CHAPTER V
Hospital Plants inthe United States
In December 1941 the Army had a total of approximately 74,250beds in about 200 station hospitals and 14 general hospitals in the UnitedStates.1 During the next eighteen months it was to build enoughadditional hospitals to house more than three times the number provided duringthe fifteen-month period of peacetime mobilization.2 In addition, itwas to have enough hospitals under construction in June 1943 to house over65,000 more beds.3 Concurrently, improvements would have to be madein the cantonment-type hospitals already in operation.4
Types of Construction
Emphasis on Simplicity
With the country at war, speed in construction andconservation of building materials became factors of paramount consideration.Accordingly the General Staff insisted upon the simplest type of construction.On 29 December 1941 G-4 revoked the authority it had previously granted toconstruct hospitals on the two-story semipermanent plan,5 and about amonth later revised the War Department construction policy. After 6 February1942 all construction at new stations, except that already in the advancedplanning stage, was to be a modified form of the type designed for theaters ofoperations.6 The Engineers interpreted this policy to mean that in stationhospitals all warehouses and utility shops, and all buildings used for housing,feeding, and entertaining male members of the hospital staff would be oftheater-of-operations-type construction, while those used in the care,treatment, feeding, and recreation of patients and as quarters, messes, andrecreation rooms for nurses were to be of cantonment-type construction.7 General
1Bed Status Rpts, end of last week in Dec 41. Off files,Health Rpts Br Med Statistics Div SGO. A few beds were reported in DarnallGeneral Hospital, but they are not included in the number given above becausethis hospital did not open until March 1942.
2
Gen. Hosp.
Sta. Hosp.
Beds Available Sep. 40
4,925
7,391
Beds Added Sep. 40-Dec. 41
10,608
51,345
Beds Added Dec. 41-Jun. 43
38,226
161,279
Source: Bed Status Rpts. Off file, Health Rpts Br Med Statistics Div SGO.
3An Rpt, 1943, Hosp Cons Div SGO. HD.
4The even larger program of construction of all types ofhousing for the Army, of which the hospital expansion program was a part, isdiscussed in Jesse A. Remington and Lenore Fine, The Corps of Engineers:Construction in the United States, a forthcoming volume in the series UNITEDSTATES ARMY IN WORLD WAR II.
5(1) See above, pp. 23-24. (2) Ltr AG 632(12-27- 41),TAG to SG and CofEngrs, 29 Dec 41, sub: Fire-Resistant Type of Cons in Hosps. SG:632.-1.
6Ltr AG 600.12(2-5-42)MO-D-M, TAG to CGs all Depts,CAs, et al., 6 Feb 42, sub: WD Cons Policy. SG: 600.12.
7Ltr, CofEngrs to TAG, 14 Feb 42, sub: Hosp in T/O Cantonments, with 1st ind AG 600.12 (2-14-42) MO-D, TAG to CofEngrs, 25 Feb 42. CE: 632 Pt 2.
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hospitals, previously expected to be of semipermanentconstruction, were now to be entirely of cantonment type. This lowering ofstandards brought quick protests from The Surgeon General.
The decision to abandon two-story semipermanent constructionfor general hospitals was modified on 31 December 1941. At The Surgeon General'srequest, G-4 approved its use if neither a loss of time nor a materialincrease in costs was involved.8 During the next two months, the Engineers andThe Surgeon General's construction officers disagreed on whether semipermanenthospitals could be shown to cost no more than cantonment-type hospitals.9 Insome instances dual bids for the erection of a hospital on either plan werecalled for, and ten hospitals, including those already begun before the war,were constructed on the semipermanent plan.10 Subsequently theEngineers found that the initial cost of semipermanent hospitals was"considerably greater," and on 16 April 1942 G-4 returned to itsposition that only cantonment-type construction be used for general hospitals.11
The decision to use theater-of-operations-type constructionfor buildings in station hospitals remained unchanged. Buildings of this typewere of the lightest possible frame construction, with exteriors usually ofheavy treated paper or fiberboard. Plumbing was omitted from barracks and placedin separate lavatory buildings. Heat was generally furnished by stoves in eachbuilding rather than by a central heating plant.12 The SurgeonGeneral based his protests against the use of theater-of-operations-typeconstruction for hospitals in the United States on its lower quality. He statedthat barracks and quarters of that type were unsuitable for conversion to wardsto meet emergency needs for additional beds, that messes lacked comfortsdesired for officer-patients, and that kitchens had inadequate refrigeration anddishwashing facilities.13 The Chief of Engineers admitted that itwould be difficult to use theater-of-operations-type barracks for emergencywards, but believed it unwise to provide better housing for Medical Departmentmen than for other troops. The General Staff agreed, and on 24 February 1942reiterated the policy announced earlier that month.14
Later in the year, as the shortage of building materialsincreased, the General Staff proposed an even lower quality of construction forsome hospitals. In May
8Memo, SG for ACofS G-4 WDGS, 31 Dec 41, with 1st ind, ACofSG-4 WDGS to SG, 31 Dec 41. SG: 632.-1.
9(1) Ltr, SG [Col John R. Hall] to TAG 19 Jan 42, sub:Fire-Resistant Type of Hosp Cons. (2) Memo, [Mr] H[arvey] J. H[all] for ColHall, 5 Feb 42, sub: Comparison Data of the Cantonment-type Cons and theSemipermanent, Fire-Resistant Type, by Bldgs. (3) Ltr, SG (JRH) to CofEngrs, 7Feb 42, sub: Fire-resistant Type of Hosp. Comparison with Cantonment Types. Allin SG: 632-1.
10(1) D/S G-4/33956, ACofS G-4 WDGS to TAG for CofEngrs, 8Mar 42, sub: Gen Hosp Cons. AG: 322.3 "Gen Hosp." (2) Ltr AG 322.3 Gen Hosp (3-8-42)MO-D, TAG to CofEngrs, 10 Mar 42, same sub. SG: 632-1. General hospitals ofthis type were Bushnell, McCloskey, Kennedy, Valley Forge, and Schick; therewere also five station hospitals of the same type, located at Camps Atterbury(Indiana), Butner (North Carolina), Carson (Colorado), Campbell (Kentucky), andWhite (Oregon).
11(1) 2nd ind, CofEngrs to TAG, 14 Apr 42, sub: Cons of Hosp, on unknown basic Ltr. CE: 632 Vol.
3. (2) Ltr AG 600.12 (4-15-42) MO-DM, TAG to CGs of AGF, AAF, SOS, et at., 16 Apr 42, sub: WD Cons Policy, ZI. SG: 600.12.
12Engineering Manual, OCE, Oct 43, Ch. IX, Pt I, par 10-03c.
13Memo, SG for CofEngrs, 9 Feb 42, sub: Proposed Hosp atCenterville and Grenada, Miss. SG: 632-1.
14(1) Ltr, CofEngrs to TAG, 14 Feb 42, sub: Hosp in T/OCantonments, with 1st ind, 25 Feb 42. CE: 632 Pt 2. (2) Ltr AG 600.12 MO-D-M, TAG to CGs, COs, and C ofArms and Servs, 24 Feb 42 sub: WD Cons Policy, ZI. SG: 600.12.
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1942 the Secretaries of War and Navy and the Chairman of theWar Production Board agreed upon a directive which required construction to bereduced to the minimum in both quantity and quality.15 In conformitywith this directive the General Staff decided to move units in advanced statesof training to field tent camps and to use existing cantonments for the trainingof new units. They proposed to provide hospitalization for field camps inscreened and floored tents.16 The Surgeon General objected andsuggested limiting hospitalization in tents to one third of that required forfield camps and providing the rest in cantonment-type buildings, erected eitherin field camps or as additions to near-by station hospitals.17 TheGeneral Staff approved the limitation of hospitalization in tentage but directedthe use of theater-of-operations-type buildings for the remainder.18Thismeant that in some places buildings used for the care and treatment of patients,as well as those for housing personnel and storing supplies, were to be of lowquality construction. Again The Surgeon General protested the use of "ahospital of a lower grade than the cantonment type unit."19 While thepolicy was not changed, the practice of using tentage andtheater-of-operations-typeconstruction for entire hospital plants seems to have been limited chiefly toAGF maneuver areas.20
Conversion of Existing Buildings
Another method of achieving speed and conservation was toconvert existing civilian buildings into Army hospitals. In mobilization plansthis method had had high priority and in the fall of 1940 The Surgeon Generalhad considered its use.21 Soon after war began his constructionofficers again started looking for civilian buildings suitablefor conversion.22 On 19 March 1942, about the time the decision wasbeing made to construct no more semipermanent hospitals, SOS headquarterssuggested the acquisition of civilian buildings to house additional generalhospital beds.23 A little over a month later the Chief of Staffconsidered the possibility of abandoning entirely the construction of newgeneral hospitals in favor of the civilian-facilities-conversion method. He gaveup that idea after The Surgeon General's Construction Division and SOSheadquarters pointed out difficulties involved.24
15Directive for Wartime Cons, 20 May 42, incl to Ltr AG 600.12 (5-20-42) MO-SPAD-M, TAG to CGs AAF, Depts, CAs, and C of Tec Servs, 1 Jun 42, same sub. SG: 632.-1.
16Draft Memo WDGCT 600.12, ACofS G-4 WDGS for CofS, n d,sub: Housing for 1943 Trp Basis. SG: 632-1.
17Memo SG for Col [Lester D.] Flory, Oprs SOS, 17 Jul 42, sub: Comments on Housing for the 1943 Trp Basis.SG: 632-1.
18(1) WD Cir 278, 21 Aug 42. (2) Mil Hosp and Evac Oprs, 15 Sep 42, par 13b (1), incl 1 to Ltr SPOPH 322.15, CG SOS to CGs and COs of SvCs, PEs, and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs. HD: 322 (Hosp and Evac).
191st ind, SG to CofEngrs thru CG SOS, 8 Sep 42, on Memo CE 354SPEOT, CofEngrs for SG, 27 Aug 42, sub: Hosp Fac for Fld Cp. SG: 632.-1.
20(1) See below, pp. 104-06. (2) Tynes, ConstructionBranch, p. 36.
21Memo, Act ACofS G-4 WDGS for CofS, 12 Nov 40, sub: Gen Hosp Program. HRS: G-4/29135-11.
22(1) Ltr, Col John R. Hall, SGO to Dr. Morris Fishbein, AMA, 4 Feb 42. SG: 601.-1. (2) Memo, Maj Achilles L. Tynes, SGO for SG, 26 Feb 42, sub: Rpt of Insp Trip to Monroe and Charlotte, NC. SG: 632.-1.
23Memo SP 632 (3-19-42), CG SOS for CofEngrs, 19 Mar 42, sub: Add Gen Hosps. SG: 632.-1.
24(1) Memo SPEX 632 (5-1-42), [Maj Gen Wilhelm D.] Styerfor [Lt Gen Joseph T.] McNarney, 1 May 42, sub: Acquisition of Existing Hosps, .. . in lieu of Cons of New Gen Hosps. (2) Memo, CG SOS for CofSA, 3 May 42. (3)Memo, JTM [cNarney] for CofSA, 5 May 42. (4) D/S 632 (5-3-42), DepCofSA forSG, n d. All in SG: 632.-1. (5) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1.
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PLAN FOR THEATER-OF-OPERATIONS-TYPE HOSPITAL
72
OLIVER GENERAL HOSPITAL converted from the Forest HillsHotel
A "Directive for Wartime Construction," issued twoweeks later, confirmed as policy the practice of converting existing buildingsinto hospitals whenever practicable and of constructing new buildings otherwise.25
Difficulties involved in the civilian-facilities-conversionmethod restricted its use. Of hundreds of buildings which civilians offered tothe Medical Department, not over 3 percent were suitable for use as hospitals.26Many were too small. Some had corridors, stairways, and doors that weretoo narrow to permit the passage of patients on litters. Others that wereseveral stories high lacked adequate elevator service. Still others were inundesirable locations.27 In some instances, where both the buildingsand locations were suitable, local politicians and owners tried to get higherprices than the War Department was willing to pay. In others, local citizens banded together to prevent Army acquisition because they feared a depreciation in neighboring property values.28 Finally, even after suitable buildings were found and all arrangements for acquisition completed, additions and alterations had to be made before the Medical Depart-
25Directive for Wartime Cons, 20 May 42, incl to Ltr AG 600.12 (5-20-42) MO-SPAD-M, TAG to CGs AAF,Depts, CAs, and C of Tec Servs, 1 Jun 42, same sub. SG: 632-1.
26Ltr, Maj Lawrence G. King, SGO to Lt Col Albert Pierson,Off ACofS G-4 WDGS, 18 Jun 42, sub: Util of Existing Bldgs as Hosps. SG: 601.-1.
27(1) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1. (2) Memo, SG for CofSA thru CG SOS, 19 May 42, sub: Preliminary Surv of Atlantic City Hotels for Hosp. HD: Hosp Insp Rpts, p. 680.
28(1) Pers Ltr, Col Harry D. Offutt to Col Don [G.] Hilldrup, 21 Apr 42. SG: 632-2 (3d SvC)AA. (2) Notes on Conf, Hosp Cons Div SGO, 26 Mar 42, sub: Gen Hosp Program. HD: 632.-1.
