Minor Changes in Hospital Administration
The outbreak of war and expansion of the hospital system produced few changes of consequence in hospital administration. In fact, as in prewar mobilization planning, greatest attention seemed to be devoted to physical plants, while the internal organization and administration of hospitals remained largely under peacetime policies and procedures. The Surgeon General's Office continued to consider such matters as belonging properly within the province of hospital commanders and concerned itself, as before the war, with attempts to modify administrative procedures outside Army hospitals that affected the length of time patients occupied hospital beds. In some instances it seemed loath to break with the past, opposing altogether or accepting reluctantly suggestions for changes in the organization of hospitals and in the manner in which they were staffed. Although it took constructive steps to eliminate problems involved in supplying and equipping new and expanded hospitals, a shortage of many items continued to plague hospital commanders until early in 1943.
Question of Simplified Organization and Internal Administrative Procedures
The practice of leaving the organization and administration of hospitals largely, within broad limits already established by Army regulations and technical manuals, to the discretion of local hospital commanders continued to result in variations as numerous as the hospitals themselves, both in the number of services supplied and in the relation of such services to one another and to the commanding officer.1 In some instances hospital commanders took advantage of the freedom permitted them and increased the efficiency of their installations by organizing services not ordinarily found in military hospitals. For example, the Camp Maxey (Texas) and Fort Bliss (Texas) Station Hospitals, adopting a practice of civilian medicine, established diagnostic clinics to expedite the "work-up" of cases and weed out those not requiring immediate hospitalization. The clinic at Camp Maxey, the hospital commander estimated, saved at least 600 hospital admissions during 1942.2 Other commanding officers showed less initiative, organizing and arranging customary services in numbers and relations which they considered desirable. Thus, in the absence of specific organizational directives and standard administrative proce-
1 An Rpts, 1942, Sta Hosps at Cps Butner, Maxey, Howze, Cooke, Bowie, and Ft Bliss, and An Rpts, 1943, Sta Hosps at Cps Carson, Beale, Lee, Maxey, and Ft Bliss. HD.
2 An Rpt, 1942, Sta Hosp at Cp Maxey, and An Rpts, 1942 and 1943, Sta Hosp at Ft Bliss. HD.
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HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR
dures, efficient organization and smooth functioning depended largely upon the administrative capabilities of hospital commanders and their staffs and upon the supervision and advice they received from higher authorities.3
In the fall of 1942 the Wadhams Committee had stated that Army hospital organization and administration needed improvement. It recommended the procurement of trained hospital administrators for assignment to key positions on the staffs of hospital commanders and as consultants to The Surgeon General and service command surgeons. It also recommended that hospital organization be simplified. Citing a hospital in which thirty-three sections or services operated directly under the commanding officer as proof of need for such action, the Committee suggested a "model organization" in which all functions of a hospital would be grouped under the chiefs of three divisions: the Medical, Administrative, and Service Divisions.4
The Surgeon General took issue with these recommendations. He expressed doubt that any hospital commander had thirty-three section or division chiefs reporting directly to him and asserted that the hospital organization outlined in Technical Manual 8-260 was the result of many years of medico-military hospital administration and represented the opinion of able officers of the Medical Department. "No advantage would appear to accrue," he stated, "for [from?] any major change at this time." He was equally opposed to the proposal to assign special hospital administrators to key positions in station and general hospitals. "Lay" administrators were used in civilian hospitals, he stated, only because doctors did not have time for administrative duties. He asserted that Medical Corps officers could administer Army hospitals best, since some functions found in civilian hospitals either were lacking in military hospitals or were handled by other Army agencies, such as the Corps of Engineers. He admitted that specialists in hospital administration were useful in some positions, pointing out that approximately one hundred had already been commissioned in the Medical Administrative Corps for administrative work in hospitals. As to the assignment of hospital administrators to his own Office or to those of service command surgeons, he made no comment.5
Later, after the commanding general, Services of Supply, directed him to take immediate action on the Committee's recommendation, The Surgeon General modified his position. On 16 January 1943 he informed General Somervell that he was negotiating with Dr. Basil C. MacLean, Superintendent of Strong Memorial Hospital, Rochester, N. Y, regarding a commission and assignment to his Office to make a comprehensive survey of military hospital organization and administration and to advise him on the procurement and assignment of additional hospital administrators from civilian life. 6 Dr. MacLean was unable to accept a commission immediately, but on 23 April 1943 he was made a lieutenant colonel and assigned to The Surgeon General's Hospitalization and Evacuation Division.
3 See An Rpt, 1942, Chief Med Br 8th SvC. HD.
4 (1) Cmtee to Study the MD, 1942, Rpt, HD. (2) Extract from Memo, CG SOS for SG, 26 Nov 42, in Cmtee to study the MD, 1942-43. Actions on Recomd, Recomd Nos 26 and 27. HD.
5 Extract from 1st ind, SG to CG SOS, 15 Dec 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 27. HD.
6 Extracts from 3d ind, SG to CG SOS, 16 Jan 43, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd Nos 26 and 27. HD.
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MINOR CHANGES IN HOSPITAL ADMINISTRATION
The Surgeon General's reaction to another of the Wadhams Committee's recommendations further exemplified his reluctance to interfere with the internal administration of hospitals. Finding that some diagnostic procedures which required only forty-eight hours in civilian hospitals sometimes took as much as ten days in Army hospitals, the Committee recommended that "a centralized system of control of the length of patients' stay be instituted to record currently the length of stay by major professional classifications for each hospital, to study the causes of abnormal occupancy, and to institute action to correct undesirable conditions."7 Such a system was already operating effectively in the Second Service Command and The Surgeon General agreed that information on the time patients stayed in hospitals would be "highly desirable from a statistical point of view." Nevertheless, he believed it "impracticable" to establish such a system for all Army hospitals because of the paper work involved, and indicated that he preferred to depend upon professional consultants "inquiring into unnecessarily long periods of hospitalization with a view to corrective action."8 To supplement their efforts The Surgeon General issued a circular letter on 9 November 1942, urging hospital commanders to prevent the padding of records by "repetition, verbosity, and inclusion of extraneous historical material and forms" and to reduce "irrelevant, routine, and repetitive requests" for laboratory examinations.9
Certain changes in the organization of general hospitals did occur as a result of their transfer from control of The Surgeon General to that of service commands in the fall of 1942. Since few were located on Army posts, most had post as well as hospital hospital functions, and their commanding officers were both post and hospital commanders. Duties of such officers as post commanders were relatively unimportant compared with their duties as hospital commanders, for post functions of a general hospital existed only to serve the hospital. Nevertheless, after general hospitals became service command installations the organization of their post function was expected to conform with the standard post organization outlined in the SOS Organization Manual, 30 September 1942. It grouped post activities functionally in seven divisions: Administrative, Personnel, Operations and Training, Supply, Repairs and Utilities, Internal Security and Intelligence, and Medical. The result was that relatively minor post functions, previously organized as administrative sections or services, were raised to division status, equal on paper at least to the Medical Division. The latter usually comprised all hospital functions, administrative—such as medical supply, the registrar's office, and the enlisted complement—as well as professional. The commanding officer's double role meant that while only some seven division chiefs reported to him directly as post commander, in most instances the original number of section or branch chiefs of the Medical Division also reported to him directly as chief of that
7 (1) Extract from Memo, CG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 25. HD. (2) Cmtee to Study the MD, Rpt, pp. 5, 7, 10, 13. HD.
8 (1) 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 25. HD. (2) History, Office of the Surgeon, Second Corps Area and Second Service
Command from 9 September 1940 to 2 September 1945, pp. 8 and 102. HD.
