CHAPTER VI
Early Adjustments in the Zone ofInterior Hospital System
As the number of hospitals in the United States increased,changes occurred in the hospital system-that is, the combination of hospitalsof different types operating under and serving different major commands. It willbe recalled that there were only two types of zone-of-interior hospitals at the beginning of the war-station and general hospitals. As the Army's needschanged with its wartime expansion and combat experience, some of theseinstallations developed characteristics or were given functions which made themdiffer from the normal. For example, special hospitals were required forprisoners of war and others had to be prepared to receive combat casualties fromtheaters of operations. Moreover the desirability of establishing a new type ofhospital to care for convalescent patients was considered. Expansion of theArmy, along with reorganization of the War Department, also raised questions asto which commands should be served by and should operate hospitals of differenttypes. Therefore, before discussing the development of special characteristicsand functions of some hospitals, an explanation of the command relationships ofstation and general hospitals with higher headquarters is in order.
Command Relationships of Hospitals
Station Hospitals
Classified according to major commands under which theyoperated, station hospitals with few exceptions were either Army Service Forces(called Services of Supply until March 1943) or Army Air Forces hospitals. ASFstation hospitals furnished hospitalization not only for men and women of theService Forces but also for those of the Army Ground Forces. Hence, large campssuch as Fort Bragg (North Carolina) and Fort Jackson (South Carolina), withseveral infantry divisions each, were served by ASF station hospitals. By August1942 there were 133 ASF station hospitals; by February 1943, 166. In Februarythey ranged in size from 18 to 3,017 beds and had an average capacity of 643beds each. AAF station hospitals were as numerous as ASF station hospitals, butwere generally smaller. Located at AAF bases and fields and normally servingonly AAF personnel, they num-
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bered 103 in August 1942 and 169 in February 1943. On thelatter date they ranged in size from 19 to 1,471 beds and had an averagecapacity of 233 beds each.1 Sincetroops of the Ground Forces and of defense commands were usually hospitalized inASF hospitals, these commands had no "named" station hospitals undertheir jurisdiction, but in a few cases they established what amounted tohospitals of that type in the United States.
Defense command troops were generally dispersed overextensive areas to guard the coasts of the United States. Receiving onlyemergency medical care in their own installations, they were ordinarily treatedin ASF hospitals, or in near-by Air Forces, Navy, and civilian hospitals. Ingeneral, this system seems to have worked well,2 but in the WesternDefense Command where troops were concentrated to ward off a sneak Japaneseattack, difficulties arose. Delays in the Defense Command's decision on troopdistributions, as well as overlapping jurisdictions of the Defense Command, theNinth Service Command, and the Army Air Forces, impeded attempts of The SurgeonGeneral, the Service Command, and SOS headquarters to provide adequatefacilities.3In April 1942, to meetan immediate need for beds in the Los Angeles area, the Western Defense Commandarranged with the Veterans Administration to take over its buildings at Sawtelle,Los Angeles, Calif., from which neuropsychiatric patients were being evacuatedinland. The 73d Evacuation Hospital, a Western Defense Command unit, then movedin and established a 750-bed hospital, which became the station hospital for alltroops, Service Forces as well as Defense Command, in the area. In the fall of1942, at the request of the Western Defense Command, the Ninth Service Commandtook over the operation of this hospital. Although a Defense Command unit, ithad actually served as a named station hospital for approximately six months.4
The hospitalization of AGF troops on maneuvers continued tobe provided during the early war years essentially as before the war. GroundForces units, such as evacuation hospitals, furnished immediate care forpatients with minor illnesses and injuries, but transferred those requiringmajor surgery and long-term treatment to near-by ASF hospitals. This sufficedfor a situation in which maneuvers shifted from place to place and lasted for acomparatively short time, but The Surgeon General considered differentarrangements necessary when in the fall of 1942 the Ground Forces began almostyear-round use of two areas, the A. P. Hill Military Reservation in Virginia andthe Desert Training Center in California and Arizona.
1Annex B to Memos, SG for CG SOS, 30 Aug 42 and 12 Feb 43, sub: Opr Plan for Hosp and Evac. SG: 705.-1.
2(1) An Rpt, 1943, Surg, Northwestern Sector WDC. HD. (2) An Rpt, 1943, Surg WDC. HD. (3) Incl 1 to Ltr, CG WDC to SG, 21 Dec 43, sub: Opr Plans for Mil Hosp and Evac. HD: Wilson files, "Hosp and Evac Plans." (4) Ltr, CG SDC to SG, 30 Mar 44, sub: Plans for Mil Hosp and Evac. Same file.
3(1) Memo, Chief Misc Br Oprs SOS for Chief Oprs SOS, 14 Apr 42, sub: Add Hosp Cons, WDC. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42." (2) 1st ind, CG WDC to TAG, 9 Oct 42, on basic Ltr not located. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42." (3) SG: 632,-1(Cp Haan)C and 632.-l(Cp Callan)C. (4) See also Memo SPOPH 632, ACofS for Oprs SOS for ACofS OPD WDGS, 26 Sep 42, sub: Hosp Fac for Eastern and Western Def Comds. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42."
4(1) Ltr, Surg III Corps to SG thru Mil Channels, 3 Feb 43, sub: An Rpt Med Activities III Corps, 1942. Ground Med files: 319.1-2. (2) Ltr, CG WDC to TAG thru CG 9th SvC, 2 Sep 42, sub: Hosp at Sawtelle, Calif, and 4 inds. SG: 632.-1 (Sawtelle, Calif)F. (3) An Rpt, 1942, 73d Evac Hosp. HD.
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Although the Ground Forces operated a numbered evacuationhospital on the A. P. Hill Military Reservation for a short time, the ThirdService Command was responsible for providing fixed hospitalization for troopsin that area. AGF headquarters maintained that the reservation was being usedonly temporarily. The Ground Surgeon believed that it was satisfactory to giveemergency care in a temporary hospital, operated by personnel of numbered unitsunder service command control, and to evacuate patients with serious illnessesand injuries to the Fort Belvoir Station Hospital fifty miles away. Supportingthe Service Command Surgeon, The Surgeon General maintained that adequatehospitals should be provided in the immediate area in which troops werequartered, in order to avoid long ambulance hauls, and that any facilities lessthan those provided in cantonment-type buildings were unsatisfactory for thehospitalization of troops in the United States. The War Department General Staffsupported the position of the Ground Forces, while SOS headquarters gavewavering support to the Medical Department, alternately approving anddisapproving recommendations of The Surgeon General. The upshot of the wholematter was that the Third Service Command, failing to secure War Departmentapproval of its plans, continued for a period of almost two years to operate inthis area a temporary hospital located in winterized tents and manned bynumbered station hospital units without nurses.5
When the War Department decided to operate the DesertTraining Center (later called the California-Arizona Maneuver Area) as asimulated theater of operations under the jurisdiction of the Army GroundForces, the Ground Surgeon agreed with other officers from AGF and ASFheadquarters that hospitalization should be provided for it in the same manneras for an actual theater. As a result, engineer units of the communications zoneerected theater-of-operations-type buildings for hospitals, and beginning inFebruary 1943, communications zone headquarters moved in numbered station andgeneral hospital units to relieve the Ninth Service Command of allresponsibility for hospitalization within the area. By June 1943 thecommunications zone had either in operation or in the planning stage eight250-bed and one 150-bed station hospitals and three 1,000-bed general hospitals.Until these were all in operation, the Desert Training Center continued to sendlarge numbers of patients to neighboring ASF hospitals. Later, as communicationszone general hospitals began to offer definitive medical care, the number ofpatients evacuated to ASF hospitals decreased. Supplied with equipmentauthorized by tables of basic allowances and manned by numbered hospital unitswhich had their own nurses with them, these communications zone hospitalscontinued to provide station and general hospital types of care until theCalifornia-Arizona Maneuver Area closed in the spring of 1944. This plan ofhospitalization not only gave participating units invaluable practicalexperience but also demonstrated the possibility of using num-
5Documents dealing with this extended controversy may be found in the following files: SG: 701.-1 (Cp A. P. Hill)C; SG: 632.-1 (Cp A. P. Hill)C; AG: 632(9-18-42) (1); HRS: MID files 600-659, "Vol. I, Jan 42-Jul 44," and HD: Wilson files, 354.1 "Cp A. P. Hill." See also An Rpts, 1943, 66th, 108th, 222d, and 230th Sta Hosps (HD) and Comment by Brig Gen Frederick A. Blesse, 5 Dec 50. (HD: 314 [Correspondence on MS] III.)