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TABLE 2-ARMY HOSPITALS ESTABLISHED IN CONVERTED CIVILIANBUILDINGS BY END OF 1943
Hospital | Civilian Buildings |
AAF Regional Sta. Hosp. | Miami Biltmore, Floridian, Gulf Stream, King Cole, Nautilus, Pancoast, and Tower Hotels |
Army & Navy Gen. Hosp. Annex | Eastman Hotel |
Ashford Gen. Hosp. | Greenbrier Hotel |
Bronx Area Sta. Hosp. | Lebanon Hosp. |
Camp Shanks Sta. Hosp. | Rockland State Hosp. |
Charlotte, N.C., Sta. Hosp. | Charlotte Sanatorium |
Dante Sta. Hosp., San Francisco, Calif. (Later part of Letterman Gen. Hosp.) | Dante Hosp. |
Darnall Gen. Hosp. | Kentucky State Hosp. |
Deshon Gen. Hosp. | Butler Hosp. |
England Gen. Hosp. (Formerly AAF Sta. Hosp., Atlantic City, N.J.) | Haddon Hall, Cedarcraft, Colton-Manor, Dennis, Keystone, New England, Rydal, Traymore, Warwick, and Chalfone Hotels |
Gardiner Gen. Hosp. (Formerly AAF Sta. Hosp., Chicago, Ill.) | Chicago Beach Hotel |
Halloran Gen. Hosp. | Willowbrook School |
Hoff. Gen. Hosp. Annex. | Jefferson School, Calif. |
Los Angeles, Calif., Sta. Hosp. | Villa Riviera Hotel |
Mason Gen. Hosp. | Pilgrim State Hosp. |
New Haven, Conn., Sta. Hosp. | Wm. Wirt Winchester Hosp. |
Oakland Area Sta. Hosp. | Oakland Hotel |
Oliver Gen. Hosp. | Forest Hills Hotel |
Pasadena Area Sta. Hosp. | Vista Del Arroyo Hotel |
Percy Jones Gen. Hosp. | Battle Creek Sanitarium |
Percy Jones Gen. Hosp. Annex | Kellogg Estate, Battle Creek, Mich. |
Ream Gen. Hosp. (Formerly AAF Sta. Hosp., Palm Beach, Fla.) | Breakers Hotel |
Rhodes Gen. Hosp. Annex | Marcy NYA Facility, N.Y. |
St. Petersburg, Fla., Sta. Hosp. | Don-Ce-Sar Hotel |
Seattle Area Sta. Hosp. | New Richmond Hotel |
Staten Island Area Sta. Hosp. | Seaside Hosp. |
Torney Gen. Hosp. | El Mirador Hotel |
Walter Reed Gen. Hosp. Annex | National Park College |
Sources: (1) Ltr, SG to Sec War thru CG ASF, 18 May 43, sub: Gen Hosp Program. Use of converted hotels (Air Forces), with 7 nds. HD: 632.-1 (Hosp Expansion). (2) Incl, Record of Expansion and Contraction, Hosp Z1, and Hosp Ships, to Memo, Chief Cons Br SGO for HD SGO, 1 Nov 46, same sub. Same file. (3) Diary Hosp Cons Br SGO, 15 and 20 Jul 44. HD: 024.7-3. (4) An Rpt, 1943, England Gen Hosp, p. 3. HD. (5) An Rpt, 27 Nov 44, Hq AAF Reg Sta Hosp No. 1, pp. 1-6. HD.
ment could move in and set up functioning hospitals. Despitethese difficulties and problems, the Army acquired enough civilian buildings bythe end of 1943 to house twenty-three hospitals and expand five others. (Table2)
Development of One-Story Semipermanent Type Hospital
Concurrently with increasing emphasis on conservation ofbuilding materials, forces were at work during 1942 which
74
were to cause the War Department to turn again to theconstruction of semipermanent hospitals. As early as February 1942 the ClayProducts Association of the Southwest began a campaign for the use ofits materials by the Army, at least in hospital construction.29 InApril the Administrator of Veterans Affairs protested against the repetition of a World War I
29(1) Ltrs, Norman W. Kelch, Engr-Mgr, Clay Products Assn of the Southwest to UnderSec War, 13 Feb and 3 Mar 42, sub: Fire-resistive Cons for Cantonment Type Hosps. (2) Ltr, UnderSecWar to Kelch, 19 Mar 42. (3) Ltr, CofEngrs to Kelch, 6 Mar 42. All in CE: 632 Pt 1.
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BIRMINGHAM GENERAL, A TYPE A HOSPITAL
mistake-the construction of hospitals that could not beconverted to postwar use.30 By June shortages of lumber had begun todevelop in some areas, while surpluses of brick and tile had begun toaccumulate. In some places, therefore, the Engineers began to buildcantonment-type hospitals of tile and brick instead of lumber.31Then, on 10 August 1942, the War Production Board informed The Surgeon Generalof the availability of tile and brick and urged their use in hospitalconstruction. The Surgeon General replied that he had always preferrednoninflammable materials for hospital construction.32 Soon afterward,his representatives joined the Engineers in work on plans for a new type ofhospital.
The chief obstacle to development of plans for a one-storysemipermanent hospital, which the Chief of Engineers proposed on 26 August 1942, was a difference of opinion betweenhis Office and The Surgeon General's over the internal characteristics ofvarious buildings. Feeling it necessary to hold the cost of construction as nearas possible to that of cantonment-type buildings, the Engineers were prone tolimit improvements and refinements to the absolute minimum. On the other hand,Colonel Hall of The Surgeon General's Construction Division saw no reason to
30Ltrs, Admin of Vet Affairs to CG SOS and to SecWar, 1 Apr 42. SG: 632.-1.
31(1) Ltr, CofEngrs to SG, 11 Jun 42, sub: Use ofStructural-Tile Exterior Walls at Ft Des Moines and Cp Dodge Hosps, with 1st ind,SG to CofEngrs, 15 June 42. SG: 632.-1. (2) Exhibit A to Memo, Col. John R. Hallfor SG, 13 Jun 42, sub: Rpt of Fid Trip covering Insp of 1411-bed Hosp at CpAtterbury and of the French Lick Hotel Property. HD: Hosp Insp Rpts, p. 726.
32(1) Ltr, Chief Bldg Materials Br Oprs WPB to SG, 10 Aug42. (2) Ltr, SG to WPB, 14 Aug 42, sub: Hosp Cons. Both in SG: 632-1.
76
design a third type of hospital if it was not materiallybetter than the cantonment type and equal, in most respects, to the two-storysemipermanent type. For example, he wanted larger and more efficiently arrangedclinical buildings, stronger and safer neuropsychiatric wards, increasedadministrative space, and better-equipped messes. After numerous conferences andwhat must have seemed to the Engineers an uncompromising attitude on the part ofthe Surgeon General's Office, they composed their differences and during thewinter of 1942-43 a civilian architectural firm employed by the Engineerscompleted drawings for the new type of hospital.33
The Type A hospital, as plants constructed according to thenew design were called, came to be considered by the Surgeon General's Officeas the best for emergency construction in the zone of interior. Basically, itwas the two-story semipermanent hospital reduced to one-story form. Being onlyone story high it was safer for patients and did not require expensive andunhandy two-story ramps. Its clinical facilities were more adequate and moreefficiently arranged than those of the two-story hospital. It also cost less tobuild. Because wards were placed on both sides of corridors and were lengthenedfrom 262 to 287 feet, the Type A hospital covered a smaller area than otherone-story plants. Its chief disadvantage was that it was designed on thedispersed-pavilion principle. Before the war's end, twelve hospitals wereconstructed on this plan.34 (Table 3)
Modification of the Type A Hospital for Postwar Use by the Veterans Administration
In the spring of 1943 plans for the Type A hospital weremodified as a result of attempts to co-ordinate wartime hospital construction withpostwar needs. On 31 March 1943 the President directed the Federal Board ofHospitalization to review plans for hospital construction of all federalagencies, including the War and Navy Departments.35 The next monththe Board proposed that the Army build some of its hospitals according tostandard plans of the Veterans Administration, for use after the war. SOSheadquarters raised no objection, but disclaimed any responsibility forjustifying and defending this proposal.36 Anticipating its approval,The Surgeon General's construction officers and the Engineers, incollaboration with the Veterans Administration, prepared layouts for Type Ahospitals which substituted five two-story VA-type ward buildings for ordinarywards. In May the President approved the Federal Board's recommendation thattwo Army general hospitals-McGuire at Richmond, Va., and Vaughan at Hines,Ill.-be constructed on that plan.37
Many factors thus shaped the kinds of hospital plants whichthe Army acquired
33(1) Ltr, CofEngrs to SG, sub: One-Story Masonry Wall GenHosp, 26 Aug 42, with 3 inds. (2) Ltr, SG to CofEngrs, 12 Nov 42, sub: One-StoryMasonry Cons Hosp, 1100 Series, Drawings by York and Sawyer, with 4 inds. All inSG: 632.-1.
34(1) Tynes, Construction Branch, pp. 37, 40-41. (2) TheType A hospitals were Battey, Birmingham, Crile, Cushing, DeWitt, Dibble,Glennan, Madigan, Mayo, Baker, and Northington General Hospitals, and WalthamRegional Hospital.
35Ltr, President of US to Sec War, 31 Mar 43. SG: 632.-1.
36Memo, CG SOS for SG 17 Apr 43, sub: Completion of GenHosp Program in U.S. SG: 632.-1.
37(1) Memo, SG for CofEngrs, 3 May 43. SG: 632.-1. (2) Ltr, CofEngrs to CG ASF, 10 May 43, sub: VA Type Ward Bldgs, with 1st ind SPRMC 600.12 (5-10-43), CG ASF to CofEngrs, n d. CE: 632 Vol 4. (3) Ltr, Dir Cons VA to Col John R. Hall, SGO, 19 May 43, with 1st ind, SG to CofEngrs, 1 Jun 43, sub: Hosp Cons. SG: 632.-1. (4) Ltr, SG to CofEngrs, 7 Jun 43, sub: 1785-bed Gen Hosp, Richmond, Va., Area. SG: 632.-1 (McGuire Gen Hosp) K.
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TABLE 3-BUILDING SCHEDULE FOR TYPE-A HOSPITAL
General Hospital Plan
Building | Type | Title | Number Required | |
For 1727 Beds | For 1515 Beds | |||
ADM | E-H | Administration Building | 1 | 1 |
ANIM | A-H | Animal House | 1 | 1 |
BKS | D-H | Med. Det. Adm. & Unit Stores | 1 | 1 |
BKS | D-H | Med. Det. Barracks | 11 | 10 |
CHAP | A-H | Chapel | 1 | 1 |
CLIN | R-H | Clinic, Dental, EEN&T | 1 | 1 |
CLIN | Q-H | Clinic, Lab. & Prof. Services | 1 | 1 |
CLIN | X-H | Clinic, X-ray, G. U. & Psysiotherapy | 1 | 1 |
FIRE | B-H | Fire Station | 1 | 1 |
GUAR | B-H | Guard House | 1 | 1 |
GUES | A-H | Guest House | 1 | 1 |
HEAT | G-H | Heating Plant, H.P. | As required | |
HEAT | E-H | Heating Plant, L.P. | As required | |
HEAT | F-H | Heating Plant, H.P. Annex to L.P. | As required | |
INC | A-M | Incinerator-3-ton | 1 | 1 |
LDY | D-H | Laundry | 1 | 1 |
LDYSP | A-H | Laundry Steam Plant | 1 | 1 |
MESS | Z-H | Enl. Patients & Med. Det. Mess | 1 | 1 |
MESS | AA-H | Officers' & Nurses' Mess | 1 | 1 |
NQ | A-H | Nurses' Qtrs. | 4 | 3 |
OQ | E-H | Officers' Qtrs. | 2 | 2 |
POPX | A-H | Post Office & Post Exchange | 1 | 1 |
REC | H-H | Med. Det. Recreation | 1 | 1 |
REC | G-H | Officers' & Nurses' Recreation | 1 | 1 |
REC | F-H | Patient's Recreation | 1 | 1 |
RECG | A-H | Receiving & Evacuation Bldg | 1 | 1 |
SHGA | A-H | Shops & Garage | 1 | 1 |
SHMO | A-H | Hospital Shop & Morgue | 1 | 1 |
STOR | I-H | Med. Storehouse | 1 | 1 |
STOR | H-H | Med. Storehouse & Offices | 1 | 1 |
STOR | J-H | Storehouse | 2 | 1 |
SURG | B-H | Clinic, Surgery | 1 | 1 |
WARD | K-H | Ward, Combination | 9 | 6 |
WARD | S-H | Ward, Detention | 4 | 3 |
WARD | J-H | Ward, Standard | 15 | 15 |
Covered walks and exit ramps are included in the plan. A number of supplementary buildings may also be added to this type of hospital construction. The basic plan is shown on the opposite page.
Source: Tynes, Construction Branch, p. 49. HD:3l4.7-2 (Hosp. Const.Br.).