9 SG Ltr 148, 9 Nov 42, sub: Hosp Admin and Professional Servs.
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HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR
division—that is, as commander of the hospital.10 (Chart 6)
Efforts To Shorten the Average Period of Hospitalization
As the number of hospitals increased and the patient load became heavier, the Surgeon General's Office along with other agencies of the War Department devoted attention to administrative procedures outside Army hospitals which affected the occupancy of hospital beds. For the most part such procedures were those that governed the disposition of patients after completion of treatment—either by return to duty or separation from the Army—and were hence essentially personnel procedures.
Attempts To Speed the Disposition of Officer-Patients
Two problems arose during the early war years in the disposition of officer-patients after hospitalization. The first resulted from keeping on active duty, rather than retiring, officers qualified for limited service only; the other, from loss of touch with units and organizations to which officers qualified for full duty should return.11
The procedure for the assignment of officers qualified for limited service only, in effect in January 1942, required hospital commanders to hold officers after completion of treatment while reports of their cases were sent through military channels to The Adjutant General in Washington for instructions on assignments.12 On 21 March 1942 a revision of this procedure cut out some of the correspondence and time involved by permitting post and corps area commanders to assign all limited service officers except those under the jurisdiction of the Army Air Forces. The latter still had to be reported to the commanding general, Army Air Forces, for assignment.13
The normal procedure for returning general service officers to their "proper" stations also needed modification. In many cases organizations to which they belonged either had left for overseas service or had moved to some other location in the United States, without informing the hospital or officer concerned. New assignments had to be made in such cases. On 6 October 1942 the War Department issued instructions permitting corps area commanders to make assignments of all officers in this category except those belonging to the Air Forces. The latter, like AAF limited service officers, could be assigned only by the commanding general, Army Air Forces.14 These changes reduced but did not eliminate entirely difficulties of hospital commanders in procuring assignments for officer-patients.15
A further revision of directives governing the disposition of officers was issued the last day of 1942. It tended to expedite the process. Under the new procedure, all officers needing hospitalization who belonged to troop units in the United States,
10 (1) SOS Orgn Manual, 1942, sec 402.02 and 406.01. HD. (2) Rpt, Conf of CGs SvCs [SOS], 2d sess, 17 Dec 42, p. 41. HD: 337. (3) An Rpts of the following Gen Hosps: Hoff, Baxter, Billings, Tilton (1942), and Ashburn, Baxter, Percy Jones, Kennedy, and Hoff (1943). HD.
11 (1) Ltr. TAG to CGs Armies, Army Corps, Divs, CAs, and Depts; CofS GHQ; C of Arms and Servs; CG AF Combat Comd; C of Armored Force; COs of Exempted Stas, 21 Jan 42, sub: Physical Fitness of Offs. AG: 201.6 (1-17-42) (3). (2) AR 40-600, par 5 a, 31 Dec 34. (3) WD Cir 24, sec III, 27 Jan 42.
12 (1) AR 40-600, par 5 a, 31 Dec 34. (2) WD Cir 24, sec III, 27 Jan 42.
13 WD Cir 83, 21 Mar 42.
14 AR 40-600, par 5 a, 6 Oct 42.
15 For example, see An Rpt, 1942, Tilton Gen Hosp. HD.
125
MINOR CHANGES IN HOSPITAL ADMINISTRATION
who had returned from theaters, or who were en route to overseas destinations, were transferred at the time they entered general hospitals to replacement pools of their respective arms and services. Upon completion of hospital treatment, whether qualified for general or limited service, they could be returned to pools to await permanent reassignment. Other officers, for example those of station complements, were not assigned to such pools and had to be returned to their proper stations. In either case, hospitals might dispose of patients as soon as their medical treatment
126
HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR
had been completed, without waiting for higher headquarters to make assignments. 16 Nevertheless, some hospital commanders continued to hold officer-patients until higher headquarters had acted upon the recommendations of hospital disposition boards.17
Attempts To Speed the Disposition of Enlisted Men
Delays in the disposition of enlisted men, both those being discharged from the Army on certificates of disability and those being returned to duty for limited service, also caused the Medical Department concern. As in the case of officers, such delays resulted in part from administrative actions required of headquarters outside hospitals. Attempts were made to remove this cause of delay during the early war years. Later, emphasis was to be placed upon simplifying procedures within the hospitals themselves.
Failure to receive service records and allied papers, such as individual clothing and equipment records, of enlisted patients transferred to general hospitals was one cause of delay. Without such records hospitals could not release men entitled to discharge from the Army. As early as December 1941 some hospitals complained about this situation.18 To correct it The Surgeon General secured the issuance of a War Department letter requiring "the immediate transfer of such papers to a general hospital when a member of the command is transferred thereto." 19 This of course did not solve the problem of patients whose records had been lost or destroyed. Several officers, including the commanding general of Lovell General Hospital, the director of training of the Services of Supply, the finance officer of the New York Port of Embarkation, and representatives of the Surgeon General's Office, became interested in it almost simultaneously.20 On 6 June 1942, therefore, the War Department published a directive permitting hospital personnel officers to prepare payrolls, final pay statements, and new service records on the basis of affidavits of men whose records had been lost in disasters either at sea or on land.21 Within a month, both SOS headquarters and the Chief of Finance decided that this policy should be broadened to include all lost records, whether or not they had disappeared as a result of military action.22 This was done by a new War Department directive published on 24 July 1942.23 Its provisions helped to speed
16 WD Cir 424, 31 Dec 42.
17 (1) An Rpts, 1943, Tilton, LaGarde, Ashburn, and O'Reilly Gen Hosps. HD. (2) Memo, Lt Col Basil C. MacLean, MC for [Brig] Gen [Raymond W.] Bliss thru Col [Albert H.] Schwichtenberg, 6 Nov 43, sub: Observations Based on Recent Visits of Varying Periods to 9 Gen Hosps. SG: Gen Bliss's Off files, "Util of MCs in ZI" (19) #1. In this letter, Colonel MacLean stated: "The wastage in days and dollars is scandalous and can be attributed directly to the stupidities of a cumbersome and complex procedure which is not easily adaptable to a war time load."
18 (1) Statement of CO Lawson Gen Hosp, Agenda of SGO Conf with COs Gen Hosps, 15 Dec 41. HD: 337.-1. (2) Inf memo, SG for TAG [Dec 41], sub: Trf of Pnts. AG: 201.3 (1-23-42) (8).
19 Ltr, TAG to CGs Armies, Army Corps, et al., 29 Jan 42, sub: Delay in Trf of S/R. AG: 201.3 (1-23-42) (8).
20 (1) Ltr, CG Lovell Gen Hosp to TAG, 21 May 42, sub: Lost S/R. HRS: G-1/10381. (2) Memo SPTRU 333.1 (5-12-42), Dep Dir Tng SOS for Dir MPD SOS, 12 May 42; sub: EM. Same file.
21 (1) 2d ind, CofF to TAG, 2 Jun 42, on Ltr, Fin Off, Brooklyn, NY to CofF, thru Fin Off 2d CA, 24 May 42, sub: Pay of EM without S/R. AG: 240 (5-24-42) (1). (2) WD Cir 177, sec I, 6 Jun 42.
22 (1) Memo, CG SOS for CofSA, 27 Jul 42, sub: Prompt Discharge of EM on CDD from Gen Hosp. HRS: G-1/10381. (2) Memo SPFDR 300.3/360354 (WD Cir), CofF for C of Admin Servs SOS, 21 Jul 42, sub: Proposed WD Cir. AG: 240 (1-3-42) (1).