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bered hospital units in the zone of interior medical service.6
General Hospitals
All general hospitals in the United States were operated bythe Army Service Forces but were planned to care for patients from the Ground,Air, and Service Forces alike. This arrangement was seriously threatened in thefall of 1942 by an attempt of the Air Forces to establish its own generalhospitals. Although unsuccessful at the time, this attempt was a forerunner ofothers which later in the war had significant effects upon the hospital system.It deserves consideration here not only for that reason but also because itillustrates difficulties created by the War Department reorganization of 1942.
Until the fall of that year only fifteen general hospitalswere in operation but beginning in September this number grew until it reachedthirty-one by January 1943.7 While new generalhospitals were opening, the Air Forces began to establish in effect-though notin name-separate general hospitals for AAF personnel. Having receivedauthority to recruit its own physicians, the Air Forces manned some of itsstation hospitals with specialists normally assigned only to general hospitals.In the winter of 1942-43 smaller AAF station hospitals began to transferpatients to these instead of general hospitals. The Air Forces also began totransfer to AAF station hospitals patients returned from theaters by airplane.With the development of such practices certain AAF station hospitals requestedthe Surgeon General's Office to reduce drastically-if not eliminatealtogether-the number of beds in general hospitals set aside for AAF patients.Later the Air Surgeon's Office asked for specialized equipment with which toestablish fifty-four specialty centers in neurosurgery, orthopedic surgery,thoracic surgery, and deep X-ray therapy in AAF station hospitals.8
The Air Surgeon found legal justification for such actions inthe reorganization of the War Department, which in his opinion established theAir Forces as a "command of equal authority" with the Service Forces,as well as in the indefinite terms of current directives governing the transferof patients to general hospitals. His attempt to set up separate generalhospitals for the Air Forces was prompted in part by a desire to establish aseparate medical department, but it also sprang from professionalconsiderations. The Air Surgeon contended that Air Forces men, especially combatcrew members, required specialized care which only AAF hospitals could give. Hebelieved that fliers were often lost to further combat duty because generalhospitals unnecessarily reclassified them for limited service. Furthermore, heinsisted that Air Forces hospitals were more efficiently operated
6(1) History of Medical Section, C-AMA. HD. (2) Draft Memo for Record, undated and unsigned. HRS: ASF Planning Div files, 353 DTC 1942-43. (3) Memo, Col William E. Shambora for ACofS G-3 AGF, 11 Mar 43, sub: Insp of La and DTC Maneuvers. Ground Med files: 354.2 "Maneuvers." (4) Interv, MD Historian with Col Shambora, 18 Apr 49. HD: 000.71. (5) An Rpts, 1943, 13th, 22d, 34th, and 297th Gen Hosps, and 37th, 59th, 94th, 107th, 127th, and 181st Sta Hosps. HD. (6) Sidney L. Meller, The Desert Training Center and C-AMA, Study No 15 (1946). AG.
7See below, Table 15, pp. 304-13.
8(1) See Tabs F, G, I, K, and L of Memo SPOPI 020, CG ASF for CofSA, 30 Apr 43, sub: Unification of Med Serv of Army by SG. AG: 020 SGO (3-30-43)(1). (2) Memo, Brig Gen C[harles] C. Hillman for SG, 15 Mar 43, sub: Rpt of Observation Trip. HD: 333. (3) Memo, Chief Professional Serv Br Air Surg Off for Chief Sup Div Air Surg Off, 5 May 43. SG: 323.7-5.
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than Service Forces hospitals and should therefore, in theinterest of economy, give the highest type of medical care for which they wereequipped and staffed.9
The Surgeon General disapproved the Air Forces'establishment of separate general hospitals under any guise, for he wished tomaintain a unified medical service under his direction as chief medical officerof the Army. Stating that men of the Air Forces were not different from those ofother arms and services, who also suffered from occupational diseases andhazards, he insisted that general hospitals were adequately staffed and equippedto care for them as well as for the sick and wounded of the rest of the Army.Permitting AAF hospitals to perform the functions of general hospitals wouldmake it more difficult, he stated, to supervise and co-ordinate professionalpractices and procedures. It would also result in duplication of hospitalbuildings (since general hospitals were already planned to care for the patientsof all major commands) and in an uneconomical use of personnel and equipment.Finally, he argued, having separate sets of hospitals for patients evacuatedfrom theaters of operations would complicate the evacuation process and wouldcause confusion in the submission of medical reports.10
The question of whether the Air Forces would be permitted toestablish separate general hospitals came to a head early in 1943 in connectionwith a movement initiated by the ASF Chief of Staff to reaffirm The SurgeonGeneral's authority as chief medical officer of the Army.11It reached the General Staff first, and finally the Secretary of War. G-4tended to favor the Air Forces, and while conceding that opposing contentions ofThe Surgeon General and the Air Surgeon were both just, he accepted the latter'sview that AAF hospitals were more efficient than those of the Service Forces. Herecommended, therefore, that the Air Forces be granted "additionalauthority" to treat all of their own combat personnel, including evacuees,in AAF hospitals.12 The Office ofthe Deputy Chief of Staff went a step further, publishing a directive on 20 June1943 which gave the Air Forces authority not only to treat its own combatpersonnel but also to operate whatever general hospitals were necessary for thatpurpose.13 Within a week the Air Surgeon'sOffice recommended the establishment of five AAF general hospitals: three by theconversion of AAF station hospitals and two
9(1) Memo, Air Surg for CG AAF, nd, sub: [Comments on Gen Somervell's Memo of 30 Apr 43 for CofSA], with 2incls. Asst SecWar for Air: 632(AAF Hosp). (2) Brief and Discussion, Tab B, toMemo, C of Air Staff for CofSA, 7 Oct 42, sub: Specialized Hosp and RecuperativeFac for AAF Pers. AAF: 354.1 "Rest Ctrs and Conv Homes." (3) Hubert A.Coleman, Organization and Administration, AAF Medical Services in the Zone ofthe Interior (1948), pp. 93-94. HD.
10(1) Memo SPMCB 701.-1, SG for CG SOS, 13 Oct 42, sub:Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.-1 "Rest Ctrsand Conv Homes" (1). (2) 1st ind, SG to CG ASF, 12 Apr 43, on Memo SPOPH020(3-30-43), CG ASF for SG, 30 Mar 43, sub: Relationship between SG and AirSurg. SG: 024.-1.
11For more details on this movement, see John D. Millett, TheOrganization and Role of the Army Service Forces (Washington, 1954), pp.132-37, in UNITED STATES ARMY IN WORLD WAR II; Blanche B. Armfield, Organizationand Administration (MS for companion vol. in Medical Dept. series), HD., andColeman, op. cit., pp. 93-107. Documents concerning it are on file asfollows: AG: 020 SGO (3-30-42) (1); HRS: G-4 file, "Hosp and EvacPolicy"; SG: 024-1; and HRS: Hq ASF, Gen Styer's files, "MedDept."
12Memo WDGDS 4440, ACofS G-4 WDGS for CofSA, 15 Jun 43, sub: MedServ of Army, with incl. HRS: G-4 file, "Hosp and Evac Policy."