78
or constructed during World War II. Such forces as necessityfor speed in construction, availability of building materials, pressure ofcivilian groups, and co-ordination of Army wartime construction with postwarneeds of other Federal agencies often seemed stronger than medicalconsiderations. The Surgeon General's Office therefore frequently found itselfin conflict with higher authorities in attempting to get what it considered tobe suitable and satisfactory hospital plants. While undesirable cantonment-typeplans drawn before the war were used for most hospitals, better plants weredesigned and the Army erected 10 two-story and 12 one-story semipermanenthospitals on new plans as well as 2 designed specifically for postwar useby the Veterans Administration.
Estimates of Hospital Capacity Needed
Speed in construction and conservation of materials alsoaffected planning for the expansion of hospitals. During most of 1942 speed was so necessary to keep hospital capacitiesabreast of the Army's growth that there was little time for reexamining thebasis already established for estimating requirements. Hence, conservation ofbuilding materials was at first achieved by lowering the quality rather than thequantity of construction. Moreover the need for speed, along with uncertaintyabout the eventual size of the Army and the rate of its movement overseas,perhaps accounted partially for the fact that until the end of 1942 littleattention was given to the co-ordination of station with general hospitalrequirements, of Army with Navy requirements, and of wartime with postwarrequirements. Even disregarding these matters, planning for a rapid and unprecedented expansion was a complicated process. In the firstpart of 1942 plans had to be made to meet immediate normal requirements. Inaddition, plans for emergencies were needed because it was feared that sneakattacks, sabotage, or severe epidemics might require hospital beds far in excessof the number normally provided. Later, when emphasis was placed upon reduction in quantity as well as quality ofconstruction, a tendency developed to make long-range plans. All three types ofplanning-normal, emergency, and long-range-were inevitably interrelated.
Early Plans To Meet Normal Requirements
Plans for station hospitals to house the number of beds authorized by theexisting bed ratio were automatically included by the Engineers in generalconstruction plans for each camp, but planning for the expansion of generalhospitals was different. Although general hospital beds were authorized for 1percent of the total strength of the Army, construction of plants to accommodatethat number did not automatically follow. Instead The Surgeon General had torequest periodically the approval of construction to house specific numbers ofgeneral hospital beds. He usually received approval for less than the 1 percentasked for. As a stopgap measure The Surgeon General on 18 December 1941recommended the construction of four new general hospitals and annexes to twoexisting hospitals to provide 6,000 additional beds. The next day G-4 approvedthis recommendation.38
38(1) Ltr, SG to TAG, 18 Dec 41, sub: Location of 6,000 Add Gen Hosp Beds.SG: 632.-1. (2) Memo, ACofS G-4 WDGS for TAG. 19 Dec 41, sub: Gen Hosps. HRS: G-4/29135-11.
79
McGUIRE GENERAL, A VA-TYPE HOSPITAL
The following February, after the troop basis for 1942was published, The Surgeon General recommended enough additional beds (18,600)to make a total by the end of 1942 of 39,600, 1 percent of the planned strengthof the Army.39 Of these, G-4 authorized only 14,000, to becompleted by 30 September 1942, advising The Surgeon General informally toinclude further requirements in longer-range planning.40By June 1942it was possible to project requirements to the end of 1943. Informed that thestrength of the Army by that time would be 6,600,000 men. The Surgeon Generalrecommended 30,026 beds in addition to those already available or authorized, tomake a total of 66,000.41 Although the SOS Hospitalization and Evacuation Branchagreed to this number for planning purposes, the SOS Construction Planning Branchdirected the Engineers a few weeks later to construct only 23,500.42
When The Surgeon General estimated total general hospital bedrequirements, he planned also their distribution among different hospitals.Before the war all new
39Ltr, SG to CofEngrs, 3 Feb 42, sub: Add Gen Hosp Beds. SG: 632.-1.
40Memo for Record, on Memo, ACofS WDGS G-4 for TAG,9 Feb 42, sub: Add Gen Hosp Beds. HRS: G-4/29135-11.
41Ltr, SG to CG SOS, 6 Jun 42, sub: Add GenHosp Beds. SG: 632.-2.
42Memo SPOPM 632, Dir Oprs Div SOS (init WLW[ilson]) for Dir Reqmts Div SOS, 17 Jun 42, sub: Add Gen Hosp Beds. HD: Wilson files,"Book I, 26 May 42-26 Sep 42." (2) Memos SPRMC 601.1, CG SOS for CofEngrs, 4 and 7 Jul 42, same sub. HD: 632.-1.
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general hospitals had been constructed on a 1,000-bed plan.Larger hospitals could be operated with a lower ratio of personnel to beds, andafter Pearl Harbor he began to recommend the construction of 1,500-bedhospitals.43 During 1942 hospitals of this size gradually supersededthose of 1,000-bed capacity.44 With this beginning, the tendency toenlarge general hospital capacities was to grow until some of them would reach6,000 by 1945.
When the Army began to emphasize reductions in quantity aswell as quality of construction, attention centered momentarily on theauthorized bed ratio. The Inspector General and the director of the SOSRequirements Division believed that it was too high.45 In June 1942there were 96,291 beds in general and station hospitals, but only about 73,285were occupied.46 According to the authorized ratio, there should havebeen 129,640 beds.47 Referring to reports on the occupancy of bedsand to directives limiting construction to the essential minimum, SOSheadquarters called upon The Surgeon General for an analytical study of bedrequirements based on the experience of the previous ten years, rather thanWorld War I, with a view to a possible reduction in authorized ratios.48 Althoughtables he submitted showed the ratio of occupied beds to Army strength from 1932to 1941 to have been nearer 3.5 percent than the authorized ratio, The SurgeonGeneral urged that the latter not be reduced. He pointed out that only 80percent of the beds provided should be considered available, since approximately20 percent of the total was lost through "dispersion"-theseparation of patients into wards according to disease, rank, and sex. Hebelieved that a higher proportion of men would require beds during war than during peacetime, because battle casualties would need extendedperiods of hospital care, recruits would have higher sick rates than seasonedsoldiers, and accidents would occur more frequently under strenuous trainingprograms.49 By the time of this reply higher authorities wereconsidering double bunking in barracks and this was to lead to a temporaryincrease, rather than a reduction, in the authorized bed ratios.
Planning for Emergencies
Hospital construction for normal use was so urgent in thefirst hectic months of the war that planning for emergencies was left largely tolocal commanders. The Surgeon General expected them to meet needs that mightarise by setting up beds in the solaria of hospital buildings, by placing morebeds in wards than were usually considered desirable, and by using as wards thebarracks of enlisted hospital-complements and, if necessary, of other troops.These methods were prescribed in
43(1) Ltr, SG to TAG, 18 Dec 41, sub: Location of 6,000Add Gen Hosp Beds. SG: 632.-1.
44Ltr, SG to CG SOS, 6 Jun 42, sub: Add Gen Hosp Beds. SG: 632.-2.
45Memo for Record, on Memo SPOPM 323.7 Hosp, CG SOS for SG, 22 Jun 42, sub: Reqmts and Distr of Hosp Beds. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42."
46Bed Status Rpts, end of last week in Jun 42. Off file, HealthRpts Br Med Statistics Div SGO.
47This figure was arrived at by multiplying the strength of theArmy in the United States by 4 percent and the total strength of the Army by 1percent and adding the results. Of a total strength in June 1942 of 3,074,184,there were in the United States 2,472,407 officers and men. Figures furnished by StrengthAccounting Branch AGO, 25 Oct 47.
48Memo SPOPM 323.7 Hosp, CG SOS for SG, 22 Jun 42, sub:Reqmts and Distr of Hosp Beds. SG: 632.-2.
491st ind, SG to Dir of Oprs SOS, 25 Jul 42, on Memo 323.7 Hosp,CG SOS for SG, 22 Jun 42, sub: Reqmts and Distr of Hosp Beds. SG: 632-2.
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Army regulations and, upon The Surgeon General'srecommendation, the use of barracks to expand hospital capacities was requiredby the SOS directive on hospitalization and evacuation issued on 18 June 1942.Included in the same directive by the SOS Hospitalization and Evacuation Branchwas another provision which The Surgeon General considered unnecessary-therequirement that subordinate commanders plan to double hospital capacities inemergencies by using civilian buildings such as apartments, hotels, schools, anddormitories.50
In the late summer and fall of 1942 a combination ofcircumstances focused attention upon the question of emergency hospitalization.Plans were being made for the North African invasion and for the reception inthe United States of large numbers of casualties. Concurrently, as a means ofreducing general construction requirements, the Chief of Staff and thecommanding general, Services of Supply, decided to require the double bunking oftroops in existing barracks. The Surgeon General warned them that the resultantreduction in per capita air space might lead to severe epidemics of respiratorydiseases.51 General Marshall believed that this risk had to betaken, but feared that existing beds might be insufficient if an epidemic shouldoccur at the same time casualties began to flow back from North Africa. On 10August 1942 he verbally directed The Surgeon General, through the latter'sexecutive officer, to plan to take over hotels in an emergency for use as Armyhospitals and to arrange with local physicians for civilian groups to man them.The next day General Marshall's deputy referred to this directive in a meetingof the General Council (a group of representatives of the General Staff, and ofAGF, AAF, and SOS headquarters) and the SOS Chief of Staffafterward directed The Surgeon General "to take immediate" steps toenlarge hospital capacities in the event of an emergency.52
The Office of Civilian Defense was making plans for theemergency hospitalization of civilians, earmarking hotels and organizing"affiliated units" of civilian physicians and nurses to staff them ifneeded.53 Realizing the possibility of conflict between OCD plans andGeneral Marshall's directive, General Magee discussed the problem with GeneralLutes and with Dr. George Baehr, who was in charge of OCD medical activities. Hethen presented it to the Office of Defense Health and Welfare Services' Healthand Medical Committee, whose function was to co-ordinate all health and medicalactivities relating to national defense.
Meanwhile, on 27 and 28 August 1942, General Mageetransmitted General Marshall's directive to service commands. They werealready listing hotels that could
50(1) AR 40-1080, C 2, 16 Mar 40. (2) The Surgeon General'sPlan for Hosp (ZI) and Evac, incl to Memo, SG for CG SOS, 31 Mar 42, sub: BasicPlan for Hosp Oprs and Evac of Sick and Wounded. HRS: ASF Hosp and Evac Sec file, "Misc Classified Correspfrom Off CG ASF to AGO." (3) 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. Same file. (4) See above, pp. 65-66.
51(1) 1st ind, SG to CG SOS, 11 Jul 42, on Memo, CG SOS for SG, 9 Jul 42, sub: Capacity of Bks. (2) Memo, SG for CG SOS, 25 Aug 42, sub: Double Bunking. All in SG: 632-1.
52(1) Extract from Mins of Gen Council, 11 Aug 42. HD: Wilson files, 600.13 "Hosp Policy and Plans." (2) Memo, CofSA for President of US, 21 Sep 42, sub: Reply to your Memo of Sep 14th Conc Util of Hotels as Mil Hosps. WDCofSA: 632 (14 Aug 42). (3) Memo, Brig Gen Larry B. McAfee for SG, 31 Oct 42. HD: 632.-1 "Hosp Expansion." (4)Statements of SG and his Exec Off, Cmtee to Study the MD, Testimony, pp. 1309ff and 1669ff. HD.
53Cmtee to Study the MD, 1942, Testimony, pp. 984ff. HD.
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be taken over in emergencies, in accordance with the SOSdirective of 18 June 1942. To comply with the new directive, they had merely toreview those lists, itemize the medical property that would be required, andarrange with a local physician to build up a staff for each emergency hospital.54
The Office of Civilian Defense and the Health and MedicalCommittee objected to this action because it threatened to interfere with plansfor emergency hospitalization for civilians and posed the danger of transferringepidemics from Army camps into cities. The Office of Defense Health and WelfareServices then informed the President of the Army's plan, suggesting that theWar Department rescind its directive and plan to provide emergencyhospitalization for military personnel entirely within the confines of Armycamps and with military professional staffs only.
Meanwhile the plan called for by the Chief of Staff wasmisinterpreted by the President, who understood that the Army intended to takeover hotels and develop them into stand-by hospitals in advance of an emergency.When asked for an explanation, General Marshall assured him that this was notso, but assumed full responsibility for having directed the earmarking of hotelsand the organization of civilian staffs for emergency use. The Presidentapparently considered this explanation satisfactory, for he passed GeneralMarshall's letter on to the Office of Defense Health and Welfare Services withthe single comment, "for your information."55
After General Marshall's explanation to the President itwas still necessary to solve the problem of simultaneous planning by the Armyand the Office of Civilian Defense to use civilian staffs in emergency hospitals. At first SOS headquarters took the position that "any plan to utilize civilian medical personnel for military hospitalization is entirely a planning matter to establish a potential means to meet major emergencies. . ."56 When this assurance failed to satisfy the Office of Civilian Defense, SOS headquarters changed its position and, strangely enough, required The Surgeon General to inform the Health and Medical Committee that it had never been War Department policy to use civilian staffs to care for military patients.57 Meanwhile General Magee had conferred with General Marshall and with Dr. Baehr. He then proposed a compro-
54(1) Memo, SG for Brig Gen LeRoy Lutes, 21 Aug 42, sub: Over-All Plan for Emergency Med Care, Civ and Mil. HD: 632.-1 "Hosp Expansion." (2) Statements by Baehr and Magee, Cmtee to Study the MD, 1942, Testimony, pp. 984ff and 1669ff. HD. (3) Ltrs, CG SOS per SG to CGs of SvCs, 27 and 28 Aug 42, sub: Hosp Expansion. HD: 632.-1.