23 WD Cir 244, 24 Jul 42.
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MINOR CHANGES IN HOSPITAL ADMINISTRATION
the discharge of enlisted men on certificates of disability by making it unnecessary to hold patients in hospitals while missing records were located or until new ones were issued by The Adjutant General. 24
At station hospitals a serious cause for delay in discharging patients for disability was that officials outside hospitals had both to initiate and to consummate the action. Under existing regulations an enlisted man's immediate commanding officer had to initiate the certificate required for this purpose (WD AGO Form 40), and an authority higher than the station hospital commander, either the post commander or the service commander, had to approve the certificate and the recommendations of the medical board who examined the man.25 When members of the Wadhams Committee visited Army hospitals in the fall of 1942, they found that complaints on this score were general. 26 The Committee recommended that authority to approve disability discharges be vested in all commanders of camps having a strength of 20,000 or more.27 About the same time, General Snyder found in a survey which he was making that approximately 12 percent of all patients were awaiting disability discharges. To free beds for other patients, he recommended that measures be taken to require organization commanders to initiate disability certificates promptly and to permitcommanders of all posts having a strength of 5,000 or more to approve disability discharges. 28 Accordingly, The Surgeon General prepared a memorandum, published by the War Department on 30 November 1942, requiring "all concerned to insure prompt action by unit commanders in initiating disability certificates. In December he also secured a modification of Army regulations to permit commanders of all stations with housing capacities of 5,000 or more to grant disability discharges.29 These actions, particularly the latter, simplified the disposition of such patients and in at least one hospital reduced the average period of their stay by almost two thirds, from fiftyeight to twenty-one days.30 Causes for delay still existed for papers still had to be transmitted between unit and hospital commanders and between hospital and post commanders.
Early in 1943 G-1 directed SOS to make a study of War Department regulations governing disability discharges "with a view to their clarification and the speedy consummation of discharges under this authority."31 The revision of regulations which SOS headquarters subsequently proposed seemed to The Surgeon General
24 (1) Ltr, GO Tilton Gen Hosp to TAG, 31 Jul 42, sub: Discharge of EM, with 1st ind, TAG to CG Tilton Gen Hosp, 25 Aug 42. AG: 220.8 (8-1-34) (1). (2) An Rpts, 1942, Torney Gen Hosp, and 1943, LaGarde Gen Hosp. HD.
25 AR 615-360, sec II, par 5, 8, 9, 11, 14, and 16, 4 Apr 35 and 26 Nov 42.
26 (1) Memo by Dr J. H. Musser, n d, sub: Visit to Louisiana Hosp Instls. Pers files of Dr Lewis H. Weed, Mem of the Wadhams Cmtee. (2) Memo by Dr Arthur H. Ruggles, n d, sub: Visit with Mr. James Hamilton to Cp Devens, Mass. Same file.
27 (1) Extract from Memo, CG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 12. HD. (2) Cmtee to Study the MD, 1942, Rpt, p. 5. HD.
28 Ltr, Asst IG to IG, 10 Nov 42, sub: Surv of Hosp Fac and their Util. IG: 705-Hosp (A).
29 (1) 3d ind, SG to CG SOS, 24 Nov 42, on Ltr, Asst IG to IG, 10 Nov 42, sub: Surv of Hosp Fac and their Util. IG: 705-Hosp (A). (2) WD Memo W40- 9-42, 30 Nov 42, sub: Delays in Processing WD AGO Form 40. Same file. (3) WD Cir 404, sec III, 14 Dec 42.
30 An Rpts, 1942, Sta Hosp at Sheppard Fld, and Surg 7th SvC. HD.
31 Memo, ACofS G-1 WDGS for Dir MPD SOS, 9 Feb 43, sub: Discharge of EM on CDD. AG:220.8 (2 Jun 42) (2) Sec 1
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HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR
likely to retard rather than to speed discharges. He therefore requested a conference of representatives of his own Office and of The Adjutant General, The Judge Advocate General, the commanding general of Services of Supply, and the Veterans Administration, to consider the entire question.32 As a result a revision was worked out which eliminated some channels of communication and placed time limits upon the transfer of papers required for disability discharges.33
Under the new procedure, published on 16 April 1943, patients were to be transferred (on paper) from their own units to the station complement of the post on which the hospital treating them was located within forty-eight hours after hospitals decided to discharge them. Thus, all steps leading up to discharges for disability were to be under the control of post commanders, independent of any action by unit commanders. Station complement commanders were required to forward disability certificates to station hospitals within twenty-four hours after they were requested, and hospital commanders had to forward all papers, with recommendations, to post commanders within fortyeight hours after action by medical boards examining patients. In addition, discharge of patients was not to be delayed until all records of previous medical examinations had been received. Furthermore, hospital commanders were charged with the responsibility, under post commanders, for processing all records within the time limits allowed.34
Under the revised regulation the amount of time needed to process the papers required for disability discharges was reduced appreciably. In the station hospital at Camp Chaffee (Arkansas) for example, the time was cut from approximately eighteen to five days.35 Here, as in other instances, the post commander eliminated even the transmission of records from station complement headquarters to hospitals and from hospitals to post headquarters. He accomplished this by placing detachments to which patients were transferred to await discharge under the command of members of the hospital staff and by permitting hospital commanders to exercise the authority of post commanders to approve disability discharges. In this way, the entire process of granting discharges on certificates of disability was centralized under station hospital commanders. 36 Such was already the case in general hospitals, because enlisted men treated in them belonged to detachments of patients, rather than to the units to which they had been assigned previously, and general hospital commanders had had authority since September 1941 to grant discharges on certificates of disability. Further simplification of procedures within hospitals themselves remained to be done during the later war years.
The disposition of psychotic patients involved problems not ordinarily encountered in other disability discharges. Until the spring of 1943 patients who became mentally deranged within six months after induction and required institutional care after discharge from the Army had to be
32 Memo SPMCH 300.3-1, SG for TAG, 7 Mar 43. AG: 220.8 (2 Jun 42) (2) Sec I.
33 Memo, CG SOS for ACofS G-1 WDGS, 17 Mar 43, sub: Discharge of EM on CDD. AG:220.8 (2 Jun 42) (2) Sec I.
34 AR 615-360, C 4, 16 Apr 43.
35 An Rpt, 1943, Sta Hosp at Cp Chaffee. HD.
36 (1) Comments of Surg, 1st, 2d, and 7th SvCs, Rpt, SGs Conf with Chiefs Med Br SvCs, 14-17 Jun 43, pp. 56-58. HD: 337. (2) An Rpts, 1943, Sta Hosps at Cp Chaffee, and Fts Custer, Bragg, and Riley. HD.
129
MINOR CHANGES IN HOSPITAL ADMINISTRATION
sent to State mental institutions or to St. Elizabeth's Hospital in Washington, D. C. Only patients with more than six months' service were "line-of-duty" cases and therefore eligible for care by the Veterans Administration. To arrange for State care of mental patients frequently required several weeks or else turned out to be impossible altogether.37 To relieve other hospitals of the accumulation of such patients awaiting discharge, The Surgeon General opened Darnall General Hospital on 1 March 1942, established additional closed ward facilities at Valley Forge and Bushnell (Utah) General Hospitals in the fall of 1942, and on 12 June 1943 activated Mason General Hospital in buildings acquired from the State of New York.38 In March 1943 Congress authorized the Veterans Administration to care for patients regardless of their "line-of-duty" status.39 Thereafter, Army hospitals encountered less difficulty in disposing of psychotic patients, since they could transfer any of them to the Veterans Administration.