13Memo WDCSA/320(5-26-43), DepCofSA for CGs AAF, AGF, ASF, 20 Jun43, sub: Med Serv of Army. HRS: G-4 file, "Hosp and Evac Policy." TheDeputy Chief of Staff, Lt. Gen. Joseph T. McNarney, was an AAF officer.
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by the transfer of the Borden (Oklahoma) and Torney(California) General Hospitals to Air Forces' jurisdiction.14By this time a new Surgeon General, Maj. Gen. Norman T. Kirk, was inoffice.15 He attacked the problemvigorously, and the entire matter reached the Secretary of War, who calledrepresentatives of the General Staff, the commanding generals of the Air andService Forces, and others into conference. General Kirk then proposed acompromise which the commanders of both the Air and Service Forces accepted.16
General Kirk admitted that Air Forces combat crews neededspecial treatment and consideration and offered to place flight surgeons in hisOffice and in general hospitals to serve as advisers in that field. He agreedalso to the Air Forces' establishment of convalescent centers. The Air Forcesfor its part agreed that all general hospitals would continue to operate underThe Surgeon General and the commanding general, Army Service Forces, and thatpatients evacuated from theaters of operations would be sent to generalhospitals. The only exception to the latter point was that combat crew memberssuffering from operational fatigue alone would be sent directly to AAFconvalescent centers. These centers were to be equipped and staffed as stationhospitals, but one of them, located at Coral Gables, Fla., was authorized toperform a function of general hospitals-the reclassification of officers forlimited service and the recommendation for their appearance before retiringboards. These terms of agreement were issued on 9 July 1943, with a statementthat they had been personally approved by the Secretary of War.17On the same day, the authority which had been granted to the Air Forces toestablish separate general hospitals was revoked.18
This agreement did not dispose of the question of whether ornot AAF station hospitals would give general-hospital-type treatment to zone ofinterior patients. At the time General Kirk drafted its terms, he had alsodrafted a statement of policy on the transfer of patients to general hospitals,defining more specifically the types of cases to be transferred. He had intendedto have it included in the 9 July 1943 agreement,19but instead, on 14 July 1943, he requested its publication as a WarDepartment circular.20 While maintaining thetraditional responsibility of station hospital commanders for the selection ofpatients for transfer to general hospitals,
14Memo [Air Surg] (init R[ichard] L. M[eiling]) for CofSA, 26 Jun 43, sub: Med Serv of AAF. Asst SecWar for Air: 632 (AAF).
15Gen Kirk assumed office on 1 June 1943.
16(1) Draft memo, prepared by SG, dated 3 Jul 43, sub: Hosp, with pencil note, "7/3/43 Personally delivered by Gen Kirk to Gen Somervell." SG: 705.-1 and SecWar: SP 632 (3 Jul 43). (2) Memo, CG AAF for DepCofSA, 5 Jul 43, sub: Hosp. Same files. (3) Memo, [Col] F. M. S[mith] for Gen Somervell, 5 Jul 43. HRS: Hq ASF Gen Styer's files, "Med Dept." How the matter reached the Secretary of War is not clear. On 19 November 1950 General Kirk wrote: "A conference was called in his [Secretary of War's] office one morning. I was called in ahead of time and Mr. Stimson told me that Secretary of Air, Mr. Lovett, had been to him that morning and told him about the memorandum. That the Air Force couldn't blame me for bringing it to his attention." Ltr, Maj Gen Norman T. Kirk to Col Roger G. Prentiss, Jr, 19 Nov 50, with incl. HD: 314 (Correspondence on MS) I.
17(1) Memo WDCSA/632 (9 Jul 43), DepCofSA for CGs AAF, ASF, AGF, 9 Jul 43, sub: Hosps. HRS: G-4 file, "Hosp and Evac Policy." (2) Memo, CG AAF for CG ASF, 5 Jul 43, sub: Hosps. AAF: 354.-1 "Rest Ctrs and Conv Homes." (3) Memo, CG ASF for CG AAF, 5 Jul 43. HRS: Hq ASF Gen Styer's files, "Med Dept."
18(1) Memo, DepCofSA for CG AAF, ASF, AGF, 9 Jul 43, sub: Med Serv of the Army. HRS: G-4 file, "Hosp and Evac Policy."
19Draft memo prepared by SG, 3 Jul 43, sub: Hosps, with incl 1, sub: Policy regarding Trf of Pnts to Named Gen Hosps. SG: 705.-1.
20Memo SPMCM 300.5-5, SG for Publications Div AGO, 14 Jul 43. AG: 704.11 (14 Jul 43)(1).
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the revised policy left them less discretion in the matter than they hadpreviously exercised. Its language was directive rather than advisory. Thefollowing categories of patients must be transferred to general hospitals: thoseneeding specialized treatment of the types for which general hospitals had beendesignated; those who would be hospitalized for ninety days or more; those uponwhom elective surgery of a formidable type would be performed; those withspecific types of fractures, and, with one exception, those evacuated fromoverseas theaters. Only Air Forces patients on a flying status, evacuatedbecause of operational fatigue alone, were to bypass general hospitals and godirect to Air Forces convalescent centers.21This directivecombined with the agreement already discussed to resolve for a time in TheSurgeon General's favor the question of the Air Forces' establishment ofseparate general hospitals.
Special Types of ASF Station Hospitals
Although all ASF station hospitals were essentially alike in the work theydid and the way they operated, a few established in the early war years differedin some respects from the normal. Among them were WAAC hospitals, all-Negrohospitals, and hospitals for civilians and prisoners of war.
Hospitals for Waacs
Formation of the Women's Army Auxiliary Corps in May 1942 emphasizedcertain problems such as the segregation of women from men in hospitals, theestablishment of services not ordinarily found in Army hospitals, and theprocurement of nonstandard drugs (that is, those not formally standardized forArmy use) for the treatment of women. The law establishing the WAAC directed the Secretary of War to provide hospitalization forits members "to conform as nearly as practicable to similar servicesrendered to the personnel of the Army" and permitted the use of"facilities and personnel of the Army" for this purpose.22The Surgeon General approved of this policy. He believed that additional wardsshould be constructed at established hospitals to supply enough beds to permitthe segregation of men from women and of women according to disease and rank.Because he expected women to have a higher sick rate, he recommended theprovision of beds for 5 percent of the strength of the WAAC, rather than for 4percent, as was the case with men. He proposed the procurement of a limitednumber of female physicians, first as contract surgeons and later ascommissioned members of the Medical Corps, to serve in hospitals where the WAACpatient load was high. Otherwise, he planned to give Waacs the same medical careas men. As experience with the hospitalization of Waacs accumulated andstatistics showed their noneffective rate to be only slightly higher than thatfor men, the Army provided hospital beds for them in the same ratio as for menand sent them to the same hospitals, though to segregated wards. Nevertheless,three Army hospitals were occupied chiefly by female patients.23
21WD Cir 165, 19 Jul 43.
22Public Law 554, 77th Cong., 2d sess., sec 10.
23(1) Rpt, SGs Conf with CA and Army Surgs, 25-28 May 42. HD: 337. (2) Memo, SG to CofEngrs, 6 May 43, sub: Med Fac for WAAC. SG: 632.-1. (3) AG Memo W 100-9-43, 3 Jul 43, sub: Housing for WAAC Pers. HD: 322.5-1 (WAC). (4) Memo, Maj Margaret D. Craighill, MC, Liaison Off for WAC for Col [Raymond W.] Bliss, 25 Aug 43, sub: Hosp for WAAC. Same file. (5) Memo, SG for CG SOS, 4 Jan 43, sub: Util of Women Doctors. HRS: Hq ASF Gen Styer's files, "Med Dept 1943."