55(1) Ltr, Exec Sec, Health and Med Cmtee to Dir Off of Def Health and Welfare Servs, 5 Sep 42. HD: 632.-1 "Hosp Expansion." (2) Ltr, Dir Off of Civ Def to same, 12 Sep 42. Same file. (3) Ltr, Dir Off of Def Health and Welfare Servs to the President, 10 Sep 42. Natl Archives: Record Group 215, Off of Community War Servs, 922.3. (4) Memo, FDR[oosevelt] for GenMarshall, 14 Sep 42. WDCofSA: 632 (14 Aug 42). (5) Memo, CofSA for the President, 21 Sep 42, sub: Reply to your Memo. . . . Same file. (6) Memo, FDR[oosevelt] for Hon Paul McNutt, [Dir Off of Def Health and Welfare Servs], 3 Oct 42. Natl Archives: Record Group 215, Off of Community War Servs, 922.3.
56(1) Memo SPOPH 701, Lt Col W. L. Wilson, Chief Hosp and Evac Br SOS for Gen Lutes, 17 Sep 42, sub: Current Program for Mil Hosp, with 2 incls. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42." (2) Ltr SPAAC 601, Chief Admin Serv SOS for Dir OCD, 9 Oct 42. Natl Archives: Record Group 215, Off of Community War Servs, 922.3.
57(1) Memo, SG for CG SOS, 8 Oct 42, sub: Planning forExpansion, Army Med Fac. HD: 632.-1 "Hosp Expansion." (2) Ltr, DirOCD to Maj Gen George Grunert, Chief Admin Serv SOS, 23 Oct 42. Natl Archives:Record Group 215, Off of Community War Servs, 922.3. (3) Memo SPAAC 632 (10-20-42),CG SOS for SG, 26 Oct 42, same sub, with 4 inds. SG: 632.-1. (4) Memo SPOPH632 (10-10-42), Dep for ACofS for Oprs SOS (init WLW[ilson]) for Chief Admin Serv SOS, 20 Oct 42, same sub. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42." (5) Memo SPOPH 632 (11-17-42), ACofS for Oprs SOS (init WLW[ilson]) for same, 22 Nov 42, same sub. Same file. (6) Ltr, Act SG to Exec Sec, Health and Med Cmtee, 14 Dec 42. SG: 632.-1.
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mise which in his opinion embodied the wishes of GeneralMarshall and met the approval of Dr. Baehr. According to its terms the Armywould plan to use in an emergency only those hotels which it could reasonablyexpect to staff with military personnel. If civilian doctors and nurses shouldbe needed temporarily the Army would borrow staffs organized by the Office ofCivilian Defense and the United States Public Health Service. Although SOSheadquarters had disavowed the use of civilian staffs shortly before, it nowapproved a letter to service commands on 11 January 1943 explaining thecompromise just mentioned.58 On 22 February Dr. Baehr sent a similarexplanation to regional medical officers of OCD.59 Since thecontemplated emergency never developed, the Army had no occasion either to takeover the hotels earmarked or to call upon the Office of Civilian Defense foremergency staffs.
SOS planning for the emergency expansion of Army hospitalswent on concurrently with that directed by General Marshall. On 25 August 1942the Chief of the Hospitalization and Evacuation Branch informed General Lutesthat no plan existed for assuring the availability of beds in case of anepidemic and requested authority to prepare one.60 Given thego-ahead signal, he proposed on 9 September 1942 that the station hospital bedratio be raised from 4 percent to 5 percent for the winter of 1942-43 and thathousing for additional beds thus authorized should be provided either byconverting cantonment-type hospital barracks into wards and constructingtheater-of-operations-type barracks for the displaced enlisted personnel or by constructingadditional cantonment-type wards wherever a medical detachment already lived intheater-of-operations-type barracks.61 This plan was approved, andon 19 September 1942 the commanding general, Services of Supply, ordered theChief of Engineers to put it into effect.62 As further provision foran emergency, the SOS Hospitalization and Evacuation Branch inserted in therevised version of the hospitalization and evacuation directive dated 15September 1942 a requirement that each hospital plan to provide additional bedsin barracks for 10 percent of the troops served.63 Thus each hospitalwould be prepared to care for 15 percent of its station's strength. The 5percent authorization proved sufficient for the winter's needs.
In the course of the Army's controversy with the Office ofCivilian-Defense, General Marshall directed General Snyder, the medical officeron The Inspector General's staff, to investigate means of meeting requirementsthat might develop in an emergency. General Snyder reported that enough bedsexisted, on the 4 percent
58(1) 3d ind, Act SG to Chief of Admin Serv SOS, 14 Dec 42, on Memo SPAAC 632 (10-20-42), CG SOS for SG, 26 Oct 42, sub: Planning for Expansion, Army Med Fac. SG: 632.-1. (2) Ltr SPX 632 (1-8-43) OB-S-SPOPH-M, CG SOS to CGs all SvCs, 11 Jan 43, same sub. HD: 632.-1.
59Ltr, Chief Med Off OCD to Regional Med Offs OCD, 22 Feb 43,sub: Cooperation with the Army in the Care of Mil Casualties. HD: 632.-1.
60Memo SPOPH 620 (7-4-42) Bks, Col Wilson for GenLutes, 25 Aug 42, sub: Capacity of Bks. HD: Wilson files, "Book I, 26 Mar-26 Sep 42."
61Memo SPOPH 322.15, ACofS for Oprs SOS (init WLW[ilson])for Cons Br Reqmts Div SOS, 9 Sep 42, sub: Opr Plans for Hosp and Evac. HD:Wilson files, "Book I, 26 Mar-26 Sep 42."
62Memo SPRMC 632 (9-9-42), CG SOS for CofEngrs, 19 Sep42, sub: Add Hosps. SG: 632.-1.
63Mil Hosp and Evac Oprs, sec I, par 3b (3), incl 1 to Ltr SPOPH322.15, CG SOS to CGs of SvCs and PEs and to SG, 15 Sep 42, sub: Mil Hosp andEvac Oprs. HD: 322.
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basis, to meet ordinary requirements plus those of a minorepidemic. He estimated that 7,500 additional beds could be made available bytreating minor cases in quarters; 6,000, by treating uncomplicated cases ofvenereal disease on a duty status; 97,000, by caring for convalescent patientsin barracks; 25,000, by reducing the floor area per bed in existing wards; and asubstantial number, by improving administrative procedures and limiting theperformance of elective operations. In case of an unusually severe epidemic, allbarracks, he believed, could be converted into hospitals and troops could bemoved into warehouses, regimental recreation buildings, and chapels.64 Underan SOS directive, The Surgeon General attempted later to carry out some ofGeneral Snyder's recommendations for more effective bed utilization.65 Hisrecommendations for meeting the needs of an epidemic never had to be put intoeffect.
Long-Range Planning
Late in 1942 the Army began to try to co-ordinate hospitalconstruction with other requirements and with postwar needs. To this end SOSheadquarters insisted that each service forecast its normal needs as far aheadas possible.66 The Surgeon General found it difficult to anticipatestation hospital requirements because they depended, as always, upon troopdistributions unknown by him. In addition, records of existing station hospitalswere unreliable, those of the divisions of the Surgeon General's Officediffering among themselves and with records of the Engineers.67 Butprojection into the future of general hospital bed requirements was lessdifficult.
In forecasting the need for general hospital beds in the fallof 1942, The Surgeon General adopted a new basis for estimates. Plans for theinvasion of North Africa were being made and it was expected that large numbersof combat casualties would be returned to the United States. From World War Iexperience it appeared that beds would be needed in general hospitals in theUnited States for 1.7 percent of all overseas forces if patients requiring 120or more days of hospitalization were evacuated from theaters of operations.68The Surgeon General therefore added .7 percent of the strength of overseasforces to the 1 percent of the total strength of the Army already established asthe basis for estimating general hospital bed requirements. On 26 September 1942he recommended that a total of 96,000 general hospital beds be provided by theend of 1943 and of 124,800 by the middle of 1944. About two months later, whenthe projected Army strength was changed, he proposed that the mid-1944 figurebe cut to 103,500. SOS headquarters approved his recommendations, and until theearly part of 1943 this figure stood as the number of beds authorized forplanning purposes, but not for construction.69(Chart 4)
64Ltr, IG per Brig Gen Howard McC. Snyder to CofSA, 10 Nov42, sub: Surv of Hosp Fac and their Util. HRS: WDCSA 632.
65See below, pp. 127, 130-31.
66(1) Memo, CofEngrs for SG, 10 Oct 42, sub: Prep of Sec V of Army Sup Program. SG: 632.-1. (2) Memo forRecord, on 3d ind SPOPH 632 (9-26-42), CG SOS to SG, 29 Oct 42, on Memo, SGfor CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps. HD: Wilson files, "Book 2, 26Sep 42-31 Dec 42."
67(1) Cmtee to Study the MD, 1942, Rpt, p. 8. HD. (2) Memo,Dir Control Div SGO for SG, 8 Feb 43, sub: Statistics on Hosp Beds. SG: 632.-2.
68Statistics of World War I were analyzed in ArmyMedical Bulletin, No. 24 (1931).
69(1) Memo, SG for CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps, with 4 inds. SG: 632-2. (2) Memo, Chief Hosp Cons Div SGO for Asst Dir Fiscal Div SGO, 19 Jan 43, sub: Bed Reqmts for FY 1944. Same file. (3) Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5.
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Early in 1943 a combination of circumstances pointed towardintensified efforts by the General Staff and SOS headquarters to limitconstruction. In January a study of hospital bed occupancy, prepared by theSurgeon General's Office for inclusion in the SOS Monthly Progress Report,showed that estimated requirements had been higher than actual needs. Whilethere was a close correlation between estimated requirements and occupied bedsin station hospitals, a discrepancy between estimated requirements and occupiedbeds in general hospitals had grown from 11,000 to 45,000 during 1942. TheSurgeon General explained that this resulted from better health and fewer combatcasualties than anticipated.70 In March 1943certain members of Congress threatened to investigate the use of all hospitalbeds, both civilian and military, in the United States.71 Soonafterward the Secretary of the Navy proposed that the Army and Navy consider thepossibility of making joint use of their hospitals.72 Furthermore,the Surgeon General of the
70(1) SOS Monthly Progress Rpt, Sec 5, Pt IV, Health,pp. 44-45, 31 Jan 43.
71Establishing a Select Committee to Investigate HospitalFacilities Within the United States of America, 78th Cong, 1st sess on H.Res. 146, 3 March 1943.
72Memo WDGDS 2857, ACofS G-4 WDGS for CofSA, 15 Mar 43, sub:Joint Army-Navy Use of Available Hosp Accommodations. HRS: G-4 files,"Hosp and Evac Policy."
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United States Public Health Service, calling attention to theinterest of Congress and of the War Production Board in the matter, suggested toBrig. Gen. Frank T. Hines, Administrator of Veterans Affairs and Chairman of theFederal Board of Hospitalization, the desirability of co-ordinating the hospitalconstruction planning of all Government agencies.73 As a result, thePresident on 31 March 1943 ordered the War and Navy Departments, the FederalSecurity Administration, and the Veterans Administration to submit all plans foradditional hospital construction to the Federal Board of Hospitalization forco-ordination and submission to him, through the Bureau of the Budget, forapproval.74
Meanwhile, despite a discrepancy between estimated and actualrequirements in 1942 and in the face of growing interest in limiting hospitalconstruction, The Surgeon General again raised his estimates. On the basis ofnew troop strength figures from the Bureau of the Budget, he asked SOSheadquarters on 11 March 1943 to approve an increase in authorized generalhospital beds from 96,000 to 102,882 for December 1943 and from 103,500 to110,693 for July 1944. He also asked approval of the higher bed ratio which hehad been using since September 1942.75 Apparently the Services of Supply,renamed Army Service Forces on 12 March 1943, was in no mood to approve eitheradditional beds or a higher ratio. Instead, its Requirements Division directedThe Surgeon General to review the proposed ratio in the light of recent warexperience and to consider a reduction of construction requirements by the jointuse of Army and Navy facilities, the expansion of existing general hospitals,and the conversion of station to general hospitals.76
Methods which ASF headquarters suggested for reducinghospital construction proved practicable only in part. A study of thepossibilities of joint Army-Navy hospitalization promised little in the way ofadditional beds for Army use.77 The proposal to reduce the bed ratiogot nowhere. The director of the ASF Control Division agreed with The SurgeonGeneral that information on World War II casualty rates was insufficient to warranta reduction, and the ASF Hospitalization and EvacuationBranch interpreted the 15 September 1942 directive on hospitalization andevacuation as giving The Surgeon General alone the authority to estimate bedrequirements for overseas casualties.78 Hence, the ASF RequirementsDivision accepted The Surgeon General's estimate of requirements and turned tothe remaining means of reducing general hospital construction-the use ofstation hospital beds and the expansion of existing general hospitals.