More than a year before this Congress had taken action which might have resulted in delaying the disposition of patients. On 12 December 1941 Congress authorized the Army to retain in its hospitals, rather than transfer to the Veterans Administration, patients whose terms of service had expired but who needed continuing hospitalization.40 The extension of all terms of service, on the following day, for "the duration plus six months," reduced the importance of this authorization considerably. 41 The question remained of how long the Army would keep patients who could not be returned eventually to active duty.
Wishing to free as many beds as possible, The Surgeon General appealed to a policy which the Federal Board of Hospitalization had established in 1940: the early transfer to the Veterans Administration of patients who could not be salvaged for further service.42 The Wadhams Committee, on the other hand, responsive perhaps to a feeling among the public that the Army should do everything possible for its sick and wounded men, recommended that the Army keep all patients, except those who were neuropsychiatric, until they had received maximum therapeutic benefits.43 This might have proved embarrassing for The Surgeon General had not the Federal Board ruled, in February 1943, that under its 1940 resolution the decision as to when patients should be transferred to the Veterans Administration rested with The Surgeon General.44 This ruling left him free either to transfer patients as soon as it was determined that they could not be returned to duty, thus saving beds for other Army patients, or to keep them for extended periods of Army hospitalization as increasing emphasis
37 (1) SG Ltrs 99, 4 Sep 42; 1, 1 Jan 43; and 6, 2 Jan 43. (2) An Rpts, 1942, Darnall, Stark, and Tilton Gen Hosps, and Sta Hosp at Cp Roberts. HD.
38 An Rpts, Hosps named above, 1942 and 1943. HD. (2) Rpt, SGs Conf with CA and Army Surgs, 25-28 May 42. HD: 337. (3) Memo, Col H. D. Offutt for Col J. R. Hall, 22 Sep 42. SG: 632.-2. (4) 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. 22. HD.
39 (1) Public Law 10, 78th Cong, 17 Mar 43, 57 Stat 10. (2) AR 615-360, C 4, 16 Apr 43.
40 (1) Public Law 333, 77th Cong., 12 Dec 41, 55 Stat 333. (2) Ltr, Franklin D. Roosevelt to SecWar, 12 Dec 41. AG: 322.8 (9-1-34) Case 1.
41 Public Law 338, 13 Dec 41, 55 Stat 338.
42 2d ind, SG to TAG, 19 Mar 42, on Ltr 220.811-1, SG to TAG, 31 Jan 42, sub: Policy Conc Discharge of Disabled EM. AG: 200.8 (8-1-34) Case 1.
43 Cmtee to Study the MD, 1942, Rpt, p. 12. HD.
44 Ltr, Chm Fed Board of Hosp to SG, 4 Feb 43, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 29. HD.
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HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR
came to be placed on Army reconditioning and rehabilitation during the later war years.
Delays in the disposition of enlisted patients occurred also, as in the case of officers, when their organizations had moved to undisclosed destinations or when men were physically fit for only limited service at the end of treatment. Such patients were found less in station than in general hospitals, since the latter treated those who had the more serious illnesses or injuries and required longer periods of medical care. Both the men whose organizations had moved and those qualified for only limited service required new assignments. To prevent their being held in hospitals awaiting assignment by higher headquarters, meanwhile occupying beds needed for other patients, The Surgeon General's Hospitalization Division recommended on 22 January 1942 that casual detachments be set up near all general hospitals for the immediate assignment, on a temporary basis, of all enlisted patients whose hospitalization had been completed.45 Instead of approving this recommendation, the Secretary of War, on the advice of the General Staff, directed that Air Corps (after March 1942, Air Forces) enlisted patients be reassigned by the chief of the Air Corps; others, by corps area commanders.46 Two days later, after Colonel Offutt protested that this failed to solve the problem, the War Department suggested that corps area commanders furnish hospitals with blocks of available assignments or that they designate stations to which enlisted men might be sent temporarily, pending permanent assignments.47 This procedure worked well in some corps areas. In others, where corps area commanders failed to establish casual detachments under such "permissive regulation," it was less successful in enabling hospitals to speed the disposition of patients.48
Other Efforts To Shorten the Period of Hospitalization
The speed-up of dispositions was notthe only way by which beds could besaved for patients who really needed them.The same result could be accomplished bylimiting the treatment given in hospitals.During the winter of 1942-43 The SurgeonGeneral instituted measures of thattype. Among them were the treatment ofpatients with uncomplicated cases of gonorrheaon a duty status and the curtailmentof elective operations.
Although the majority of patients withgonorrhea in civilian life were treated onan out-patient basis, the Army had customarilyhospitalized soldiers with thatdisease.49 In the fall of 1942 such patientsoften remained in hospitals for more thana month and, according to General Snyder,occupied approximately 6,000 beds.During 1942, some posts in the FourthService Command had begun to use sulfonamidecompounds to treat patientswith gonorrhea on a duty status, thusavoiding long periods of hospitalization.On 10 November 1942 General Snyderrecommended the immediate considera-
45 Ltr, SG to TAG, 22 Jan 42, sub: Disposition of Pnts. SG: 705.-1.
46 (1) 1st ind AG 220.31 (1-22-42) EA, TAG to SG, 30 Jan 42, on Ltr, SG to TAG, 22 Jan 42, sub: Disposition of Pnts. SG: 705.-1. (2) WD Cir 24, 27 Jan 42.
47 Ltr, TAG to CGs of all CAs, 29 Jan 42, sub: Disposition of Pnts in Gen Hosps. AG: 322.3 Gen Hosp (1-28-42) (1).
48 (1) Ltr, Col Harry D. Offutt to Col W. H. Smith, 9 Mar 42. SG: 323.7-5 (LaGarde GH)K. (2) Rpt, SGs Conf with CA and Army Surgs, 25-28 May 42, p. 2. HD: 337.
49 Paul Padgett, The Diagnosis and Treatment of the Venereal Diseases (1948). HD.
131
tion of standardizing this practice throughoutthe Army.50 The Surgeon Generalthen requested the appointment of aboard of medical officers to review accumulatedexperience to determine the wisdomof extending on-duty treatment ofgonorrhea patients.51 By January 1943 theboard had completed its work. It recommendedthat the policy of treating patientswith uncomplicated cases of gonorrhea ona duty status be encouraged, but not required.52 Adoption of this policy reducedthe number of patients in hospitals andthereby lessened both construction andpersonnel requirements.53
At the same time, to achieve the sameend, General Snyder also recommendedthe curtailment of elective operations,such as the repair of hernias, the removalof pilonidal cysts, and the correction ofinternal derangements of knee joints andother preinduction disabilities.54 In conformitywith this recommendation, TheSurgeon General directed hospitals to considerfor elective operations only men whomight be of definite value to the Armyafterwards.55 Although this directive didnot require a curtailing of elective operations,some hospitals reduced the numberperformed.56 Later during 1943, when themanpower shortage demanded maximumuse of available men, it was necessary torelax this policy.57
Early Changes in the Size and Composition of Hospital Staffs
With the war making increasinglyheavy demands upon the Nation's availablemanpower, zone of interior hospitalsfaced the prospect of having to functionwith staffs that had progressively lowerproportions of Medical Corps officers andable-bodied enlisted men. Although reductionswere carried to greater lengths during the latter part of the war, theystarted during its early years and thepractice of replacing physicians and ablebodiedenlisted men by personnel in othercategories began at that time.