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At the WAAC training centers-Fort Des Moines (Iowa), Daytona Beach (Florida), and Fort Oglethorpe (Georgia)-the station hospitals became predominantly WAAC hospitals, staffed largely by women and caring mainly for women. This was especially true at Daytona Beach. By the end of 1943 its 601-bed hospital had an enlisted complement made up almost entirely of women, only fifty men being assigned for duty in and around the hospital. At Fort Des Moines, female doctors engaged as contract surgeons were assigned for duty with the Waacs. At first the development and supervision of special professional services for women were left largely to local hospital commanders. Station hospitals at training centers developed gynecologic and obstetric services and procured locally special drugs required for the medical care of women. In May 1943, approximately a year after the WAAC was established and a month after Congress authorized the commissioning of women physicians in the Army, The Surgeon General assigned a female Medical Corps officer to his Office to supervise the handling of medical problems peculiar to female personnel.24
All-Negro Hospitals
The establishment of two all-Negro station hospitals in the United States came not as a result of any policy of The Surgeon General to segregate patients racially for medical care and treatment, but rather as a result of The Surgeon General's opposition to the integration of Negro doctors and nurses with white professional personnel in the operation of hospitals caring for white patients.25 This consideration had already resulted in the establishment in May 1941 of groups of all-Negro wards in the hospitals at Fort Bragg (NorthCarolina) and Camp Livingston (Louisiana). Perhaps because of unencouragingreports from these experiments, the Army had not extended the practice to otherhospitals. After war started, The Surgeon General revived a recommendation,previously disapproved by the General Staff, that all-Negro hospitals beestablished to employ additional Negro doctors and nurses. The Staff reversedits earlier decision, and during 1942 an all-Negro station hospital wasorganized at Fort Huachuca (Arizona), a post at which Negro troops were beingtrained. A separate hospital, manned by white doctors and nurses, continued inoperation to care for white patients. The year before, the Army Air Forces hadestablished an all-Negro hospital at Tuskegee, Ala.
Establishment of all-Negro hospitals and wards did not signify a general abandonment of the Army's long-established policy of nonsegregated treatment. Other hospitals manned by white doctors and nurses continued to treat patients of both races on a nonsegregated basis throughout the war.26 Nor did it mean that the Medical
24(1) An Rpts, 1943, Sta Hosps, Daytona Beach and Ft Oglethorpe. HD. (2) Memos, Dr Paul Titus, Consultant, to SG, [27 Sep 43] and 1 Nov 43, sub: Rpts on Surg (Obstetrics-Gynecology) as an Army Serv. HD:210.01. (3) Memo, SG for CG SOS, 4 Jan 43, sub: Util of Women Doctors. HRS: HqASF Gen Styer's files, "Med Dept 1943." (4) Mattie E. Treadwell, TheWomen's Army Corps (Washington, 1954), Ch. XXXI, in UNITED STATESARMY IN WORLD WAR II. (5) Margaret D. Craighill, History of Women's MedicalUnit (1946). HD.
25For a full discussion of the question of the use of Negro professional personnel by the Medical Department, see John H. McMinn and Max Levin, Personnel (MS for companion Vol. in Medical Department series). HD. Also see Ulysses Lee, The Employment of Negro Troops, a forthcoming volume in the series UNITED STATES ARMY IN WORLD WAR II.
26(1) Ltr, SG to TAG, 25 Oct 40, sub: Plan for Util of Negro Offs, Nurses, and EM in MD, and 3 inds. (2) Memo, SG for ACofS G-1 WDGS, 7 Jul 41, sub: Rpts on Util of Negro Med Pers. (3) Memo, Maj Arthur B. Welsh for [Brig] Gen [Larry B.] McAfee, 17 Jan 42. (4) Memo, SG for ACofS G-3 WDGS, 30 Jan 42. (5) Memo, SG for TAG, 16 Mar 42, sub: SecWar's Press Conf on Use of Negro Doctors. All in HD: 291.2. (6) Memo, ACofS G-l WDGS for CofSA, 4 Aug 41, sub: Almt of Negro MD Res Offs and Female Nurses. HRS: G-l/15640-46. (7) Memo, P. W. Clarkson, Off ACofS G-1 WDGS for Record, 8 Aug 41. Same file. (8) An Rpt, 1942, Post Surg Ft Huachuca. HD.
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Department would fail to use Negro enlisted personnel and civilians in other hospitals. As early as December 1941, for example, Negro enlisted men were assigned to the medical detachment of at least one station hospital-that at Chanute Field (Illinois).27Later Negro enlisted men and women were assigned to other Army hospitals. While many were employed in housekeeping and maintenance operations, some were assigned to technical and administrative duties.28
Before leaving this subject one needs to look ahead to thelater war years. At that time the practice of using Negro doctors and nurses ona segregated basis was modified. Such civilian groups as the NationalAssociation of Colored Graduate Nurses, certain segments of the press, somemembers of Congress, the Negro civilian aide to the Secretary of War, and thePresident's wife (Mrs. Franklin D. Roosevelt) urged The Surgeon General, ASFheadquarters, and the Secretary of War to use more Negro nurses and to use themon a nonsegregated basis.29 In December 1943 and again in May 1944ASF headquarters directed The Surgeon General to procure and use additionalNegro nurses.30 Accordingly, Negro nurses on duty with the Armyincreased from 218 in December 1943 to 512 by July 1945. Although some continuedto serve with all-Negro hospitals in this country and in theaters of operations,others were used on a nonsegregated basis in 4 general hospitals, 3 regionalhospitals, and at least 9 station hospitals in the United States.31 During 1945 nonsegregated use of Negro doctors occurred in at least one instance. When the troop strength of Fort Huachuca declined, the patient load decreased and professional staffs of the two station hospitals at that post were reduced accordingly. Services of the two then gradually merged and both doctors and nurses of the two races served together to care for white as well as Negro personnel.32 Thus the primary reason for the establishment of separate all-Negro wards and hospi-
27An Rpt, 1941, Sta Hosp, Chanute Field. HD.
28(1) An Rpts, 1942, Sta Hosps, Cps Shelby and Forrest,and An Rpts, 1942, 702d, 720th, 721st, and 730th Med Sanitary Cos.HD. (2) McMinn and Levin, op. cit.
29Letters to this effect may be found in the following files: SG: 211 "Nurses, Negro"; OSW: Civ Aide to SecWar,"Nurses"; and AG: 211 "Nurses, Negro." See also Florence A. Blanchfield and Mary W. Standlee, The Army Nurse Corps in World War II (1950),pp. 161-205. HD.
30(1) Memo, CG ASF for SG, 14 Dec 43, sub: Utilization ofNegro Nurses. SG: 291.2-1. (2) Memo, CofS ASF for SG, 6 May 44, same sub. ASF:210.31.
31(1) Memo, Col Florence A. Blanchfield (SGO) for ColArthur B. Welsh (SGO), 17 Dec 43, sub: Distr of Colored Nurses. SG: 291.2-1. (2) Memo, SG for CivAide to SecWar, 26 Jul 45. SG: 211 "Nurses, Negro." (3) Facts aboutNegro Nurses and the War, prepared jointly by the National Association ofColored Graduate Nurses and the National Nursing Council for War Service, ca.Jan 45. OSW: Civ Aide to SecWar, "Nurses."
32(1) Memo, Asst Aide to SecWar for SG, 29 Mar 45, sub: Staffof Sta Hosp No 1, Ft Huachuca, Ariz. (2) Memo, Dep Chief [of Oprs Serv] for Hospand Domestic Oprs [SGO] for SG, 8 Jun 45, sub: Rpt of Visit to Sta Hosp, FtHuachuca, Ariz. (3) Ltr, CO Sta Hosp Ft Huachuca to Maj Gen G[eorge] F. Lull,SGO, 16 Aug 45. All in OSW: Civ Aide to SecWar, "Huachuca." There wassome question during the war whether the two hospitals at Huachuca were ever infact two separate hospitals or merely two sections of one hospital. This aroseapparently from the fact that the post surgeon, a white Medical Corps officer,served in addition as commander of the white hospital and exercised at the sametime considerable authority over the commanding officer of the all-Negrohospital. Failure to settle this question resulted in dissatisfaction on thepart of the latter. See letters in the file just cited and in SG: 323.3 (Ft Huachuca)N.