In a conference attended by representatives of the Surgeon General's Office on 8 April 1943, the ASF Requirements Divi-
73Ltr, SG USPHS to Brig Gen Frank T. Hines, 18 Mar 43. SG: 632.-1.
74(1) Ltrs, Franklin D. Roosevelt to SecWar and to Dir Bu of Budget, 31 Mar 43. SG: 632.-1. (2) Ltr, Dir Bu of Budget to Chm Fed Board of Hosp, 2 Apr 43. Same file.
75Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5.
761st ind, CG ASF to SG, n d, on Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5.
77(1) 2d ind, SG to CG ASF, 31 Mar 43, on Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5. (2) 1st ind, SG to CG ASF, 12 Jun 43, on Memo, CG ASF for SG, 19 Mar 43, sub: Joint Army-Navy Use of Available Hosp Accommodations. SG: 705.-1.
78(1) Memo SPOPH 632 (5 Apr 43), ACofS for Oprs ASF (init WLW[ilson])for ACofS for Mat ASF, 7 Apr 43, sub: Hosp, Gen Hosps. HD: Wilson files,"Book IV, 16 Mar 43-17 Jun 43." (2) Memo, Dir Control Div ASF for CGASF, 2 Apr 43, sub: Situation with Respect to Army Hosps. SG: 322.15.
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sion pointed out that the construction or acquisition ofgeneral hospitals to provide a total of 83,000 beds had already been approved.To provide approximately 103,500 beds by December 1943, about 20,500 additional beds would be required. On the basis ofprojected overseas movements, 5,400 station hospital beds would be surplus bythat time. If they should be converted to general hospital use, housing for only15,100 additional general hospital beds would need to be constructed. Additionalgeneral hospital requirements during 1944 could be met by using increasinglylarge numbers of surplus station hospitals for that purpose. ASF headquarterstherefore approved the expansion of thirteen existing general hospitals by 250beds each, the construction of seven new general hospitals, and the acquisitionof Pilgrim State Hospital, Brentwood (Long Island), New York, in order toprovide the total number of beds required by December 1943.79
Reviewing this plan as the President had directed, theFederal Board approved the construction of the thirteen 250-bed annexes, theacquisition of Pilgrim State Hospital, and the construction of two new generalhospitals.80 Before it acted on the five other general hospitals,the Air Forces gave up certain buildings it had been using, including theChicago Beach Hotel at Chicago and the Haddon Hall Hotel at Atlantic City.Furthermore, ASF headquarters decided that adjustments in the military programwould make possible a reduction in authorized beds by approximately 7,000.Accordingly on 22 June 1943 the commanding general, Army Service Forces,directed The Surgeon General to withdraw from the Federal Board requests forapproval of 8,750 additional beds and to provide, instead, 1,810 beds in the two hotels being vacated by the Air Forces.In the opinion of ASF, this would complete the general hospital building programin the United States.81
The events just described reveal a pattern that was to berepeated later in the war-increases in estimated bed requirements by TheSurgeon General, publication of statistics showing relatively low occupancy ofbeds already provided, and subsequent efforts by higher headquarters to limit orreduce the number authorized. In this instance, such efforts resulted fromattempts to reduce construction costs and save building materials but later froma need to conserve personnel. Earlier, as already noted, the urgent necessityfor additional hospitals precluded doubts about estimated requirements as wellas co-ordination of hospital construction programs of various federal agencies,both military and civilian. When such co-ordination was finally undertaken, theArmy program had been virtually completed. Experiences encountered in planningfor emergency hospitalization revealed the difficulties involved in co-ordinatingplans of the Army with those of other agencies and in permitting several WarDepartment agencies to work independently on a single problem.
79(1) Memo, "Basis used by Gen Wood at Conf onHosp, ZI, SOS, 8 Apr 43, attended by Hall, Offutt, Wickert, Welsh," undated and unsigned. HD: SGOOprs Div files. (2) Memo, CG ASF for SG, 9 Apr 43, sub: Completion of Gen Hosp Program in US. HRS:Hq ASF Somervell files, "SG 1943." (3) Memo, CG ASF for SG, 10 Apr 43, same sub. SG: 632.-1.
80Photostat copy, Res adopted by Fed Bd Hosp, 21 May 43. SG: 632.-1 (McGuire Gen Hosp)K. See also pp. 000, above.
81(1) Ltr, SG to SecWar thru CG ASF, 18 May 43, sub: GenHosp Program, Use of Converted Hotels (AF), and 6 inds. SG: 632.-1. (2) Memo,CG ASF for SG, 22 Jun 43, sub: Completion of Gen Hosp Program. Same file.
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Location, Siting, and InternalArrangement of Hospital Plants
In the hospital construction program attention had to begiven not only to types of construction and estimates of the capacity needed butalso to the location, siting, and internal arrangements of hospital buildings.After war was declared the selection of locations and sites, especially forgeneral hospitals, became more complicated, while the need for speed inconstruction raised again the question of control over the internal arrangementsof hospitals.
Selection of Locations and Sites
Station hospitals had to be located at camps whose situationwas chosen by higher authority than the Surgeon General's Office, butselection of sites within those camps was a joint enterprise of The SurgeonGeneral and the Chief of Engineers. In selecting locations for general hospitalsThe Surgeon General had more authority but not a free hand. He set up criteriaof his own but was also subject to policies established by higher authority, toreview of ASF headquarters, and to the Engineers' opinion of the suitabilityof available sites within general areas.
After war began The Surgeon General continued to regard asimportant such factors as climate, terrain, utilities connections,transportation systems, and communications networks. Moreover the growth of warindustries and military installations necessitated more careful investigationthan before of available labor, housing, and commodity markets. Furthermorethere was the well-established policy of locating general hospitals in areas near large training camps, in order to simplify thetransfer of patients from station to general hospitals. Occasionally thesefactors conflicted with each other. For example, cities with adequate housing,labor, and commodity markets were scarce in the South and Southwest, where mosttroops were concentrated.82 A policy of hospitalizing war casualtiesnear their homes was not established until the general hospital constructionprogram had been virtually completed.83 It therefore had littleeffect upon hospital locations. If it had been established earlier, more generalhospitals might have been located in centers of population rather than incenters of troop density and the problem of finding areas with adequate marketsmight have been less difficult.
Early in 1942 G-4 ordered all new general hospitals to belocated between the Atlantic and Pacific coast ranges as a safety masure.84It was immediately evident that this policy conflicted with the necessityof placing hospitals near ports of debarkation where they could readily receivepatients returning from overseas theaters.85 InJune 1942, therefore,SOS headquarters permitted the construction of some general hospitals near thecoasts to support ports of debarkation, but it made even more restrictive thearea for the location of others by moving its boundaries inland to a linerunning from
82The above information was taken from numerous reports ofinspection of areas for hospital locations. They are filed in SG: 632.-1 and inHD: Hosp Insp Rpts.
83See below, pp. 116-17.
84(1) Rpt on SGO Staff Conf, 17 Feb 42, in Diary of SGO HistSubdiv. HD. (2) Info furnished by Col John R. Hall (Ret), 2 Dec 50. HD: 314(Correspondence on MS) III.
85Ltr, SG to TAG, 14 Feb 42, sub: Add Gen Hosp Beds. SG:632.-1.
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LOCATION OF GENERAL, CONVALESCENT, AND REGIONAL HOSPITALSDURING WORLD WAR II
90
Spokane to Phoenix to El Paso to Temple (Texas) to Atlanta toCleveland.86 This limitation was not strictly observed and toward the end of1942 General Marshall in a conference with General Magee verbally abrogated boththe G-4 and SOS restrictions.87 Of the 51 general hospitalsauthorized, acquired, or constructed between the beginning and end of the war,28 were outside the area prescribed by SOS headquarters, 4 were on its edge and19 were within it.88 Of the 28 outside the area, 9 were in thepopulous northeastern section of the country and 7 were in the Pacific Coastarea.
Increasing emphasis during 1942 upon the use of existingcivilian buildings for Army hospitals complicated the process of site selectionand sometimes interfered with proper location. In some instances severalbuildings, such as hotels or civilian hospitals, had to be surveyed forengineering features and potential bed capacities before a decision could bemade either to use one of them or to erect a new Army plant in the same generalarea. In the latter case a satisfactory site still had to be selected. Existingbuildings were sometimes chosen simply because they were suitable for conversioninto Army hospitals, even though they were in towns that were smaller than TheSurgeon General considered desirable or were outside the area prescribed by SOSheadquarters.89
The Surgeon General's selection of locations for generalhospitals had to be reviewed by SOS headquarters before the Engineers couldinvestigate specific sites for their construction. Of eighteen locations whichThe Surgeon General proposed in June 1942, the SOS Hospitalization and EvacuationBranch changed almost a third because its chief considered them too near thecoast or other general hospitals and too far from adequate rail facilities and largetowns.90 During the winter of 1942 that Branch urged The SurgeonGeneral rather unsuccessfully to locate more hospitals in the West, to care forpossible increases in troop concentrations and evacuee loads in that area.91About the same time, the SOS Requirements Division became involved, insistingupon the speedy selection of locations for all hospitals to be constructed byJune 1944. This made selection more difficult, according to both The SurgeonGeneral and the Chief of Engineers, and in some instances The Surgeon Generalfound it expedient to agree to sites which, although
86Opr Plans for Hosp and Evac, sec I, par 5 c, incl 1 to Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs and Gen Hosps, and to SG,18 Jun 42, same sub. HD: 705.-1.
871st ind, SG to CG SOS, 15 Jan 43, on Memo SPRMC 632,CG SOS for SG, 18 Dec 42, sub: Hosp, Gen Hosps. SG: 632.-1.
88General Hospitals established outside the area were:Ashford, Newton D. Baker, Birmingham, Brooke, Butner, Cushing, Dibble, Deshon,DeWitt, Edwards, England, Finney, Fletcher, Foster, Hammond, Halloran, Madigan,Mason, McCaw, McGuire, Moore, Oliver, Pickett, Ream, Rhoads, Torney, ValleyForge, and Woodrow Wilson; those inside the area were: Ashburn, Battey, Borden,Bruns, Bushnell, Carson, Gardiner, Glennan, Harmon, Kennedy, Mayo, Nichols,Percy Jones, Prisoner-of-War General Hospital No. 2, Schick, Thayer, Vaughan,Wakeman, and Winter; those on the edge were Baxter, Crile, McCloskey, and Northington.
89(1) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1. (2) Memo CE 632 (Hosps) SPEOT, CofEngrs for CG SOS, 19 Dec 42, sub: Adv Planning for Add Gen Hosp Fac. SG: 632-1.
90Memo SPOPM 632, ACofS for Oprs SOS (init WLW[ilson]) for Dir Reqmts Div SOS, 17 Jun 42, sub: Add Gen Hosps. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42."
91(1) 3d ind SPOPH 632 (9-26-42), CG SOS (Oprs SOS) to SG, 29 Oct 42, with n. for record, on Memo, SG for CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42." (2) 5th ind SPOPH 632 (9-26-42), ACofS Oprs SOS for ACofS Mat SOS, 5 Dec 42, on same memo. Same file.
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less desirable in his opinion, were superior for constructionpurposes.92
Throughout the early war years, local pressure on the WarDepartment sometimes complicated the process of selecting hospital locationsand sites but apparently did not often sway the judgment of those responsiblefor making the choice. In their attempts to lure additional wartime activities,many communities and cities made attractive offers, including the presentationof lands for general hospitals and the extension of utilities lines to the edgesof those areas. In some instances there seemed to be a buyers' market. Forexample, after The Surgeon General planned to establish a general hospital inthe Fort Worth-Waco (Texas) area, six cities offered valuable inducements.From the sites offered, The Surgeon General selected the one which, in theopinion of his representative and that of the Chief of Engineers, seemed bestsuited for hospital purposes.93 In other instances local authoritiesbanded together to prevent the establishment of hospitals in their areas.94Sometimes United States Senators and Representatives also attempted to influencethe selection of certain locations. Generally they seem to have met with littlesuccess. For example, Sens. Charles L. McNary and Rufus C. Holman and Rep.Walter M. Pierce were particularly insistent upon the establishment of hospitalsnear LeGrande and Hot Lake, Oreg., rather than at Spokane and Walla Walla,Wash., but after appropriate investigations the latter locations were approved.95Likewise, Sen. John H. Bankhead and Rep. Carter Manasco sought a hospital forJaspar, Ala., a mining town suffering from a lack of war projects, but TheSurgeon General's representative recommended that Jaspar not be selected, and the place finally chosen for the one hospital in Alabama wasTuscaloosa.96 On the other hand, a hospital was located atMartinsburg, W. Va., a city commended for that purpose by Rep. JenningsRandolph;97 and, as a rule, after The Surgeon General'sConstruction Division made tentative selections of locations and sites, itdiscussed them with appropriate Senators and Representatives and secured theirco-operation and help in dealing with local authorities.98
In view of the many factors involved, it is not surprisingthat the process of site selection was slow and gave rise to considerablecriticism later in the war. Much of this criticism sprang from the fact thatthere were too few hospitals in densely populated areas to enable all patients
92(1) Memo, CG SOS (Dir Reqmts Div) for SG, 18 Dec 42, sub: Hosp, Gen Hosps, with 1st ind, SG to CG SOS, 15 Jan 43. SG: 632.-1. (2) Memo CE 632 (Hospitals) SPEOT, CofEngrs for CG SOS, 19 Dec 42, sub: Adv Planning for Add Gen Hosp Fac. Same file. (3) Ltr, Col John R. Hall to Lt Col Don J. Leehey, Off Div Engr, Portland, Oreg, 23 Mar 42. SG: 601.-1.