Throughout 1942 the personnel guidethat had been issued in April 1941 remainedeffective for station hospitals, andthe Surgeon General's Office instructedgeneral hospitals to use tables of organizationof corresponding numbered units astheir guide.58 During the year, his Officenot only revised such tables but in Decemberpresented for Staff approval newguides for manning both station and generalhospitals in the zone of interior.59Made partly at the instance of the GeneralStaff as a means of reducing theArmy's requirements for physicians,60
50 Ltr, Asst IG to IG, 10 Nov 42, sub: Surv of Hosp Fac and their Util. IG: 705-Hosp (A).
51 (1) 3d ind, SG to CG SOS, 24 Nov 42, on Ltr, Asst IG to IG, 10 Nov 42, sub: Surv of Hosp Fac and their Util. IG: 705-Hosp (A). (2) Ltr, SG to CG SOS, 19 Nov 42, sub: Apmt of Bd for Investigation of Treatment of VD on Duty Status. Same file.
52 WD AGO Memo W40-2-43, 19 Jan 43, sub: Treatment of Individuals with Uncomplicated Gonorrhea on a Duty Status. HD: 726.1-1.
53 An Rpts, 1942, Sta Hosps at Cp Butner and Ft Bragg. HD.
54 Ltr, Asst IG to IG, 10 Nov 42, sub: Surv of Hosp Fac and their Util. IG: 705-Hosp (A).
55 SG Ltr 167, 30 Nov 42, sub: Performance of Elective Oprs for Pre-Induction Disabilities.
56 An Rpts, 1943, Fletcher Gen Hosp and Sta Hosp at Cp Chaffee. HD.
57 SG Ltr 190, 17 Nov 43, sub: Sel of Cases for Elective Opr for Pre-Induction Disability.
58 Ltr, Col H. D. Offutt to Col E. R. Gentry, Borden Gen Hosp, 4 Nov 42. SG: 323.7-5 (Borden GH)K.
59 Incl 1, Annexes A and B, to Memo, Act SG for DepCofS WDGS thru Mil Pers Div SOS, 14 Dec 42, sub: Availability of Physicians. SG: 322.051-1.
60 Memo, ACofS G-1 WDGS for SG thru Pers Div SOS, 1 Apr 42, sub: Availability of Physicians. HRS: G-1/16331-16335. For a full treatment of the question of the Army's requirements and the availability of physicians, see John H. McMinn and Max Levin,
Personnel (MS for companion vol. in Medical Dept, series), HD.
132
HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR
TABLE 4—POSITIONS AND RANKS IN ZONE OF INTERIOR HOSPITALS PERMITTED BUT NOT
REQUIRED TO BE FILLED BY MEDICAL ADMINISTRATIVE CORPS OFFICERS, 9 APRIL 1941
these changes were expected to lower the number of Medical Corps officers authorized for hospitals of various sizes and to increase the use of Medical Administrative Corps officers in administrative positions.
Throughout 1942 allowances of Medical Corps officers for zone of interior hospitals were considerably higher than those later prescribed in the guides. For example, on 21 October 1942 the Surgeon General's Office informed the commander of a 1,500-bed general hospital that his allotment should consist of eighty officers of the Medical Corps, ten of the Medical Administrative Corps, and additional members of other corps.61 An allotment based on the revised table of organization for numbered general hospitals would have had 23 fewer Medical Corps officers, and one based on the December 1942 guide for named hospitals would have had 34 fewer Medical Corps officers and 13 more Medical Administrative Corps officers. High allotments were somewhat offset by the fact that in most cases the number of Medical Corps officers actually assigned failed to equal the allowance. Hospital commanders therefore complained of shortages, but their complaints seem to have been based on this discrepancy alone and not on a consideration of all their resources. In addition to assigned physicians, many hospital commanders had at their disposal medical officers of units attached for training as well as those awaiting assignment in Medical Department pools. Moreover, later in the war hospitals had to get along with even fewer assigned Medical Corps officers, and as commanders continued to assert that their hospitals provided a high standard of medical care their complaints of shortages of physicians during this period should be taken at something less than face value.62
61 Ltr, Lt Col Paul A. Paden to Brig Gen R[oyal] Reynolds, Kennedy Gen Hosp, 21 Oct 42. SG: 323.7-5 (Kennedy GH)K.
62 (1) An Rpts, 1942, Chiefs Med Br SvCs, 1st-9th SvCs. HD. (2) An Rpts, 1942, Lovell, Hoff, Billings, Kennedy, and Ashburn Gen Hosps, and Sta Hosps at Fts Benning and Belvoir, and Cps Adair, Lee, Blanding, and Chaffee. HD.
133
MINOR CHANGES IN HOSPITAL ADMINISTRATION
Replacement of physicians in administrativejobs by Medical AdministrativeCorps officers began in 1942. At the beginningof the war the personnel guide fornamed hospitals permitted but did not requirethe use of Medical AdministrativeCorps officers in certain positions. (Table 4)At that time the Surgeon General's Officeapparently considered them primarily asassistants to Medical Corps officers in themore responsible administrative positions.63 Early in 1942, therefore, physicians,sometimes with Medical AdministrativeCorps assistants, held such positionsas executive officer, registrar, adjutant,mess officer, medical detachment commander,and medical supply officer inmany hospitals in the zone of interior. Incompliance with General Staff and SOSdirectives,64 The Surgeon General madeplans during 1942 to use Medical AdministrativeCorps officers more widely. Firsthe proposed to increase the supply byopening a second Medical AdministrativeCorps officer candidate school.65 Then inJune he requested certain hospital commandersto make studies of the positionswhich administrative officers could fill.66Before such studies could be completed, aWar Department directive, issued on therecommendation of SOS headquarters,ordered the commanding generals of theAir and Ground Forces and of corps areasto relieve Medical Corps officers of allduties not requiring professional medicaltraining and to replace them with MedicalAdministrative Corps or Branch Immaterialofficers.67 This action left to individualcommanders the decision as to whichpositions were suitable for administrativeofficers. Generally they were considered tobe those of detachment commander, medicalsupply officer, adjutant, and registrar.68 By the end of 1942 service commands reported that administrative officershad replaced physicians in administrativepositions to the extent which supplyof the former permitted.69 The qualifyingphrase was important, for a shortage ofMedical Administrative Corps officers foruse in the zone of interior existed throughout194270 and their widespread substitu-
63 (1) Ltr, Act SG to the Hon D. Lane Powers,Mem of Gong, 29 Mar 41. SG: 210.2-1. (2) Ltr, LtCol John M. Welch to Dr Wilburt G. Davison, Dean,Sch of Med, Duke Univ, 31 Jan 42. SG: 210.1-1. (3)Ltr, Col George F. Lull to Col C[harles] M. Walson,5 Jun 42. Same file. (4) Ltr, Brig Gen W[illiam] L.Sheep, CG Lawson Gen Hosp to Col H. D. Offutt,12 Feb 42. SG: 323.7-5 (Lawson GH)K.
64 (1) Memo, ACofS G-1 WDGS for SG thru PersDiv SOS, 1 Apr 42, sub: Availability of Physicians.(2) Memo, ACofS G-1 WDGS for Pers Div SOS, 9May 42, same sub. (3) Memo, CG SOS for SG, 22May 42, same sub. All in HRS: G-1/16331-16335.
65 (1) Ltr, SG to Pers Sec SOS, 26 May 42, sub:Procurement Objective, MAC. (2) Memo, CG SOSfor CofSA, 29 May 42, sub: Increase in ProcurementObjective, MAC, with 2d ind, SG to Chief Pers ServSOS, 6 Jun 42. (3) Memo, CG SOS for CofSA, 5 Jun42, same sub. (4) Ltr, TAG to SG, 13 Jun 42, samesub. All in AG: 210.1(1-14-42) (2) Sec 2A.