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tals-opposition to the integrated use of Negro and whiteprofessional personnel in the care of both white and Negro patients-had begunto lose some of its force by the end of the war.
Army Hospitals for Civilians
By the end of 1942 a situation developed which required theestablishment in the United States of several hospitals for civilian employeesand their families. During 1941 the Army had initiated industrial hygieneprograms in Army-owned plants and depots. Under Medical Department supervision,these programs expanded rapidly during 1942 to keep pace with wartime industrialgrowth. Designed to give only emergency medical care, industrial hygienefacilities were adequate in areas where civilian hospitals were available.Toward the end of 1942, when the Ordnance Department established storage depotsfor explosives in isolated regions, lack of hospitals retarded employeeprocurement and increased absenteeism. Workers were reluctant to move with theirfamilies to such areas and failure to receive prompt medical care often resultedin prolonged illnesses. To help maintain depot production levels, The SurgeonGeneral proposed in December 1942 that the Army construct and operate hospitalsin remote areas which lacked adequate medical facilities. In February 1943 theSecretary of War authorized the construction of hospitals at the Sierra(California), Umatilla (Oregon), Black Hills (South Dakota), Tooele (Utah),Sioux (Nebraska), and Navajo (Arizona) Ordnance Depots. Constructed during 1943,these hospitals operated under service command supervision until after the endof the war. They differed from other Army station hospitals in having a minimum ofmilitary personnel assigned to them, in providing family medical care, includinggynecologic and obstetric services, and in requiring payment for servicesrendered. Despite recommendations of The Surgeon General, similar hospitals werenot established in other places. In one instance, permission was granted toestablish an Army hospital but was withdrawn partly on account of politicalpressure and partly because the community itself, after an extended period oftime, provided additional hospital accommodations. In another, authority wasgranted to hospitalize civilian employees and their families in a near-by Armystation hospital.33
Hospitals for Prisoners of War
Early in 1942, when prospective combat operations demandedpreparation for the internment of prisoners of war, The Provost Marshal Generaland The Surgeon General agreed upon basic policies for their hospitalization. Incompliance with the Geneva Convention,34 hospital accommodations andmedical care for prisoners of war were to be equal to those for United Statestroops, and prisoners
33(1) Ltr, SG to SecWar thru CG SOS, 11 Dec 42, sub: MedCare for Civ Employees of Army-Operated Plants, and their Families, with 4 inds.(2) Ltr, SG to CofS SOS, 21 Jan 43, same sub. (3) Memo WDGDS-2172, SecWar forCG SOS, 9 Feb 43, same sub. All in AG: 701(9-17-41)(1). (4) W. L. Cooke, Jr,Organization and Administration of Preventive Medicine Program, pp. 53-59. HD.(5) An Rpts, 1943, Sta Hosp Black Hills and Tooele Ord Depots. HD. (6) An Rpts,1942 and 43, Surg, 1st thru 9th SvC. HD. (7) Memo, Capt J[ames] J. Souder for Col J[ohn] R. Hall, 8 Apr 43, sub: Conf on Prov of Hosp Fac for Instis in Ogden,Utah, Area. SG: 632.-1.
34Article I, Chapter I, Conventions of 1906 and 1929.See Army Medical Bulletin, No. 62 (1942), pp. 88 and 105.
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were to assist in the care of their compatriots. Promulgated in tentative regulations published in April 1942 and reiterated in September 1943, these policies governed the hospitalization of prisoners throughout the war. For separate prisoner-of-war camps, the Army constructed hospitals with beds for 4 percent of the inmates. For prisoners at Army posts, wards surrounded by wire fences were added to existing station hospitals. Whether in separate camps or on Army posts, such hospitals operated under service command supervision and, except for the use of captured enemy personnel and civilian registered nurses, were similar to other service command hospitals. Prisoners requiring more specialized care than offered in station hospitals were transferred to generalhospitals.35
Port and Debarkation Hospitals
Hospitals were needed near ports for large numbers of transients-troopsawaiting shipment overseas as well as patients being returned to generalhospitals in the United States. In accord with SOS directives, hospitals forports and staging areas were exempt from service command jurisdiction andoperated directly under port commanders who in turn were subject to control bythe Chief of Transportation.36 For most of 1942, many ports lacked adequatestaging area hospitals and therefore sent patients to others located near by. AtLos Angeles, for example, patients from the port were cared for in the WesternDefense Command's 73d Evacuation Hospital at Sawtelle. The ports atCharleston, New Orleans, and San Francisco used Stark, LaGarde, and LettermanGeneral Hospitals, respectively, while those at Boston and Hampton Roads sentpatients to near-by service command station hospitals. During 1942 and1943 special port and staging area hospitals were constructed and opened to carefor port personnel and transient troops. They differed from other stationhospitals primarily in that their surgical services were considerably smallerand less important than their medical services, because they normally performedonly emergency surgery for the thousands of troops who passed through ports.37
The kind of hospitals that would be used to receive transientpatients returning from theaters of operations remained uncertain until thelatter part of 1942. Special debarkation hospitals under port control might beestablished in existing buildings with only the personnel and equipment neededto "process" returning patients-that is, replace their missingrecords, make partial payments of the
35(1) Memo, Capt Charles M. Huey, Mil Intel Aliens Div OPMG for Chief Aliens DivOPMG, 26 Dec 41, sub: Conf Regarding the Estab of Hosp . . . in PW Cps. SG:255.-1. (2) Tentative Regulations: Interned Alien Enemies and Prisoners of War. AG:383.6(8-9-42)(1). (3) PW Cir 1, 24 Sep 43. PW Off OPMG. (4) Memo, CofS ASF for SG andQMG, 26 May 43, sub: Hosp Fac for PW Cps, and 1st ind. SG: 632-1. (5) An Rpts, 1943, Surg, 7th and 8th SvCs. HD. (6) An Rpts, 1943, Sta Hosp PW Cps at Florence, Ariz; Cp Clark, Mo; andComo, Miss. HD. (7) See also: Rene H. Juchli, Record of Events in the Treatment of Prisoners of War, World War II (1945). HD.
36Mil Hosp and Evac Oprs, incl 1 to Ltr SPOPH 322.15, CG SOS to CGs and COs of SvCs and PEs and to SG, 15 Sep42, sub: Mil Hosp and Evac Oprs. HD: 322(Hosp and Evac).
37(1) An Rpts, 1942 and 43, Surg, Boston, New York, Hampton Roads, Charleston, New Orleans, Seattle, and Portland PEs, and An Rpts, 1943, Surg, Cps Myles Standish, Kilmer, and Plauche. HD. (2) Opr Plan for Mil Hosp and Evac, Boston, 30 Nov 42; New York, 10 Dec 42; Hampton Roads, 15 Dec 42; Charleston, 24 Nov 42; New Orleans, 12 Dec 42; San Francisco, 9 Jul and 1 Dec 42; and Seattle, 27 Nov 42. HD: Wilson files. (3) SG: 632.-2, 1942 and 43, (LaGarde GH)K, (Letterman GH)K, and (Stark GH)K.
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money due them, classify them according to disease or injury,and prepare them for further travel to general hospitals. Such hospitals hadbeen used during World War I,38 and for a while in 1942 it seemed as if SOSheadquarters and certain port commanders expected their revival. One SOSdirective implied that ports might establish special debarkation hospitals,39and Charleston, Seattle, and San Francisco expressed a desire for them.40
The Surgeon General had other plans. During the emergencyperiod he had used general hospitals near ports-Tilton for New York, Stark forCharleston, LaGarde for New Orleans, and Letterman for San Francisco-toreceive and care for patients brought in on ships. After war began he continuedthis system, granting unlimited bed credits in near-by general hospitals toports receiving overseas casualties.41 He also located some of thegeneral hospitals planned early in 1942 in coastal areas, though not in closeproximity to ports,42 with the expectation that they would processpatients arriving from theaters.