93(1) Memo, Col John R. Hall for SG, 31 Dec 41, sub: Rpt ofInsp Trip Made for the Purpose of Locating Add Gen Hosp . . . in North TexasArea, with 12 incls. SG: 632.-1. (2) D/S, ACofS G-4 WDGS to TAG, SG, and CG8th CA, 19 Jan 42, sub: Site for Gen Hosp, Temple, Tex. HRS: G-4/29135-11.
94Notes on Conf, 26 Mar 42, Hosp Cons Div SGO, atchdto Ltr, SG to TAG, 14 Feb 42, sub: Add Gen Hosp Beds. HD: 632.-1.
95(1) Ltr, SG to Hon Rufus C. Holman, US Sen, 21 Apr42. SG: 601.-1. (2) Memo, Col John R. Hall for SG, 3 Jun 42, sub: Insp Trip toOreg, Wash, and Calif. Same file.
96(1) Memo, Maj Lee C. Gammill for Col John R. Hall, 6 Jul 42, sub: Jaspar, Ala, Hosp Sites. HD: Hosp Insp Rpts. (2) Memo, Lt Col Achilles L. Tynes for SG, 22 Aug 42, sub: Rpt on Site Bd Surv for Location of Gen Hosp at Greeneville (sic), SC and Jaspar, Ala. SG: 601.-1.
97Memo, Col John R. Hall for SG, 15 Jun 42, sub: Insp of Proposed Sites Offered by City of Martinsburg, W. Va.HD: Hosp Insp Rpts.
98Info furnished by Col Hall (Ret), 2 Dec 50. HD: 314 (Correspondence on MS) III.
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evacuated from overseas theaters to be cared for near theirhomes. It was generally forgotten-or ignored-that most of the generalhospitals were located to facilitate the transfer of patients from stationhospitals in training camps and that the War Department did not establish apolicy of hospitalizing overseas evacuees near their homes until most of thegeneral hospitals had been established.
Control over Internal Arrangement of Hospitals
The Surgeon General continued to insist that buildingschedules, hospital layouts, and floor plans of all new hospitals, plans for all"major" alterations to existing buildings, and all subsequent changesin such plans should be referred to his Office for approval.99 On theother hand, the Chief of Engineers attempted, as did The Quartermaster Generalbefore him, to decentralize as much authority as possible in order to save time.Beginning in February 1942, he again raised the question of having The SurgeonGeneral approve standard building schedules and layouts for use in the field,without further reference to the latter's Office, but apparently neither theChief of Engineers nor SOS headquarters wished to challenge The Surgeon General'sposition. While official construction policy letters did not require thereference of layouts and plans to his Office, the Engineers generally followedthat practice.100
The extent of The Surgeon General's authority over hospitalconstruction was discussed but not defined after reorganization of the Servicesof Supply in the late summer of 1942. On 5 August General Magee requested thatcertain functions be "retained" in his Office, not decentralized to the field. Among them were the approval of hospital floorplans and layouts, plans for the conversion of civilian buildings into Armyhospitals, and all major alterations to existing hospital buildings.101 GeneralSomervell's reply was inconclusive. He stated that the approval of floor plansand layouts had been and was at that time a responsibility of the Chief ofEngineers, but that it was the practice to secure concurrence of the SurgeonGeneral's Office in them. Plans for the conversion of civilian buildings, hestated, fell in a "twilight zone" that was not well defined eitherbefore or after the reorganization. As for alterations to existing hospitals,General Somervell stated that there was no clear definition of the word"major." He implied that The Surgeon General should agree with theChief of Engineers to decentralize authority for alterations to servicecommands. If The Surgeon General could not trust service command surgeons tosupervise alterations properly, General Somervell concluded, he should replacethe surgeons.102
99(1) Ltr, SG to CofEngrs, 9 Feb 42, sub: Hosp Bldg Schedules. (2) 1st ind, SG to CofEngrs, 1 May 43, on Ltr 600.92 (Gen) SPEEG, CofEngrs to SG, 25 Apr 42, sub: Typical Hosp Layouts. (3) 1st ind, SG to CofEngrs, 2 Aug 42, on Synopsis Ltr, CofEngrs to SG, 28 Jul 42, sub: Auth of Div Engr to Auth Cons. All in SG: 632.-1.
100(1) Ltr, SG to CofEngrs, 9 Feb 42, sub: Hosp Bldg Schedules. SG: 632.-1. (2) Ltr 600.92 (Gen) SPEEG, CofEngrs to SG, 25 Apr 42, sub: Typical Hosp Layouts. Same file. (3) Ltr AG 600.12 (2-19-42) MO-D-M, TAG to CGs of all Depts and CAs, COs of Exempted Stas, and C of Arms and Servs, 24 Feb 42, sub: WD Cons Policy, ZI. HRS: G-4/31751. (4) 1st ind, CofEngrs to CG AAF, 25 Aug 42, on Ltr, CG AAF to CofEngrs, 19 Aug 42, sub: Hosp Cons. AAF: 632 "B Hosp and Infirmaries."
101Ltr, SG to CG SOS, 5 Aug 42, sub: Liaison in Reorgnof SvCs. SG: 020.-1.
1021st ind, CG SOS to SG, 15 Aug 42, on Ltr, SG to CGSOS, 5 Aug 42, sub: Liaison in Reorgn of SvCs. SG: 020.-1.
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Within the same month it became apparent that local changesin approved plans for converting civilian buildings into hospitals needed to bemore strictly controlled. Aware of the difficulties of such conversions, TheSurgeon General asked authority on 2 August 1942 to commission five civilianarchitects to serve as advisers on the spot in the alterations required. Thecommanding general, Services of Supply, disapproved this request because theChief of Engineers considered it an encroachment upon his responsibility.103Meanwhile word reached Washington that local engineer and medical officers hadmade unnecessary and expensive changes in plans for one of the conversions.After a conference on this problem on 14 August 1942 among representatives ofthe Services of Supply, the Chief of Engineers, The Surgeon General, and the WarProduction Board, General Somervell directed that no changes should be made inapproved plans for altering hotels or other buildings without the writtenconsent of both The Surgeon General and the Chief of Engineers.104
In following months The Surgeon General and the Chief ofEngineers agreed upon a partial decentralization of authority to approvealterations of existing hospitals. On 5 October 1942 the War Departmentdelegated to service commanders the authority to approve alterations costing upto $10,000 on any building, at any one time and place.105 On 13November 1942 The Surgeon General suggested, as he had before, that all"major" alterations to hospital buildings, regardless of cost, be sentto his Office for approval. He defined "major" alterations as thoserequiring structural changes to convert sections of buildings or entirebuildings from one use to another, to convert ward to office space or vice versa, or to extendbuildings into areas expected to be kept vacant. The Chief of Engineers insistedthat the term "major" changes would be misleading and suggested thatthe phrase "changes involving more than $10,000" be used instead.Undoubtedly aware of the War Department's action of 5 October 1942, TheSurgeon General reluctantly agreed and on 3 December 1942 the Chief of Engineersissued a letter authorizing local alterations costing up to $10,000 on hospitalbuildings, without prior approval of The Surgeon General.106
InNovember 1942 the Wadhams Committee attributed what it considered to beshortcomings in hospital construction partially to the limited extent of TheSurgeon General's authority but also to the inadequacy of his own constructionstaff. Stating that the division of responsibility between the Chief ofEngineers and The Surgeon General had permitted "passing the buck," itrecommended that the latter be given more authority over construction. At thesame time the committee proposed that The Surgeon General strengthen hisconstruction staff by adding to it outstanding civilian hospital architects andby placing at its head a nonmedical man
103(1) Memo for Record, on DF, CG SOS to SG, 17 Sep 42, sub: Increase in Procurement Objective, AUS. AG:SPGA 210.1 Med 1-20.
104(1) Memo 323.7 Hosp SPPDX, Mr. L. G. Woodford for GenHarrison, 14 Aug 42, sub: Conversion of Hotels to Army Hosps. SG: 632-2. (2)SOS Memo S100-2-42, 27 Aug 42, sub: Limitation on Alterations to Hosps. CE:632, Pt 2.
105AR 100-80 C 3, 5 Oct 42.
106(1) Memo, SG for CofEngrs, 13 Nov 42, sub: Routing of Project Ests Affecting Hosp Bldgs, with 1st ind CE600.94 (Surg Gen) SPEUU, CofEngrs to SG, n d; 2d ind, SG to CofEngrs, 25 Nov 42,and 3d ind CE 600.94 (Surg Gen) SPEUU, CofEngrs to SG, 7 Dec 42. SG: 632.-1.(2) Ltr, CofEngrs to CGs of SvCs, 3 Dec 42, sub: Nonrecurrent Project EstsInvolving Hosp Bldgs. CE: 632, Pt 2.
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experienced in hospital planning. The Surgeon Generalnaturally agreed that he should have more authority, but he concurred with thechief of his Hospital Construction Division in defending the practice of placinga doctor at its head and ascribed the division's shortage of trainedarchitects to the disapproval of his request to commission five to assist in theconversion program.107
Maintenance of Hospital Plants
Responsibility for Maintenance
Even before The Surgeon General lost control over hospitalalterations costing less than $10,000, he had also lost authority over theexpenditure of funds for hospital repair and maintenance. At the beginning of1942 funds from three appropriations were used for hospital maintenance. Two ofthem, the Barracks and Quarters (B&Q) appropriation and the Construction andRepair of Hospitals (C&RofH) appropriation, were Engineer appropriations;the third, the Medical and Hospital Department (M&HD) appropriation, wasmade to the Medical Department. Funds from the B&Q appropriation and from theM&HD appropriation were controlled exclusively by the Engineers and theMedical Department respectively. Those from the C&RofH appropriation werecontrolled jointly by the Chief of Engineers and The Surgeon General. B&Qfundspaid for such things as firing boiler plants of hospitals and repairing certainbuildings occupied and used by operational personnel. C&RofH funds providedfor the maintenance of buildings occupied and used by patients and for theupkeep of installed equipment. M&HD funds were used to maintain noninstalledMedical Department equipment and to meet expenses connected with the purchase of medicalsupplies.108
The use of three funds for hospital maintenance producedcomplications. One was confusion about the fund to which various expendituresshould be charged. In January and February 1942 questions arose over whetherrepairs to hospital barracks should be charged to B&Q or to C&RofH funds.109Fine distinctions sometimes had to be made in applying the C&RofH fundrather than the M&HD fund and vice versa. For example, carpenters wereemployed from both. Those paid with M&HD funds could repair hospitalfurniture and non-installed equipment, but not buildings and installedequipment; those paid with C&RofH funds had to do that.110Another problem arose in the joint administration of C&RofH funds. Althoughthey were Engineer funds, their appropriation was based on estimates prepared byThe Surgeon General and they were allotted to hospitals on his recommendation.Corps area and post surgeons controlled their expenditure and reported on it toThe Surgeon General, but post engineer officers performed the work.111
107(1) Cmtee to Study the MD, 1942, Rpt. HD. (2) Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 31. HD. (3) Memo, Col John R. Hall for Exec Off SGO, 3 Dec 42. SG: 632.-1.
108Tynes, Construction Branch, p. 54. Also see thelanguage of the appropriations acts.
109(1) Ltr CE 121.2 (Funds) CU, CofEngrs to SG, 7 Jan 42, sub: Policy for Div of B&QA Funds and C&RofHA Funds, with 1st ind, SG to CofEngrs, 1 Mar 42. (2) Ltr CE 121.2 (Funds) CUC, CofEngrs to SG, 25 Feb 42, sub: Policy for Div of B&QA, C&RofHA and Air Corps Tec Funds, and 1st ind, SG to CofEngrs, 1 Mar 42. Both in SG: 632.-1.
110Memo, Col F[rancis] C. Tyng for Budget Off WD, 22 Mar42, sub: Trf of Approp C&RofH from a Sep Approp to M&HD, A. SG: 632.-1.
111(1) Memo, Col F. C. Tyng for Budget Off WD, 22 Mar 42, sub: Trf of Approp C&RofH from a Sep Approp toM&HD, A. SG: 632.-1. (2) AR 40-585, par 3 and 4, 16 Jul 31.