66 Memo, SG for COs Sta Hosps at Sheppard Fld,Fts Lewis, Ord, Sam Houston, Leonard Wood,Devens, Indiantown Gap Mil Res, Cp Lee, and Fitzsimons,Army and Navy, Wm. Beaumont, WalterReed, and Lawson Gen Hosps, 29 Jun 42, sub: Conservationof Available MC Offs. SG: 322.051-1.
67 Ltr, TAG to CGs AGF, AAF, all CAs, 13 Jul 42,sub: Relief of MC Offs from Duties Which Do NotRequire Professional Med Tng. AG: 210.31(7-10-42) (4).
68 (1) Ltr, CG 8th CA to TAG, 22 Jul 42, sub: Reliefof MC Offs. AG: 210.31(7-10-42) (4). (2) Memo,SG for Dir Mil Pers SOS, [10 Oct 42]. SG: 322.051-1.(3) Ltr, Lt Col J[ames] R. Hudnall, SGO to Lt ColArthur J. Redland, 5th SvC, 10 Aug 42. SG: 320.3-1(5th SvC).69 (1) Rpt, Conf of CGs SvCs [SOS], 2d sess, 17 Dec42, pp. 19, 33, 96. HD: 337. (2) An Rpts, 1942, ChiefMed Br (Surg) 3d and 9th SvCs. HD.
70 (1) Ltr SPMCQ 322.056.-1, SG to TAG, 28 Sep42, sub: Increase in Procurement Objective AUS forDuty with MAC (SG). AG: SPGA 210.1 Med 1-20.(2) Memo, SG for Dir Mil Pers SOS [10 Oct 42]. SG:322.051-1. (3) Ltr SPMCM 210.1-1, SG to Dir MilPers SOS, 13 Oct 42, sub: Procurement Objective,MD. AG: SPGA 210.1 Med 1-20. (4) Memo, Lt Col
134
HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR
tion for Medical Corps officers remained to be carried out during the later war years.
Changes in the composition of the enlisted staffs of hospitals were more general. Experience in the employment of civilians had already demonstrated that ablebodied enlisted men could be replaced by personnel of other types. During the first year and a half of the war the practice of substitution was extended. Limited service enlisted men (that is, those with physical defects which disqualified them for service with the field forces) and Women's Army Auxiliary Corps enlisted women were added to civilians as replacements for enlisted men who were physically qualified for general service.
Early in 1942 hospital commanders often had fewer enlisted men than they considered desirable, and the Surgeon General's Office reported continual shortages for Medical Department activities. Large numbers were needed for the many new hospitals opening in the zone of interior. Units going overseas had to have full complements and hospitals called upon to supply them often had difficulty securing replacements.71 In July SOS headquarters issued a directive, recommended by the Surgeon General's Office, to give such hospitals priorities on replacement requisitions.72 About the same time it announced that the Army would begin in August to induct limited service men and assign them directly to hospitals and other zone of interior installations.73 These measures were apparently helpful, for by the end of 1942 many hospitals reported that their allotments were full.74 Even so, a few commanders complained of shortages,75 but generally, complaints were less of shortages than of difficulties in using limited service men and civilians.
Basil C. MacLean for Gen Bliss thru Col Schwichtenberg, 6 Nov 43, sub: Observations Based on Recent Visits for Varying Periods to Nine Gen Hosps. SG: Gen Bliss's Off files, "Util of MCs in the ZI" (19) #1.
Hospitals had had experience with limited service enlisted men as early as December 1941, when the War Department began to transfer physically unfit men from field force units to zone of interior installations.76 At first hospitals absorbed men of this type readily because they were few in number and were used to fill vacancies, supplementing existing forces of able-bodied men. Gradually it became the practice to withdraw ablebodied men from hospital staffs for service with field forces and to use limited service men not as supplements but as substitutes for them.77 As this happened hospital commanders encountered difficulties. The
71 (1) Memo, SG for Dir Mil Pers SOS [10 Oct 42]. SG: 322.051-1. (2) DF WDGAP 322.051, ACofS G-1 WDGS to SG thru Mil Pers Div SOS, 28 Oct 42. Same file. (3) Rpt, SGs Conf with CA and Army Surgs, 25-28 May 42, pp. 20, 31. HD: 337. (4) An Rpts, 1942, Chief Med Br 2d and 5th SvCs. HD.
72 Ltr SPX 220.31 (7-11-42)EC-SPMCP-PS-M, CG SOS to CGs SvCs and CGs Gen Hosps, 28 Jul 42, sub: Filler Repls for Units Ordered Overseas. SG: 220.31-1.
73 SOS Cir Ltr 25, 10 Jul 42, sub: Asgmt of Limited Serv EM. SG: 220.31-1.
74 An Rpts, 1942, Hoff, Ashford, Billings, Lovell, Tilton, Hammond. Bushnell, Torney, O'Reilly, and Lawson Gen Hosps and Sta Hosps at Cps Wheeler, Murphy, Young, Croft, Roberts, Chaffee, McCoy, Sheppard Fld, and Fts Knox and Riley. HD.
75 An Rpts, 1942, Sta Hosps at Jefferson Bks and Cp Lee. HD.
76 Ltr AG 220.31 (1 2-18-41) EA-A, TAG to all Army, CA, and Exempted Sta Comdrs other than AC and C of Armored Force, 23 Dec 41. sub: Clearing Fld Force Units of Pers not Physically Qualified for Fld Serv. SG: 220.31-1.
77 (1) SOS Cir 13, 12 May 42, sub: Absorption of Limited Serv Pers in Overhead Instls of SOS. AG: 220.3(12 May 42) (2). (2) WD Memo W615-3-42, 17 Aug 42, sub: Asgmt of Limited Serv Pers. HD: 220.31-1. (3) Ltr AG 220.31(4-5-43)PE-A-SPOA, CG ASF to C of Tec Servs, 7 Apr 43, sub: Util of Limited Serv Pers. Same file.
135
MINOR CHANGES IN HOSPITAL ADMINISTRATION
field forces tended to place "problem" men in the limited service category and to promote others just before transfer—actions bound to create morale problems for receiving hospitals.78 Moreover, limited service men were often unable to do a full day of hard work, and hospitals—operating around the clock—found it difficult to assign all of them to special jobs within their physical limitations. Of equal importance, such men had often had no Medical Department training. Hospitals therefore had to maintain continuous training programs for newcomers. Even so they could not always train enough technicians, for in many instances physical incapacity happened to be coupled with low mentality and little education.79 By the end of 1942 this problem had become so serious that The Surgeon General sought a commitment from SOS headquarters to assign to the Medical Department greater numbers of limited service men of good caliber.80 Failing in this, he resorted to the establishment in April 1943 of special regiments to train whatever limited service men the Medical Department might receive.81
As limited service men came to constitute a larger part of the enlisted force, hospitals gradually began to think of civilians as supplementing rather than replacing enlisted men. By the end of 1942 many hospitals with full complements of enlisted men also had sizable numbers of civilian employees. In recruiting civilians, hospital commanders encountered the same problems they had experienced in 1941. In addition, they found it increasingly difficult to maintain stable civilian forces. As able-bodied civilian employees were inducted into the armed services, they had to be replaced by women and elderly or physically-handicapped men. Even the widespread use of civilians of these types failed to bring stability, for they left hospitals in growing numbers to take better paying jobs elsewhere. Competition with war industries and other government agencies was keen and hospital wagescales were frequently lower than those prevailing in surrounding areas. As a result, hospital commanders found the use of civilians "very vexatious, time consuming, and expensive,"82 and by the end of 1942 some of them began to think it would be better to replace civilians with limited service men, however unsatisfactory, or with members of the Women's Army Auxiliary Corps.83
When the question of using Waacs in Army hospitals was first raised in the spring of 1942, The Surgeon General expressed opposition because, he said, their use would conflict with civilian personnel employment, would interfere with training of enlisted men, and would create diffi-
78 (1) Ltr AG 220.31(4-1-42)EA-A, TAG to CGAGF, CGs Eastern, Western, Southern, and CentralDef Comds, and all CA Comdrs, 2 Apr 42, sub: ClearingFld Force Units of Pers Not Physically Qualifiedfor Fld Serv. SG: 220.31-1. (2) Ltr AG 220.31(7-2-42), TAG to CGs AGF, AAF, SOS, etc., 14 Jul 42,same sub. Same file.