A final decision to this effect came in the fall of 1942 in connection with plans for the reception of casualties from the North African invasion. At that time whole trainloads of patients with a variety of ills could be sent to a single general hospital, because hospitals had not yet been designated for the specialized treatment of certain types of cases nor had the policy of hospitalizing casualties near their homes been established.43 Two alternatives therefore presented themselves, namely, ship-to-train movements, in which patients would be transferred directly from ships to trains for transfer to distant general hospitals, and ship-to-hospital movements, in which they would be moved from ships to near-by hospitals before undertaking further travel.44 Thepossibility of using ship-to-train movements exclusively, thereby eliminatingthe need for a debarkation hospital at or near the port, arose at Hampton Roads.Piers at that port had ample trackage to accommodate hospital trains, making itpossible to move patients under cover directly from ships to trains. The portcommander preferred this procedure, his surgeon explaining that it wouldmaintain the port as an agency of movement, its primary purpose.45While The Surgeon General and the chief of the SOS Hospitalization andEvacuation Branch recognized the merits of this position, both felt that someship-to-hospital movement would be unavoidable. Some patients would requireimmediate hospital care before further travel; in some instances ship-to-trainevacuation might
38The Medical Department . . . in the World War (1923),vol. V, pp. 426-33, 786, 791, 800.
39Mil Hosp and Evac Oprs, par 5 d (3) (d), incl 1, to Ltr SPOPM 322.15, CG SOS to CGs and COs, CAs, PEs, GHs and SG, 18 Jun 42,sub: Opr Plans for Mil Hosp and Evac. HD: 705.-1.
40Opr Plans for Mil Hosp and Evac, Jul 42, Charleston, Seattle, SanFrancisco, New Orleans, and Boston. HD: Wilson files.
41For example, see: (1) Ltr, SG to CG NYPE, 18 Feb 42, sub: Bed Almts inGen Hosps. Same file. (2) Ltr, SG to CG 9th CA, 5 Jan 42, sub: Bed Almts inBarnes Gen Hosp. SG: 632.2 (Barnes GH)K. (3) 2d ind, SG to CG NYPE, 9 Mar 42, onLtr, Port Surg Sub-Port of Boston to Port Surg NYPE, 5 Mar 42, sub: Bed Credits.SG: 632.-2 (NYPE)N. (4) 1st ind, CG SOS (SG) to CO CPE, 29 Aug 42, on Ltr, COCPE to CG SOS, 21 Aug 42, sub: Bed Credits. SG: 632.-2 (Stark GH)K.
42For example, Valley Forge, Woodrow Wilson, Moore, Torney, Hammond, Baxter,and McCaw General Hospitals. Also see above, pp. 88-90.
43See below, pp. 116-17.
44Rpt, Conf, CofT, SG, SOS, NYPE, and HRPE, 23 Oct 42. TC: 370.05(Plans, Policies, Procedures).
45(1) Ltr, CG HRPE to SG, 10 Nov 42. SG: 705.-1 (HRPE)N. (2) Ltr, Port Surg HRPE to SG, 15 Dec 42, sub: Opr Plans for Mil Hosp and Evac. HD: Wilson files.
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interfere with troop movements; in others, casualties mightarrive unexpectedly when trains were unavailable.46 For these reasonsthey overruled the port commander. Since the housing shortage in Norfolk madeimpracticable a proposal to take over a hotel for hospital use, arrangementswere made to use the station hospital at Fort Monroe and five hundred beds inthe Veterans Administration hospital at Kecoughtan, Va., for debarkationpurposes.47 This action made it clear that some hospital, whateverits kind, would be established to receive casualties at every port ofdebarkation.
Unlike his counterpart at Hampton Roads, the port commanderat New York wanted Halloran General Hospital, being opened on Staten Island, toserve solely as a debarkation hospital under port control.48 TheChief of Transportation, on the other hand, wished to keep ports free of theburden of administering large hospitals and on 9 November 1942 announced thatSOS directives authorized ports to operate hospitals for assigned personnel andtransient troops only, not for patients being returned from theaters.49 Concurrenceof the SOS Hospitalization and Evacuation Branch in this interpretation placedan official stamp of approval on The Surgeon General's plan to use generalhospitals under service command control, rather than special hospitals underport control, for debarkation activities.
Most general hospitals located near ports performed dualfunctions-providing definitive treatment for some patients and processingothers for further travel-until late in the war. This created complications.Ports were granted unlimited bed credits in such hospitals, but near-by stationhospitals also continued to receive bed credits in them. This overlapping caused some concern inSOS headquarters.50 Investigation showed that Halloran GeneralHospital kept a list of patients earmarked for transfer to other generalhospitals when the evacuation load required it.51 Stark, LaGarde, and BarnesGeneral Hospitals simply waited until the necessity arose and then transferredpatients receiving definitive care to other general hospitals located fartheraway from ports. Others, notably Letterman and Lovell, kept beds vacant whileawaiting the arrival of evacuated casualties. This system occasionally causedthe transfer of patients needing general hospital care to station hospitals. Inthe opinion of some hospital commanders, it was also wasteful of bothprofessional personnel and highly specialized equipment.52 Later,when the evacuation load reached its peak, The Surgeon General partially sharedtheir view, for in 1945, as will be seen later, he proposed the conversion of
46(1) 1st ind, Chief Hosp and Evac Br SOS to CofT, 18 Nov 42, sub: Evac, on unknown basic Ltr. TC: 370.05(Plans, Policies, Procedures). (2) Ltr,CG HRPE to SG, 10 Nov 42. SG: 705.-1 (HRPE)N.
47(1) Off memo, signed by Col H. D. Offutt, 9 Nov 42. HD:370.05 "Spec Oprs." (2) Ltr, Act SG to CG HRPE, 14 Nov 42. SG: 705.-1 (HRPE)N.
48(1) Diary, Chief Hosp and Evac Br SOS, 2 Nov 42. HD: Wilson files, "Diary." (2) Ltr, Port Surg NYPE to Col H. D. Offutt, 12 Nov 42. SG: 705(NYPE)N. (3) An Rpt, 1942, Halloran Gen Hosp. HD.
49(1) Diary, Chief Hosp and Evac Br SOS, 3 Nov 42. HD: Wilson files, "Diary." (2) Ltr, CofT to CGs of PEs, 9 Nov 42, sub: Mil Hosp and Evac. TC: 370.05 (Plans, Policies, Procedures).
50Diary, Chief Hosp and Evac Br SOS, 14 Dec 42. HD: Wilsonfiles, "Diary."
51Memo SPOPH 701, Chief Hosp and Evac Br SOS for ACofS for OprsSOS, 27 Dec 42, sub: Availability of Hosp Beds for Port of NY. HD: Wilson files,"Book 2, 26 Sep 42-31 Dec 42."
52An Rpts, 1942 and 43, Halloran, Stark, LaGarde,Barnes, Letterman, and Lovell Gen Hosps. HD.