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Early in 1942 the Chief of Engineers began to simplify theadministration of the C&RofH fund. In order to reduce bookkeeping, heproposed on 31 January 1942 the abandonment of a practice of subdividing thefund into several smaller project-funds.112He also began to makeallotments directly to district engineers, without securing The Surgeon General'sand corps area surgeons' recommendations.113Then he directeddistrict engineers to prepare estimates of C&RofH funds in the same way theydid those of B&Q funds.114 The Surgeon General went along withthese changes, but insisted that corps area surgeons be informed of allotmentsmade to hospitals and that they continue to report to him on all expendituresmade from such allotments.115
The next month the merger of the C&RofH appropriationwith either the B&Q or the M&HD appropriation came up for consideration.The Chief of Engineers wanted the C&RofH fund merged with the B&Q fundunder his control. Hearing of pending legislation to that effect, The SurgeonGeneral recommended to the Budget Officer of the War Department on 22 March 1942that the C&RofH and the M&HD appropriations be combined into one, underMedical Department control. In support of this recommendation he pointed outunsatisfactory features of having a fund controlled jointly by the Engineers andthe Medical Department.116 This action came too late, because themerger of C&RofH with B&Q funds under a single appropriation calledEngineer Service, Army, had already occurred on 5 March 1942.117 The SurgeonGeneral protested against this "radical departure" from acceptedpractices, maintaining now that joint control of the C&RofH fund had beensatisfactory, that only doctors could determine the maintenance required for hospitals, and that Congress hadalways been, and might be expected to continue to be, more liberal inappropriating funds for hospital maintenance than for the routine maintenance ofArmy posts.118 He failed, however, to keep control over fundsexpended for hospital maintenance, for on 23 May 1942 the War Department chargedthe Chief of Engineers with responsibility for repairs and utilities at generalhospitals and on 9 June 1942 rescinded the Army regulation which had outlinedThe Surgeon General's former authority over hospital maintenance.119Withthe reorganization of the Services of Supply, the Chief of Engineers requestedThe Surgeon General on 17 August 1942 to close out all fiscal transactionspertaining to hospital
112Memo CE 121.2 (Projects) CUC, CofEngrs for SG, 31 Jan42, sub: Project Revision. SG: 632.-1.
113Ltr, Surg 4th CA to SG, 19 Jan 42, sub: C&RofHFunds, with 2d ind, CofEngrs to SG, 13 Feb 42. SG: 632.-1 (4th CA) AA.
114Ltr CE 315 (Forms) CUC, CofEngrs to SG, 27 Jan 42, sub: Application of OCE Forms No 395 and 395-A to An Est of Funds Req of C&RofH, A. SG: 632.-1.
115(1) 1st ind, SG to CofEngrs, 23 Jan 42, on Ltr, Surg4th CA to SG, 19 Jan 42, sub: C&RofH Funds. SG: 632.-1 (4th CA)AA. (2) Ltr,Maj Seth [O.] Craft to Surg 2d CA, 7 Mar 42. SG: 632.-1 (2d CA)AA. (3) Ltr, sameto Capt Joe [E.] McKnight, MAC, Off of Surg 1st CA, 4 Feb 42. SG: 632.-1 (1st CA)AA.
116(1) Ltr, SG to CofEngrs, 25 Feb 42, sub: C&RofH Funds, as Affected by Pending Legislation, H. Res.6611. SG: 632.-1. (2) Memo, SG for Budget Off WD, 22 Mar 42, sub: Trf of AppropC&RofH . . . to M&HD, A, for FY 1943. SG: 632.-1.
117(1) 5th Supp Nat Def Approp Act, 1942, Public Law 474,apvd 5 Mar 42. (2) GAO Acts and Procedures Ltr 4236, 7 Mar 42. HD: 121.2.
118(1) Ltr CE 121.2 (Funds) CUC, CofEngrs to SG, 24 Mar 42, sub: Maintenance of Hosp Structures. (2) Memo, SGfor Maj Gen T[homas] M. Robins, Asst CofEngrs, 26 Mar 42, sub: Maintenance andRepair of Hosps. (3) Memo CE 600.3 (Gen)-CU, CofEngrs for SG, 10 Apr 42, sub:Repairs and Util Functions at MD Fac, with 1st ind, SG to CofEngrs, 23 Apr 42. Allin SG: 632.-1.
119(1) WD Cir 157, 23 May 42. (2) AR 100-80, 9 Jun 42.
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maintenance and to plan to transfer the funds, personnel, andequipment used in that work to the Engineers as of the close of business on 31August 1942.120
After responsibility was concentrated in the Chief ofEngineers, the maintenance and repair of hospitals failed to suffer as theSurgeon General's Office had anticipated. The surgeons of several servicecommands reported favorably on the performance of maintenance work under the newsystem.121 As late as 1945, Col. Achilles L. Tynes, of theHospital Construction Division, pointed out that hospitals had experienced nodifficulty in getting repairs during the war and that it could not be provedthat retention of control of funds by the Medical Department would have been moresatisfactory than control by the Engineers.122
Reflooring and Reroofing
Throughout the war, maintenance programs of magnitude had tobe carried on concurrently with new construction programs, largely as the resultof the use of cantonment-type construction in the majority of hospitals builtboth before and after the war began. Green pine lumber, the only type availablein many cases, was frequently used for both flooring and roofing. As it driedand warped, it pulled the nails through tar-paper roofing, tearing it andproducing leaks, and caused floors to shrink and splinter, leaving themunsightly, insanitary, and dangerous. Beginning late in 1941 and continuingthrough 1942, The Surgeon General and the Chief of Engineers initiated andcarried through extensive programs of reroofing and reflooring. Asphalt stripshingles gradually replaced tar-paper roofs, and old floors were covered withlayers, first of plywood and then of linoleum or similar material. Incorridors, imitation-rubber strip-runners were laid to protect floors, to reducenoise, and to increase patients' safety. These costly programs might have beenavoided had better materials been available and authorized for initial hospitalconstruction.123
Efforts to Increase the Safety and Comfort of Patients
Despite the War Department's policy of "Spartansimplicity" in construction and maintenance during 1942 and 1943, theEngineers and the Medical Department tried to increase the safety and comfort ofpatients in hospitals. The practice of installing automatic sprinkler systems asprotection against fire in cantonment-type wards was continued and extended toinclude recreation, mess, post exchange, and clinic buildings as well.124 Numerousrequests from separate hospitals for heat in corridors, to protect patients aswell as the pipes of sprinkler systems from extreme cold, had prompted TheSurgeon General
120Ltr, Asst CofEngrs to SG, 17 Aug 42, sub: Trf ofRepairs and Util Functions. SG: 632.-1.
121An Rpts, 1942, Surg 5th, 7th, and 9th SvCs. HD.
122Tynes, Construction Branch, p. 64.
123Correspondence among The Surgeon General, TheQuartermaster General, and the Chief of Engineers on these programs is on filein SG: 632.-1; SG: 632.-1 (1st thru 9th CAs)AA; and CE: 632 Vol. 3. Also seeSpeech, Lessons Learned from Planning and Constructing Army Hospitals, by ColHall, 16 Sep 43 (HD: 632.-1), and Tynes, Construction Branch, pp. 65-67.
124(1) 2d ind, SG to TAG, 19 Jan 42, and 3d ind AG 671.7 (31 Dec 42) MO-D, TAG to CofEngrs, 26 Jan 42, on Synopsis Ltr, Div Engr Carib Div to CofEngrs, 31 Dec 41, sub: Automatic Sprinkler Systs. SG: 671.-2. (2) OCE Cir Ltr 1665, 2 Jun 42, sub: Automatic Sprinkler and Fire Alarm Systs in Small Hosps. CE: 671.3, Pt 1. (3) SOS Memo S30-2-42, sub: Policy Governing Instl of Automatic Sprinkler Systs and Fire Alarm Systs. SG: 671.2.
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in October 1941 to reverse an earlier decision and requestthe installation of heating facilities.125 On 4 February 1942 theSecretary of War authorized their installation in the corridors of allcantonment-type hospitals then under construction or planned.126Getting approval for the installation of air-cooling systems in hospitals in hotsouthern areas was considerably more complicated.
During the first summer that the Army began to usecantonment-type hospitals on a wide scale, hospital commanders and corps areasurgeons, especially in areas with high temperatures, had complained thatpatients suffered from heat in wards and that the temperature in operating roomsand clinics was frequently unbearable.127 The attic space above thelow-ceilinged cantonment-type buildings collected and held heated air, raisingthe temperature in the buildings higher than on the outside. Dust in new campsoften made it necessary to close all windows, and use of sterilizers anddeveloping tanks in clinics and dark rooms increased humidity in those sectionsof hospitals.128 Colonel Offutt, Chief of The Surgeon General'sHospitalization Division, promised in September 1941 that attempts would be madeto correct this situation by the summer of 1942.129
During the next spring the Surgeon General's Officecollaborated with local surgeons and representatives from manufacturing concernsin working out systems employing mechanical air conditioners, evaporativecoolers, and forced-air ventilation. The mechanical air conditioners wereself-contained package-type coolers, like those used in restaurants and offices.Outside air was drawn into buildings over coils containing a refrigerating gas,and air-duct installation was not required. Evaporative coolers were useful in dry areas of theSouthwest, where the humidity was extremely low. These devices drew hot outsideair into buildings through wet, porous substances; as the moisture evaporated,the air cooled. In the hot and humid climate of the South and Southeast, whereevaporative cooling was not practicable, forced ventilation was used. Exhaustfans in attics blew out hot air, producing a condition in the wards belowsimilar to that found outside in the shade with a light breeze.130Using C&RofH funds allocated by The Surgeon General, local hospitalcommanders and utilities officers began to install such systems during thespring of 1942.131
Before this program had gotten very far it encountered adirective, on 20 May
125Ltr, SG to QMG, 29 Oct 41, sub: Heating of EnclosedCorridors. CE: 632, Pt I.
126Ltr SGO 674.-1, SG to CofEngrs, 7 Jan 42, sub: Instl of Heating Fac in Corridors of Cantonment-type Hosps, with 1st ind, CofEngrs to TAG, 27 Jan 42, and 2d ind, TAG to CofEngrs, 4 Feb 42. CE: 632, Pt I.
127For example, see: (1) Synopsis Ltr, AF Combat Comd Hqto CofAC, 5 Jul 41. SG: 632.-1. (2) 1st wrapper ind, Surg 9th CA to SG, 3 Jul 41.SG: 673.-4 (9th CA)AA. (3) Ltr, Surg 4th CA to SG, 6 Sep 41, sub: Comfort andWelfare of Pnts in Cantonment Hosps. SG: 632.-1 (4th CA)AA.
128Speech, Lessons Learned from Planning and ConstructingArmy Hospitals, by Col Hall, 16 Sep 43. HD: 632.-1.
129Ltr, SG (per Col H. D. Offutt) to Surg 4th CA, 10 Sep 41, sub: Comfort and Welfare of Pnts in Cantonment Hosps. SG: 632.-1 (4th CA)AA.
130(1) Speech, Lessons Learned from Planning and Constructing Army Hospitals, by Col Hall, 16 Sep 43. HD: 632.-1. (2) Memo, Col John R. Hall for SG, 16 Jun 43, sub: R?sum? of Procurement of Air-Conditioning andVentilative Equip for Cantonment-Type Hosps. SG: 673.-4.
131(1) 1st ind, SG to CofEngrs, 14 Feb 42, on Ltr,Carrier Corp to SG, 12 Feb 42. (2) Ltr, SG to CofEngrs, 6 Apr 42, sub: SpecialFeatures for Ventilation of Hosps. (3) Ltr, SG to Various Sta and Gen Hosps, 3d,4th, 5th, 6th, 7th, and 8th CAs, 6 May 42, sub: Air Conditioning ofOperating Rms, X-ray Rms, and Recovery Rms. All in SG: 673-4.
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1942, severely restricting the use of mechanical andelectrical equipment in Army construction.132The Chief ofEngineers, who by now controlled funds for the purchase of cooling equipment andwas responsible for its installation, sought approval of the War ProductionBoard for installing the apparatus recommended by The Surgeon General.133The Board approved the use of air conditioners in operating rooms, X-rayclinics, and recovery wards, but failed to deal with The Surgeon General'sproposal to install exhaust fans or evaporative coolers in other hospitalbuildings.134 The supply of fans and coolers already on hand wasbelieved to be limited, but no Government agency actually knew its extent.135Consequently the SOS Resources Division wanted to limit installation tocases of greatest need and in August 1942 approved only a limited program.136Early in 1943 a practice of transferring equipment from nonessential tomilitary uses developed and the War Production Board ascertained that dealershad considerable stocks of air-conditioning and mechanical-ventilating equipmenton hand.137 When The Surgeon General resubmitted his proposalin January and February,138 therefore, the War Department issued apolicy letter on the subject.