79 (1) An Rpts, 1942, Sta Hosps at Ft Knox, CpsRoberts, Bowie, Maxey, Chaffee, Atterbury, Lee,Wolters, Forrest, and Hoff and Tilton Gen Hosps.HD. (2) An Rpts, 1942. Chiefs Med Br 1st, 2d, 3d,and 7th SvCs. HD.
80 (1) Memo. SG for Dir Mil Pers SOS thru Dir TngSOS, 3 Dec 42, sub: Asgmt of Class I and Class IILimited Serv Pers to MRTCs. SG: 220.31-1. (2)Memo SPGAE/220.3(12-3-42)-132, Dir Mil PersSOS for SG, 10 Dec 42, same sub. Same file.
81 Ltr, CG ASF per SG to CGs MRTCs, MDETS,etc., 16 Apr 43, sub: Util of Limited Serv Pers. HD:220.31-1.
82 Ltr, CO LaGarde Gen Hosp to Col G[eorge] F.Lull, SGO, 28 Dec 42. SG: 323.7-5(LaGarde GH)K.
83 The above paragraph is based on: An Rpts, 1942,Ashford, Billings, Bushnell, Hoff, Percy Jones, Tilton,and Torney Gen Hosps, and Sta Hosps at Ft Riley,and Cps Atterbury, Blanding, Chaffee, Croft, Howze,Lee, Maxey, Roberts, Wheeler, Wolters. and Young.HD.
136
HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR
culties centering around housing and recreation.84 During 1942, as civilians becameincreasingly hard to get and keep and aslimited service men replaced those qualifiedfor overseas service in growing numbers,the idea gradually gained currencyamong hospital commanders, service commandsurgeons, and members of the SurgeonGeneral's Office that Waacs, whocould not leave their jobs and who hadsufficient ability and education to absorbtechnical training, were a 'better bet'than either civilians or limited service enlistedmen.85 Meanwhile, as plans weremade to expand the women's corps, boththe War Department General Staff andSOS headquarters put pressure on all ofthe services, including the Medical Department,to use Waacs extensively torelease men for combat duty.86 About thesame time, the Wadhams Committee recommendedtheir employment in hospitals.87 Accordingly, early in 1943 the SurgeonGeneral's Office began to plan fortheir assignment to Medical Departmentinstallations.
At first The Surgeon General decided toconduct experiments at Halloran (NewYork) and Valley Forge (Pennsylvania)General Hospitals to see what jobs Waacscould fill.88 Failing to obtain WAAC unitsfor this purpose, on 26 January 1943 heappointed a board of officers, composed ofthe chief of his Hospitalization Divisionand members of the Personnel and TrainingDivisions, to study the problem. Soonafterward he requested reports from servicecommands, the Air Forces, the TransportationCorps, and the Army MedicalCenter on hospital jobs which Waacs couldfill, the numbers needed, and the constructionrequired to house them.89 Fromthese surveys The Surgeon General'sboard found that the Air Forces planned to use Waacs in all hospitals having 200 ormore beds and that the commanders ofSOS hospitals having 500 or more bedsfelt that they could use them to replacefrom 30 to 50 percent of their enlistedmen. Not all hospital commanders, itshould be noted, were enthusiastic aboutusing Waacs, their attitudes depending toa large extent upon what General Grant,the Air Surgeon, called the 'personalequation.'90 The board estimated that
84 Memo, Lt Col Gilman C. Mudgett, SOS for SG,31 Mar 42, sub: Possible Use of Mems of the WAACin Army Hosps, with 1st ind, SG to CG SOS, 14 Apr42; and 2d ind SPTRS 290 (WAAC) (3-21-42), CGSOS to SG, 29 Apr 42. SG: 322.5-1 (WAC).
85 (1) Ltrs, CO LaGarde Gen Hosp to Col H. D.Offutt, SGO, 21 and 29 Sep 42, and to Col G. F. Lull,SGO, 28 Dec 42. SG: 323.7-5 (LaGarde GH)K. (2)An Rpts, 1942, Cp Howze and Sheppard Fld StaHosps, and Chief Med Br 3d SvC. HD. (3) Ltr, COValley Forge Gen Hosp to SG, 19 Jan 43, sub: RequestAllocation and Asgmt of a WAAC Unit, with1st ind. SG: 322.5-1. (4) Ltr, Col G. F. Lull, SGO toCol W. H. Smith, LaGarde Gen Hosp, 5 Jan 43. SG:323.7-5(LaGarde GH)K. (5) Ltr, Lt Col D[aniel] J.Sheehan. SGO to Brig Gen James E. Baylis, CGMRTC, Cp J. T. Robinson, Ark, 22 Feb 43. HD:220.31-1.
86 (1) Memo S635-2-42, 22 Oct 42, sub: Asgmt ofWAAC. AG: 320.2(10-l-32) (3) Sec 16. (2) Memo,CG SOS for C of Sup and Admin Servs, 22 Oct 42,sub: Data for Study on Use of WAAC. Same file.
87 Extracts from Memo, CG SOS for SG, 26 Nov42. and from 2d ind, CG SOS to SG, 21 Dec 42, inCmtee to Study the MD, 1942-43, Actions onRecomd, Recomd No 88. HD.
88 (1) Extract from 3d ind, SG to CG SOS, 16 Jan43. on extract from Memo, CG SOS for SG, 26 Nov42. (2) Extract from 1st ind, SG to CG SOS, 8 Mar43, on extract from Memo, CofS SOS for SG, 26 Feb43. Both in Cmtee to Study the MD, 1942-43, Actionson Recomd, Recomd No 88. HD.
89 (1) SG OO 41, 26 Jan 43. (2) Memo, CG SOS perSG for CG 1st SvC, attn Chief Med Br, 29 Jan 43,sub: Employment of WAAC in Sta and Gen Hosps,ZI. HD: 322.5-1. The same letter was sent to all ServiceCommands. (3) Memos, SG for CG AAF, MDWand AMC, and for CofT, 3 Feb 43, same sub. Samefile.
90 1st ind, CG AAF per Air Surg to SG, 26 Feb 43,on Memo, SG for CG AAF attn AF Surg, 3 Feb 43,sub: Employment of WAAC in Sta and Gen Hosps,ZI. SG: 322.5-1.
137
MINOR CHANGES IN HOSPITAL ADMINISTRATION
more than ten thousand Waacs would beneeded for hospitals and in March 1943recommended that WAAC headquartersbe asked what number they could supply.91 The Surgeon General then sent eachservice commander a tabulation of Waacrequirements for hospitals in his command,for inclusion in the Waac requisitionwhich it was anticipated SOS headquarterswould require each to submit.92Soon afterward, Waac recruiting collapsedand WAAC headquarters could promiseThe Surgeon General, on 2 June 1943,only 150 to 170 women for training eachmonth, beginning in September 1943.93The extensive use of Waacs in hospitalstherefore had to wait.