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staging area station hospitals into debarkation hospitals.53
Designation of General Hospitalsfor Specialized Treatment
Early in 1943 The Surgeon General initiated a formal programof specialization in general hospitals. During World War I the MedicalDepartment had manned and equipped certain hospitals for the care of particulartypes of cases.54 In the interval between wars specialization hadcontinued on a limited scale. By January 1942, for example, deep X-ray therapyhad been established as a specialty in the Army and Navy, Fitzsimons, Lawson,Letterman, Walter Reed, and William Beaumont General Hospitals.55 In March1942 Darnall General Hospital opened to receive psychotic patients who neededclosed ward treatment.56 Other specialty centers graduallydeveloped at hospitals where eminent specialists were assigned,57andtoward the end of 1942 The Surgeon General made it known that he intended toformalize and extend existing specialization. Apparently he awaited only thedevelopment of circumstances warranting such action.58
In the winter of 1942 that development occurred. Beginning inSeptember new general hospitals opened in increasing numbers.59Itwas soon evident that a limited supply of specialists would prohibit thestaffing of each one for all kinds of surgical and medical work. Referring tothis problem, the surgeon of the Fourth Service Command suggested in January1943 that certain general hospitals in his area be equipped and manned to givespecialized care in different branches of surgery.60 Simultaneously withthe opening of the new general hospitals, a transition from defensive tooffensive warfare presaged the arrival of large numbers of combat casualtiesrequiring complicated surgery. Moreover, public insistence upon hospitalizationof casualties near their homes grew until The Adjutant General in December 1942proposed establishment of a policy to conform with the demand.61 Ifadopted and applied too rigidly, such a policy would conflict with The SurgeonGeneral's unpublished plan to transfer casualties to hospitals specializing inparticular diseases or injuries. He therefore made a counterproposal: patientsneeding specialized treatment would be sent to general hospitals designated forsuch, while those requiring prolonged but not specialized treatment would betransferred to hospitals in the vicinity of their homes.62
53See below, p. 192.
54The Medical Department . . . in the WorldWar (1923), vol. V, pp. 171-73.
55SG Ltr 44, 15 May 41, and SG Ltr 1, 2 Jan 42.
56An Rpt, 1942, Darnall Gen Hosp. HD.
57An example of this development was found in Tilton GeneralHospital which established a special neurosurgical section during 1942 and wasdesignated a neurosurgical center in March 1943. An Rpts, 1942 and 43, TiltonGen Hosp. HD.
58(1) Memo, SG for Dir Control Div SOS, 1 Aug 42. SG: 020.-1. (2) Memo, Chief Pers Serv SGO for DirMil PersSOS, 2 Dec 42. SG: 323.7-5.
59
Month | Number of General Hospitals Reporting Patients Weekly |
August 1942 | 15 |
September 1942 | 17 |
October 1942 | 19 |
November 1942 | 22 |
December 1942 | 26 |
January 1943 | 31 |
60Ltr, CG 4th SvC (Chief Med Br) to SG, 23 Jan 43, sub: Surg Serv, Gen Hosps, with 1st ind, CG SOS (SG) to CG 4th SvC attn Chief Med Br, 8 Feb 43. SG: 323.7-5 (4th SvC)AA.
61(1) Draft memo, TAG for CofS SOS, 29 Dec 42, sub: Hosp ofCasuals Returned to the US as Battle Casualties. AG: 701(12-29-42)(1). (2) IAS, TAG to SG, 29 Dec 42, same sub. Same file.
62(1) 1st memo ind, SG to TAG, 7 Jan 43, on IAS, TAG to SG, 29 Dec 42, sub: Hosp of Casualties. AG: 701(12-29-42)(1). (2) Memo SPOPH 701(1-16-43), ACofS for Oprs SOS for TAG, 19 Jan 43, same sub. Same file.
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Approval and publication of this policy on 1 February 194363required the formal designation of specialty centers. For several weeksafterward The Surgeon General's Hospitalization and Evacuation Division workedon this problem,64 and on 6 March 1943 the War Department designatednineteen general hospitals for the following specialties: chest surgery,maxillofacial and plastic surgery, ophthalmic surgery and the treatment of theblind, neurosurgery, and the performance of amputations.65About twomonths later, two additional specialties-vascular surgery and the treatmentof the deaf-were announced and another general hospital was placed on thelist.66 Further extension of specialization occurred during the later war years.
The Question of EstablishingConvalescent Hospitals
During the latter part of 1942 the opinion gained favor bothin civilian and military circles that special accommodations for convalescentpatients should be provided either as separate hospitals or as annexes toexisting hospitals. Among civilians it developed apparently from a desire eitherto "do something for the boys" or, in some instances, to dispose oflarge estates with questionable market values.67 In the Army it arose from theneed to save both manpower and hospital beds. The idea was not new, for duringWorld War I the Medical Department had conducted "reconstruction"programs in general hospitals and convalescent centers both in the United Statesand France.68 In the latter half of 1942 several widely separated hospitals-theFort Bliss Station Hospital in Texas, the Jefferson Barracks Station Hospital inMissouri, and the Lovell General Hospital in Massachusetts-established programs to hardenpatients for return to duty, to reduce the period of their convalescence, and tosalvage for full field duty those who might otherwise be either discharged fromthe Army or placed in the limited service category.69 In January 1943the surgeon of the Eighth Service Command recommended the organization of casualdetachments to recondition convalescent patients and salvage psychoneuroticsoldiers for full duty.70 The surgeon of the Ninth Service Command proposedthe establishment of "overflow installations" to free hospital beds ofpatients no longer needing hospital care but not yet ready for full militaryduty.71 In this connection, General Snyder, a medical officer on thestaff of The Inspector General, found in a survey in November 1942 thatapproximately 67 percent of the patients
63WD Cir 34, 1 Feb 43.
64(1) Memo, SG for TAG, 24 Feb 43, sub: Cir Ltr 50, Spec Hosps. AG: 705(2-24-43)(1). (2) Ltr, Col Arden Freer, SGO to Col S[anford] W. French, Hq 4th SvC, 8 Feb 43. SG: 323.7-5 (4th SvC)AA.
65WD Memo W40-9-43, 6 Mar 43, sub: Gen Hosps for Spec SurgTreatment. AG: 705(2-24-43)(1).
66WD Memo W40-14-43, 28 May 43, sub: Gen Hosp,Specialized Treatment. AG: 323.7-5(W40-9-43) (3-6-43).
67The Surgeon General received numerous offers. For some of the replies he made, see: (1) Ltr SPMCC, SG to Mr. W. K. Kellogg, 4 Aug 42. (2) Ltr, Act SG to Hon Joseph F. Guffey, US Sen, 20 Nov 42. (3) Ltr, Act SG to Hon Lex Green, H. R., 12 Dec 42. All in HD: 601.-1.
68(1) The Medical Department . . . in theWorld War (1927), vol. XIII, pp. 79-222. (2) Charles E. Remy, The History ofa Convalescent Camp of the American Expeditionary Forces in France (1942). HD.
69An Rpts, 1942, Sta Hosps at Ft Bliss and Jefferson Bks, andLovell Gen Hosp. HD. Similar action was being taken in the European Theater ofOperations at the same time. See Memo, Consultant in Surg ETO to DirProfessional Serv ETO, 28 Sep 42, sub: Rpt on Visit to Med Instls in Northern Ireland. HD: ETO file, "Col Elliott C. Cutler, Rpts Jul 42-Dec 42."
70An Rpt, 1942, Chief Med Br 8th SvC. HD.
71An Rpt, 1942, Chief Med Br 9th SvC. HD.
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in Army hospitals were convalescent and could be cared for in barracks, ifnecessary, to release hospital beds for patients requiring close medicalsupervision.72
While medical officers in the field were becoming aware of the convalescent problem, it was also receiving attention in Washington. In September 1942 it came up in the hearings of the Wadhams Committee.73 A month later the Air Forces requested authority "to establish and operate specialized hospital and recuperative centers for individualized treatment, rehabilitation, and classification of Air Forces personnel."74 The Air Surgeon believed that special hospitals should be established under Air Forces' control to treat and rehabilitate Air Forces patients suffering from such conditions as staleness, anoxia, operational fatigue, aeroneurosis, and aero-embolism.75 Surgeon General Magee, on the other hand, strongly disapproved the establishment by the Air Forces not only of general hospitals, as discussed earlier, but also of any hospitals other than the station hospitals which they already operated. Moreover, he preferred to carry on reconditioning programs in existing hospitals. He argued that convalescent patients often needed observation and sometimes "active therapeutic management" by doctors fully acquainted with their cases and should therefore not be moved far from hospitals where they received definitive care. He contended furthermore that the establishment of convalescent hospitals would lead to duplication of buildings and a waste of personnel and equipment. Hence, he refused to concur in the Air Forces' proposal, but gave his approval instead to the establishment of nonmedical AAF rest camps. To the Wadhams Committee's recommendation for the establishment of separate convalescent accommodations free of the hospital atmosphere, TheSurgeon General replied on 15 December 1942: "It is the opinion of thisoffice that convalescent sections may be more advantageously operated asintegral parts of military hospitals. . . "76
Before final action was taken on the Air Forces' request,both the Air Surgeon and The Surgeon General began to initiate reconditioningprograms in existing hospitals. In November 1942 the Wadhams Committeerecommended this step as well as the establishment of convalescent hospitals.77The next month, the commanding general, Army Air Forces, published adirective, prepared by the Air Surgeon, requiring all Air Forces hospitals"to institute recreation and reconditioning programs for convalescentpatients."78 In January 1943 The Surgeon General pro-
72Ltr, Asst to IG (Brig Gen Howard McC. Snyder) to IG,10 Nov 42, sub: Surv of Hosp Fac and their Util. IG: 705-Hosp(A).