Under the new policy the installation of cooling equipmentfrom existing inventories or from recaptured stocks was permitted in areas wherethe average July temperature exceeded 75? Fahrenheit. Depending uponhumidity of the area in which a hospital was located, either evaporative coolersor exhaust fans were permitted in operating rooms, wards, X-ray rooms, clinics,dispensaries where minor operations were performed, and patients' mess halls.Where neither of these types served the purpose, air conditioners might be installed inoperating rooms, X-ray rooms, flight surgeons' clinics, and recovery wards. Indesert areas, evaporative coolers might also be used in quarters occupied bypersonnel on night duty.139
Installation of the long-desired equipment now began. Sinceauthority to approve jobs amounting to $10,000 or less had been decentralized toservice commands, the installation of air-conditioning andmechanical-ventilating systems was a responsibility of local engineers. TheChief of Engineers and The Surgeon General developed guides for their use, andon 15 April 1943 the Chief of Engineers informed service command engineers ofprocedures to follow in processing requests
132Directive for Wartime Cons, 20 May 42, incl to Ltr AG600.12 (5-20-42) MO-SPAD-M, TAG to CGs of AAF, Depts, and CAs and to C of TecServs, 1 Jun 42, same sub. SG: 632.-1.
133(1) Ltr, CofEngrs to Refrigeration Sec and Fan and Blower Sec WPB, 20 Jun 42. CE: 673, Pt 3. (2) Ltr, SG to CofEngrs, sub: Ventilation and Air Conditioningfor Cantonment-type Hosp Bldgs, 13 Jun 42. SG: 673-4.
134Ltr, WPB to CofEngrs, 23 Jun 42. CE: 673, Pt 3.
135(1) Memo, 1st Lt James J. Souder for Col John R. Hall, 2Aug 42, sub: Conf on Evaporative Cooling for Hosp Bldgs. SG: 673.-4. (2) Noteson tel conv between Lt Col Norris G. Kenny and Col John R. Hall, 29 Jun 42. Samefile.
136(1) Memo, Dir Resources Div SOS for SG, 30 Jun 42,sub: Exception from 'List of Prohibited Items for Cons Work' of VentilationFans for Hosps. SG: 673.-4. (2) Memo SPRMC 674.4(8-11-42), CG SOS forCofEngrs, 16 Aug 42, sub: Policy Determining Instl of Humidifying Coolers. CE:673, Pt 3.
137Memo, Capt James J. Souder for Col John R. Hall, 15Feb 43, sub: Conf on Air Conditioning and Ventilation for Hosps. SG: 673.-4.
138(1) Memo, SG for Maj Frank Seeter, Resources Div SOS,23 Jan 42, sub: Ventilative Treatment in Cantonment-Type Hosps. SG: 673.-4. (2)Memo, SG for Production Div SOS, 22 Feb 43, same sub. Same file.
139WD Memo W100-4-43, 24 Mar 43, sub: Policy forAir-Conditioning, Cooling, and Ventilation of Army Insls, Continental US. SG: 673.-4.
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for that work.140 Although delivery of unitswas delayed in some cases until the fall of 1943, many hospitals had air-coolingsystems in time for both patients and operational personnel to benefit fromreduced temperatures during the summer of that year.141
Correction of Errors in Cantonment-Type Hospitals
While improvements already mentioned were being made, theEngineers and the Medical Department worked to correct inadequacies of space forvarious functions, especially in cantonment-type hospitals. The prewar practiceof providing more room for administrative and service activities, X-ray work,storage, and recreation was continued.142 Action was also taken tofurnish ear, eye, nose, and throat (EENT) clinics with more space than thatoriginally planned. This occurred after the War Department established a policyof giving eye examinations and spectacles to all soldiers who required them.Existing EENT clinics were enlarged or were abandoned in favor of new ones setup in ward buildings.143
In the fall of 1942 the Wadhams Committee found faultparticularly with shortage of occupational therapy facilities, inadequacy ofspace for post exchange and recreational activities, and lack of safety featuresin neuropsychiatric wards.144 The chief of The Surgeon General'sHospital Construction Division, Colonel Hall, agreed that post exchanges andrecreational facilities were too small but stated that War Departmentconstruction policies were responsible for that fault. He believed that it wasunnecessary and impractical to have occupational therapy facilities in stationhospitals, because in his opinion all patients needing occupational therapy shouldbe sent to general hospitals.145 Nevertheless, in compliance withan SOS directive, The Surgeon General submitted a comprehensive program on 17January 1943 for the construction of additional occupational therapy buildings,recreation buildings, detachment dayrooms, post exchanges, libraries, chapels,officers' and nurses' recreation buildings, and theaters in all hospitals oftwo hundred or more beds.146 SOS headquarters apparently consideredthis program as one going beyond the bounds of War Department constructionpolicies, and returned it for reconsideration. After
140(1) Memo, SG for CofEngrs, 27 Apr 43, sub: Instl Plans for Air Conditioning, Evaporative Cooling, andMechanical Ventilation. SG: 673.-4. (2) Ltr, CofEngrs to CG 2d SvC attn Dir ofReal Estate, Repairs, and Utils, 15 Apr 43, same sub. Same file.
141For example, see: An Rpts, 1943, of Kennedy and Ashburn Gen Hosps and of Sta Hosps at Scott Fld and Cps Bowie, Beale, and Maxey. HD.
142(1) Ltr, SG to CofEngrs, 27 Jan 42, sub: Request forUrgent Emergency Cons. SG: 632.-1. (2) Ltr, SG to CofEngrs, 6 Jul 42, sub:Request for Working Drawings for Admin Bldg, Type HA-1 and HA-2, with 4 inds.Same file. (3) An Rpts, 1942, Sta Hosps at Cps Dodge and Forrest and 1943, Sta Hosps at Cps Beale, Hale, and Hood. HD.
143(1) Memo, Col John R. Hall for Chief Professional Serv SGO,30 Jul 42, sub: Conversion of Ward Bldg into an Enlarged EENT Clinic. SG: 632.-1.(2) Ltr, SG to CofEngrs, 7 Aug 42, sub: Plans for Conversion of a Ward Bldg intoan EENT Clinic. Same file. (3) An Rpt, 1942, Sta Hosp at Cp Forrest and 1943,Sta Hosps at Cps Beale, Ellis, Hale, and Hood. HD.
144(1) Cmtee to Study the MD, 1942-43, Actions on Recomd,Recomd Nos 10, 15, and 47. HD. (2) Cmtee to Study the MD, 1942, Rpt, pp. 6, 7,12, and 24. HD.
145(1) Memo, Col John R. Hall for Exec Off SGO, 3 Dec 42. SG: 632.-1. (2) Extract from 1st ind, SG to CG SOS, 15 Dec 42, on extract from Memo, CG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd Nos 10 and 15. HD.
146Extracts from Ltr, SG to CG SOS, 17 Jan 43, sub:Recreational Fac in Army Hosps, in Cmtee to Study the MD, 1942-43, Actions anRecomd, Recomd No 10. HD.
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that, it seems to have passed for some months among theoffices of The Surgeon General, the Chief of Engineers, and the SOS RequirementsDivision,147 and improvements of the kind asked for were notapproved until the latter half of the war.
With regard to neuropsychiatric wards, Colonel Hall pointedout that plans for their construction had been completely revised during 1941.Faults that continued to exist, he said, resulted either from failure ofconstruction officers to follow specifications closely or from the difficulty ofconstructing wards in wooden buildings so that patients could not escape orcommit suicide yet at the same time could be easily removed in case of fire.148On his advice, The Surgeon General recommended on 31 December 1942 thatthe Engineers be instructed to provide all neuropsychiatric wards, includingthose already constructed, with the features called for in revised plans.149During the first half of 1943 the Engineers undertook a program ofimproving neuropsychiatric wards in compliance with this recommendation.150
In the spring of 1943, in order to eliminate the need foralterations and additions to hospitals after completion, plans for somecantonment-type buildings were redrawn. This may have resulted from a reportmade by the Seventh Service Command's Inspector General. Investigatingconstruction projects at hospitals in his area, he concluded on 9 March 1943that similar alterations could be avoided in the future by a revision ofconstruction plans.151 Soon after his report reached Washington,the Engineers began to collaborate with the Surgeon General's Office inrevising plans for cantonment-type administration buildings, clinics, and messes. By the middle of 1943 this project had apparentlybeen completed,152 but this was too late to effect significantsavings in hospital alterations, for the major portion of the hospitalconstruction program had already been completed.
Conformity of Hospital Construction to Needs
As hospitals were constructed to meet wartime needsexperiences encountered in the period of peacetime mobilization were repeated inindividual instances. With the Army growing by leaps and bounds troops sometimesmoved into new camps before hospitals were completed, and old camps wereexpanded before existing hospitals could be enlarged. In some areas there wereunexpected delays in construction. For these there were numerous causes. Amongthem were unfavorable weather conditions; shortages of equipment such aselectric cables, pumps, motors, and especially high pressure boilers; and labortroubles, including scarcity of laborers and disputes between employers and em-
147Cmtee to Study the MD, 1942-43, Actions on Recomd,Recomd No 10. HD.
148(1) Memo, Col John R. Hall for Exec Off SGO, 3 Dec 42. SG: 632.-1. (2) Extract from 1st ind SG to CG SOS, 14 Dec 42, on Memo, CG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 47. HD.
149Ltr SPMCC 632.-1, SG (init JRH[all]) to CG SOS, 31 Dec 42,sub: NP Wards. CE: 632, Vol. 3.
150Ink note, "All items referred to have been takencare of by revised drawings and specifications and by circular letter andinformal conference with SGO, 7/29/43," on Ltr, SG to CG SOS, 31 Dec 42,sub: NP Wards. CE: 632, Vol. 3.
151Ltr, IG 7th SvC to IG, 9 Mar 43, sub: Cons Plans, Gen Hosps, with 2 inds. SG: 333.1-1 (7th SvC)AA.
152(1) Memo, CofEngrs for SG, 24 Mar 43, sub: Hosp Bldg Plans, with 1st ind, SG to CofEngrs, 2 Apr 43. SG: 632.-1. (2) Ltr CE 600.13 (Hosp) SPEEW, CofEngrs to SG, 31 Mar 43, sub: Proposed Hosp Messes, with 3 inds. Same file.
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ployees. For posts where actual needs outstripped hospital construction, The Surgeon General set aside additional beds in general hospitals and local medical officers resorted to expedients used before the war to provide adequate hospital care.153
As a whole, construction kept up with actual needs even though it lagged considerably behindestimated requirements. During the first year and a half of the war the numberof station hospitals increased from about 200 to more than 425; and the numberof normal beds (that is, those for which 100 square feet of space each wasprovided in ward buildings) rose from about 58,725 to over 220,000. During theentire period the total number of station hospital beds that were occupiedthroughout the United States was continuously lower than the total number ofnormal beds provided. From December 1942 to March 1943, when the incidence ofrespiratory diseases increased and the transfer of patients from station togeneral hospitals was restricted to save places for anticipated casualties, thenumber of patients in station hospitals exceeded the number of normal bedsavailable but not of normal beds provided. (Only 80 percent of the beds providedwere considered available, because the necessity of segregating patients intoseparate wards according to disease, sex, and grade meant that empty beds in"wrong" wards, amounting as a rule to 20 percent of the total, couldnot be used.) During the entire period, however, emergency and expansion beds(that is, those set up on the basis of 72 square feet each not only in wards butalso in porches, solaria, halls, etc.) made the number of all beds availablegreater than the number of beds occupied.154
The number of general hospitals in operation increased from14 in December 1941 to 40 by June 1943; of beds in them, from about 15,500 tomore than 53,750. The total number of occupied beds never reached the total ofnormal beds provided, but from April through September 1942 in general hospitalsthe number of occupied beds exceeded the number of normal beds available. Thisovercrowding resulted largely from the policy of giving the station hospitalprogram priority over that for general hospitals because of the more immediateneed for station hospital beds. General hospitals, as did station hospitals, setup emergency and expansion beds when they were needed. Older andbetter-established hospitals, such as Walter Reed and the Army and Navy GeneralHospital, tended to be more crowded than newer ones, because the latter had toawait the presence of supplies and equipment as well as full complements ofpersonnel before patients could be transferred to them in large numbers. By June1943, as more new general hospitals opened, the number of available normal bedsoutnumbered by a comfortable margin the number of occupied beds.155 (Chart5)
153(1) An Rpts, 1942, Surg 1st, 3d, and 4th SvCs. HD. (2) An Rpts, 1942, Sta Hosps at Cps McCoy and Adair and Borden Gen Hosp. HD. (3) Memo CE 600.914 (WWGH) SPEOT, CofEngrs for SG, 15 Dec 42, sub: Progress at Woodrow Wilson Gen Hosp. SG: 632.-1 (WWGH)K. (4) Ltr, CO Valley Forge Gen. Hosp to SG, 17 Oct 42, sub: Completion Date. SG: 632.-1 (VFGH)K. (5) Ltr, Col E[rnest] R. Gentry to Col H. D. Offutt, 24 Oct 42. SG: 323.7-5 (Borden GH)K. (6) Rpts on Status of Hosp in US, 1 and 6 Feb 43.SG: 632.-1. (7) Memo, SG for CG ASF, 31 Mar 43. HD: 632-2.
154The above is based on: (1) Bed Status Rpts. Off file, Health Rpts Br Med Statistics Div SGO. (2) ASF Monthly Progress Rpt, Sec 7, Health, pp. 13-16, 28 Feb 43.
155The above is based on: (1) Bed Status Rpts. Off file, Health Rpts Br Med Statistics Div SGO. (2) ASF Monthly Progress Rpts, Sec 7, Health, 28 Feb and 31 May 43.
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