Problem of Furnishing Supplies
and Equipment for Hospitals
Providing sufficient medical suppliesand equipment for large numbers of newstation and general hospitals, and for oldhospitals that were expanding with unprecedentedrapidity, as well as for dispensaries,infirmaries, induction stations, andmedical units destined for overseas service,presented the Medical Department aproblem of great magnitude.94 It was partiallysimplified by the practice of issuinghospital assemblages as single items. Usingequipment lists prepared during the emergencyperiod, medical depots packedassemblages which included, within thelimits of supplies and equipment available,all items needed to establish hospitals ofvarious sizes and kinds, ranging from25-bed station hospitals to 1,000-bed generalhospitals. As new hospital plants wereconstructed the Surgeon General's Officehad assemblages of appropriate sizesshipped to them. As established hospitalswere expanded, local medical supply officers requisitioned standard assemblages tofit their needs.95 This system not only savedtime and personnel that would have beenrequired to list the manifold items requiredfor each hospital but also relievedlocal supply officers, many of whom wereunacquainted with tables of equipmentand inexperienced in estimating hospitalneeds, of the necessity of determining whatitems would be required for hospitalexpansions.
Changes in the requisitioning procedureused by hospitals to meet recurrent operationalneeds became imperative as soonas the wartime expansion began. Beforethe war, hospitals were permitted to makeonly quarterly and emergency requisitions,all of which had to be reviewed bycorps area surgeons before being sent todepots for filling. To enable hospitals tomeet urgent needs that resulted fromrapid expansions, as contrasted with emergencyneeds that could not be foreseen,The Surgeon General early in January1942 permitted the submission of 'special'requisitions at any time.96 To eliminate anunnecessary step and thus speed the requisitioningprocess, he began a system of
91 Rpt of Proceedings of Bd of Offs, n d, incl 4 toMemo, SG for Planning Serv WAAC Hq, 13 Mar 43,sub: Util of WAAC in MD. HD: 322.5-1.
92 Memo, CG SOS per SG for CG 3d SvC, 27 Mar43, sub: Employment of WAAC in Sta and GenHosps, ZI. HD: 322.5-1.
93 (1) Memo, SG for CG ASF, 2 Jun 43, sub; TecTng for WAAC Pers. HD: 322.5-1. (2) Mattie E.Treadwell, The Women's Army Corps, Ch. XIX.
94 Except where otherwise noted, this section isbased on Richard E. Yates, The Procurement andDistribution of Medical Supplies in the Zone of theInterior during World War II (1946), pp. 169-87.HD.
95 (1) Ltr, SG to MD Depots, 2 Feb 42, sub: MedDepot Program for 1942. SG: 475.5-1. (2) SG Ltr 141,2 Nov 42, sub: MD Equip Lists. (3) SG Ltr 156, 24Nov 42, sub: Sup Policies and Procedures, ZI Instls.
96 SG Ltr 2, 8 Jan 42, sub: Requisitions.
138
HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR
direct supply on 10 February 1942. After that date hospital medical supply officers could submit requisitions directly to depots, without corps area intervention.97
In the early months of the war, theMedical Department continued to behandicapped by a shortage of many items.As a result, depots found it necessary toship incomplete assemblages and partiallyfilled requisitions. Missing items wereplaced on back order, to be shipped whenavailable. Among the items which hospitalsmost frequently failed to receive weredental supplies and equipment, surgicalinstruments and operating room equipment,laboratory equipment, X-ray developing-tanks and cassettes, hospital furnitureincluding beds, and food carts. Newhospitals suffered most from these shortages.In a few instances the receipt ofincomplete assemblages delayed theiropening or the opening of some of theirclinics and wards. When hospitals openedwith incomplete equipment they usuallyhad to send surgical patients to near-byhospitals and have dental, laboratory, andX-ray work done elsewhere. To make upfor shortages that continued to exist, theyresorted to borrowing, improvising, andpurchasing in the open market. Some borrowedbeds from the local quartermasterand such items as X-ray developing-tanks,cassettes, and food carts from other Armyhospitals or from Veterans Administrationfacilities. Others improvised X-ray developing-tanks and food carts. Many hadtheir own 'utilities' personnel build missingitems of hospital furniture. Sometimes,when money was available, hospitals purchasednecessary supplies on the localmarket. In some instances, officers usedtheir own instruments and in one case,where there was a shortage of typewriters,civilian typists were required to providetheir own. While these shortages undoubtedlytaxed the ingenuity of hospital commandersand operating personnel, theyfailed, apparently, to affect medical careadversely, for hospital commandersseemed able to arrange for the use of localcivilian or near-by Army facilities withoutundue difficulty.98
In the latter part of 1942 The SurgeonGeneral intensified his efforts to solvemedical supply problems. Most measurestaken toward that end, such as the improvementof depot operations, are outsidethe scope of this study. Two deserveconsideration here. The requisition systemwas completely revised and placed on amonthly basis, effective 1 January 1943.After that date hospitals submitted separatemonthly requisitions for standard - expendable,standard - nonexpendable, and nonstandard items. They could stillsubmit 'special' and emergency requisitions.99 Concurrently, the stock-controlsystem was revised. The system formerlyin effect had permitted hospitals to keeplarge stocks on hand and had not requiredaccurate 'due in' records. As a resultsome hospitals held in storage items thatwere needed by others, and medical supplyofficers often did not know which itemsof their requisitions remained to be shippedby depots. In the fall of 1942, therefore,the Surgeon General's Office establishedlower stock levels and devised a new stock-
97 SG Ltr 11, 10 Feb 42, sub: Direct System of Supfor Posts, Cps, and Stas.
98 The above paragraph is based on information inthe following: An Rpts, 1942, Chiefs Med Br 1st, 3d,4th, 5th, 6th. 7th, and 9th SvCs; Ashford, Bushmen,Billings, Deshon, Harmon, Hoff, and Percy Jones GenHosps; and Sta Hosps at Fts Belvoir and Bliss, SheppardFld, and Cps Adair, Atterbury, Butner, Cooke,Howze, Maxey, and McCoy. HD.
99 SG Ltr 156, 24 Nov 42, sub: Sup Policies andProcedures, ZI Instls.
139
MINOR CHANGES IN HOSPITAL ADMINISTRATION
record card for posts and general hospitals.These changes not only produced bettersupply administration but also releasedlarge amounts of supplies and equipmentfor redistribution to hospitals sufferingfrom shortages.100 The combination ofmeasures begun in 1942, along with completionof the hospital expansion programduring 1943, resulted in a greatly improvedsupply situation. During the rest ofthe war hospitals and service commandsurgeons reported generally that requisitionswere promptly filled and that thesupplies and equipment which they received were of good quality and of sufficientquantity to meet their needs.101
100 For example, see the following: An Rpts, 1943,Surg 7th SvC, and Sta Hosps at Cps Lee and Maxey.HD.
101 (1) Memo, Dir Sup Planning Div SGO for ActChief, Sup Serv SGO, 22 Dec 43, sub: Rpt of Visits toHosp Instls. SG: 333.1-1. (2) Memo, Dir Distr andReqmts Div SGO for Mr. Edward R. Reynolds, 20Jan 44, sub: Data for Inclusion in ... Rpt on Accomplishmentsof SGO. SG: 024.-1. (3) An Rpts atrandom; for example, An Rpts, 1943, Hoff, PercyJones, Ashford, and Dibble Gen Hosps; An Rpts,1944. Surg 2d, 5th, and 9th SvCs, and Beaumont,Baker, Birmingham, and Lovell Gen Hosps; An Rpts,1945. Surg 2d SvC, and Beaumont and BirminghamGen Hosps. HD.
