is difficult because of thecontroversial atmosphere in which it was prepared. In April 1943 the director ofthe ASF Planning Division stated that the 15 September 1942 version was"the first world-wide system for operations in the history of the WarDepartment, under which the sick and wounded might be received from overseascommands and cared for and transported ultimately to a general hospital in theUnited States."63 Considered objectively this was undoubtedly anoverstatement, but the directive did have certain values which stand out withconsiderable clarity.
In its initial form the directive helped, at a time whenother efforts were being made to achieve the same end, to clarifyhospitalization and evacuation responsibilities. It was not strictly applicableto Ground and Air Forces commanders, however, for it was issued in the first twoversions as an SOS directive only. When published in later versions as a WarDepartment circular, it became binding upon Ground, Air, and Service Forcesalike. In
59Memo, SC for CG SOS, 30 Aug 42, sub: Opr Plans for Hosp andEvac. SG: 704.-1.
60(1) Memo SPOPH 322.15, CG SOS for CGs and COs of SvCs and PEs and for SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs, with incl 1, same sub. SG: 704.-1. (2) Memo, SG for Chief Oprs SOS, 27 Jan 43. SG: 705.-1.
61SG 00 456, 7 Nov 42.
62(1) Memo, SG for CG SOS, 12 Feb 43, sub: Opr Plans forHosp and Evac. SG: 705.-1. (2) WD Cir 316, 6 Dec 43.
63Memo SPOPI 370.05, Dir Planning Div ASF for ACofS for Oprs ASF, 23 Apr 43, sub: Hosp and Evac Plans. HD: Wilson files, "Book IV, 16 Mar 43-17 Jan 43."
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each version, the directive served as a valuable referencedocument, for it assembled in one place statements of several policies andprocedures that existed only in separate letters, circulars, and regulations. Itwas not comprehensive in this respect, nor was it always up to date, for manyadditional policies and procedures had to be established and old ones changedduring the periods between revisions. In September 1942 Colonel Offutt statedthat his Division could operate effectively under the current version.64 Thefollowing February, when Colonel Wilson visited field installations to evaluateoperations under the directive, he found that each headquarters visited, withone exception, thought it clear, understandable, practicable, and of definitebenefit.65
The value of the subordinate plans submitted in compliancewith the basic directive is less clear. Each came to be what The Surgeon General'sexecutive officer, Col. John A. Rogers, called one of them in September 1942-"justa plan to be tucked away."66 Each was reviewed by the hospitalization andevacuation sections of both the Surgeon General's Office and SOS headquarters.They were then filed for future reference.67 That no emergencydeveloped to require their use need not detract from the foresightedness ofhaving emergency expansion plans on hand, but whether those on file would havebeen adequate for a major disaster seems to have been doubted in the fall of1942.68 Tabulations of shortages of personnel, equipment, hospital beds, andtransportation usually arrived too late to have any appreciable effect upon thesupply of those elements, for problems of shortages were handled when theyappeared and could not await the submission at periodic intervals of subordinateplans for hospitalization and evacuation. This requirement was dropped fromsubsequent versions of the directive early in 1944.69
In conclusion, one may question whether the benefits derivedfrom the directive counterbalanced the friction and bad feeling which itsissuance engendered between SOS headquarters and the Surgeon General's Office.Similar results might have been achieved more harmoniously if the principals inboth agencies had been more considerate and understanding in dealing with eachother or if relationships and responsibilities of the SOS Hospitalization andEvacuation Branch and the Surgeon General's Office had been more clearlydelineated. Such was not the case, however, and the controversy that developedin this instance illustrated dangers and difficulties inherent in the newstructure of the War Department and the new position of The Surgeon General.
64Diary, Hosp and Evac Br SOS, 22 Sep 42. HD: Wilson files, "Diary."
65(1) R?sum? of Conf, SvCs and Ports, Feb-Mar 43, incl 1 to Memo SPOPI 337, CG ASF for SC and CofT, 30 Apr43, same sub. HD: Wilson files, "Book IV, 16 Mar 43-17 Jun 43." (2)Memo, Col W. L. Wilson for Chief Hosp and Evac Br ASF, 17 Feb 43, sub: Visit to8th SvC and Southern Def Comd. MD: Wilson files, "Book III, 1 Jan 43-15 Mar 43."(Col Robert C. McDonald succeeded Colonel Wilson as Chief, Hospital andEvacuation Branch on 6 February 1943.)
66Notes on tel conv between Col E. C. Jones, Surg 5th SvC and Col Rogers, 1 Sep 42. HD: Oprs Div files.
67(1) Memo SPOPH 322.15, Chief Hosp and Evac Br SOS forChief Oprs SOS, 16 Nov 42, sub: SvC and Port Plans for Hosp and Evac Oprs. HD:Wilson files, "Book 2, 26 Sep 42-31 Dec 42." (2) Memo, SG for CGSOS, 30 Aug 42, sub: Oprs Plans for Hosp and Evac. SG: 704-1. (3) Copies ofthe subordinate plans are in Wilson files, HD.
68See below, pp. 80-84.
69(1) For example, see 1st ind SPOPH 322.15 (8-30-42), CGSOS to SG, 26 Sep 42, on Memo, SG for CG SOS, 30 Aug 42, sub: Oprs Plans for Hosp and Evac. CE: 632. (2) WD Cir 140, 11 Apr 44.