73Cmtee to Study the MD, 1942, Testimony, pp. 205, 383-84, 441-42, and 460. HD.
74Memo, C of Air Staff for CofSA, 7 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF:354.1 "Rest Ctrs and Conv Homes."
75(1) Cmtee to Study the MD, 1942, Testimony of Brig Gen David N. W. Grant, pp. 383-84. HD. (2) Brief and Consideration of Non-Concurrence [of SG], Tab B and par IV of Memo, C of Air Staff for CofSA, 7 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.1 "Rest Ctrs and Conv Homes."
76(1) Cmtee to Study the MD, 1942, Testimony of Offs of SGO, pp.163-66, 441-42, 460, HD. (2) Memo SPMCB 701.-1, SG for CG SOS, 13 Oct 42,sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.1 "RestCtrs and Conv Homes" (1). (3) 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 No 24. HD.
77Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 14. HD.
78(1) AAF Memo 25-9, 14 Dec 42, sub: Recreation andReconditioning for Conv Pnts in AAF Hosps. AAF: 300.6. (2) Howard A. Rusk,"Convalescence and Rehabilitation," Doctors at War, MorrisFishbein, ed. (New York, 1945), pp. 303-04.
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posed a War Department circular to require all fixed hospitals, overseas as well as in the United States, to inaugurate reconditioning programs. Fearing that such programs would require additional personnel and construction and doubting its own authority to order their establishment, SOS headquarters delayed publication of this directive until 11 February 1943.79 Both the Air Forces and War Department directives provided for programs of recreation, graded exercises, and drills; the former, for a program of education as well. Until late 1943 only a few hospitals, among them the station hospitals at Camp Crowder (Missouri), Fort Benning (Georgia), Jefferson Barracks (Missouri), and the O'Reilly General Hospital, developed effective programs.80
Meanwhile the Air Forces' persistence in demanding separate convalescentfacilities led the General Staff to consider that problem. At first G-4 wasreluctant to permit the Air Forces to establish even rest centers, proposinginstead that they "farm out" convalescents in civilian resort hotels.G-4 felt that the convalescent problem was one for the future, since theimmediate needs of combat zones could be met by the organization of rest campsin theaters and patients returned to the United States either would be ready forsick leaves at home or would need definitive care in general hospitals.81 Boththe Ground and Service Forces agreed with this viewpoint82 but the Air Surgeon wasstriving for authority to establish "specialized hospital and recuperativecenters."83 Tending to agree with the Air Forces on the need, G-1 on 16March 1943 recommended the provision of such facilities not only for the AirForces but for the Ground and Service Forces as well.84 Because ofconflicting opinions, G-4 called the commanding generals of the Ground, Service, and Air Forces intoconference with the General Staff on 7 May 1943.85 The viewpoint of G-1prevailed and on 14 June 1943 G-4 directed ASF headquarters toinvestigate the proposal to establish convalescent facilities, to determine therequirements of the Army as a whole, and to take whatever action appeareddesirable.86
Two days before this directive was issued Surgeon GeneralKirk had instructed his Hospital Construction Division to prepare a program forthe establishment of convalescent annexes at general hospitals. On
79(1) Ltr SPMCB 300.5-1, SG to TAG, 7 Jan 43, sub: WD Cir, withatchd corresp from various offs in SOS. AG: 701(l-7-43)(1). (2) AG Memo W40-6-43,11 Feb 43, sub: Conv and Reconditioning in Hosps. Same file.
80An Rpts, 1942 and 43, Sta Hosps at Jefferson Bks, and1943-44, Reconditioning Div SGO. HD.
81Memo WDGDS 2317, ACofS G-4 WDGS for ACofS G-l WDGS, 6 Feb 43,sub: Rest and Recuperation of Mil Pers. AAF: 354.1 "Rest Ctrs and ConvHomes."
82(1) Memo 720 GNGAP-A, CG AGF for ACofS G-l WDGS, 25 Feb 43, sub: Rest Cps for AGF Pers. AAF: 354.1 "Rest Ctrs and Conv Homes." (2) DF SPGAM/720/Gen(2-8-43)-16, CG SOS for ACofS G-1 WDGS, 27 Feb 43, sub: Rest and Recuperation of Mil Pers. HRS: G-1/354.7(2-8-43).
83(1) Comment No 2, Air Surg to Dir Base Serv AAF, 10Feb 43, on R&R Sheet, Dir Base Serv AAF to Air Surg, 2 Feb 43, sub: Renamingof Pers Rest Ctr Projects. AAF: 354.1 "Rest Ctrs and Conv Homes." (2)R&R Sheet, Dep C of Air Staff to Air Surg, 18 Feb 43, sub: Specialized Hospand Recuperative Fac for AAF Pers, with atchd draft Memo, CG AAF for AsstSec Warfor Air, 10 Feb 43, and draft Memo, AsstSec War for Air for SecWar, 15 Feb 43. Same file.
84Memo, ACofS G-1 WDGS for CofSA, 24 May 43, sub: SpecializedTreatment for Aircraft Combat Crew Pers. HRS: G-l/354.7(2-8-43).
85Coleman, op. cit., pp. 384-86, citing Memo, ACofS G-4 WDGS for ACofS G-1, G-3, OPD WDGS, and CGs AGF, AAF, ASF, n d, and Memo WDGAP/354.7(3-8-43), ACofS G-1 WDGS for CofSA, 25 May 43.
86Memo WDGDS 4588, ACofS G-4 WDGS for CG ASF, 14 Jun 43, sub:Recuperation Ctrs for Conv Pnts. Filed as incl to ind dated 29 Jul 43. HD: Wilsonfiles, "Day File, Jul 43."
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21 June 1943 ASF headquarters approved the program TheSurgeon General presented.87 Neither mentioned separate facilitiesfor the Air Forces, hoping apparently to keep the convalescent care of allpatients under their own control. The day before, however, a short-livedmemorandum (already discussed) had granted the Air Forces authority tohospitalize combat crew members returned from theaters of operations and tooperate whatever general hospitals were necessary for that purpose.88As a part of the compromise settlement of this question, it will be recalled,Surgeon General Kirk agreed to the Air Forces' establishment of convalescentcenters for the care of both combat crew members suffering solely from operational fatigue and other AirForces patients whose medical care had been completed in general hospitals,while the Air Surgeon agreed to the continued operation of all general hospitalsby the Service Forces. The Air Forces therefore activated eight convalescentcenters in the latter half of 1943,89 while the Service Forces establishedconvalescent annexes at each general hospital. Convalescent hospitals as suchwere not authorized until the spring of 1944.90
87(1) Memo, Col John R. Hall for SG, 12 Jun 43. (2) 1st ind SPRMC 322 (18 Jun 43), CG SOS to SG, 22 Jun 43, onunknown basic Ltr. Both in SG: 632.-1.
88See above, pp. 107-08.
89AAF Memo 20-12, 18 Sep 43.
90See below, pp. 188-90.
