PART ONE
HOSPITALIZATION
DURING THE EMERGENCY PERIOD
8 SEPTEMBER 1939-7 DECEMBER 1941
Introduction
The State of Army Hospitalization, 1939
When President Roosevelt proclaimed a "limitednational emergency" on 8 September 1939, just one week after Germanyinvaded Poland, the Medical Department of the United States Army was operating 7general hospitals and 119 station hospitals. Five of the general hospitals werelocated in the United States-Walter Reed at Washington, D. C.; Army and Navyat Hot Springs, Ark.; Fitzsimons at Denver, Colo.; Letterman at San Francisco,Calif.; and William Beaumont at El Paso, Tex. The other two were in overseaspossessions-Tripler in the Hawaiian Islands and Sternberg in the Philippines.Of the station hospitals 104 were on Army posts in the United States and Alaska,while the remainder were divided among the Philippine Islands, the HawaiianIslands, and the Panama Canal Zone. Each station hospital was designated by thename of the post on which it was located and each general hospital, except one,was named for a deceased medical officer. Hence, station and general hospitalsin the United States in both peace and war, as well as those in overseaspossessions in peacetime, were called "named hospitals."
Station hospitals and general hospitals had differentfunctions. The former served local and ordinary needs, usually receivingpatients from stations where located and treating those with minor ills andinjuries only. General hospitals, on the other hand, were designed to servegeneral and special needs. By transfer from station hospitals they receivedpatients who suffered from severe or obscure diseases as well as those whoneeded complicated surgery.
Capacities of named hospitals depended largely upon trooppopulations served. Other factors also influenced their capacities, such asclimate, prevalence of disease, general physical condition of troops, and typesof activities in which the latter were engaged. Hospital capacities and hospitalrequirements were expressed in terms of beds, which in the Army meant not onlybeds themselves but also shelter, equipment, utilities, and personnel that wentwith them. For an Army strength of 135,749 in the United States and Alaska inJune 1939 there were 4,136 general hospital beds and 8,234 station hospitalbeds. This represented a bed ratio to strength of approximately 3 percent forgeneral hospitals and 6 percent for station hospitals. For a strength of 10,993in the Philippines there were 317 general hospital beds and 360 station hospitalbeds. In the Hawaiian Islands, the most healthful of overseas possessions, therewere 350 general hospital beds and 360 station hospital beds for a strength of20,601. The Panama Canal Zone, with next to the highest sick rate in the Army,had only 269 station hospital beds for a strength of 13,533, a ratio of 1.98percent. This unusual situation resulted from the fact that civilian Canal Zonehospitals-Gorgas, Colon, and Corozal-staffed with Army Medical Corpsofficers but under the control of the Governor of the Canal Zone,
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cared for a considerable portion of the Army's patients inthat area.1
The Surgeon General believed that the Army's hospitals wereinadequate, even for peacetime needs. He had begun a long-range program in 1934to improve and expand them but funds appropriated by Congress for MedicalDepartment construction had been sufficient for little more than essentialmaintenance of existing buildings. As a result, the Army's hospitals in 1939were poorly suited to any increase in its strength. In Panama only fifty bedswere located in a hospital building. The remainder were crowded into buildingserected for other purposes. Hospital plants in the Hawaiian and PhilippineIslands needed repairs and alterations. In the United States hospital buildingswere small and widely scattered among a number of permanent Army posts. Erectedtwenty-five to thirty years before, many lacked facilities for the separation ofpatients according to grade, sex, and disease, and for such modern diagnosticand treatment procedures as basal metabolism, X-ray, and oxygen and physicaltherapy. Of the entire number, The Surgeon General considered only twenty-fiveas modern, fire-resistant buildings and only fifty of the remainder as worthmodernization. The others, he believed, should be replaced with new buildings.2
For the care of patients in theaters of operations in wartimethe Medical Department had a doctrine of hospitalization and evacuation thatdated from the Civil War and had been successfully applied during both theSpanish-American War and World War I. Casualties were given emergency treatmentat a series of medical stations established in the forward areas of combatzones. To provide such treatment as well as the transportation of patients, whennecessary, from one station to another farther to the rear, every regiment andseparate battalion of all arms and services, except medical, had a medicaldetachment, and every division had a medical regiment, medical battalion, ormedical squadron. To furnish as near the front as possible a higher type oftreatment than first aid or emergency medical care, hospitals designed for easymovement and hence called "mobile hospitals" were assigned to fieldarmies. They were of three types: surgical hospitals, evacuation hospitals, andconvalescent hospitals. Surgical hospitals were planned for use in eitherdivision or army areas of combat zones. In division areas they were to carry outemergency procedures, such as treatment of shock, control of stubbornhemorrhage, reconstitution of blood following hemorrhage, and fixation ofcomplex fractures, in order to prepare men with serious injuries for furtherremoval to the rear. In army areas they performed much the same function asevacuation hospitals. Evacuation hospitals normally served only in the rearareas of combat zones. They provided definitive treatment for evacuees fromforward areas and for the sick and
1Annual Report of The Surgeon General, U.S. Army, 1939 (Washington, 1940), pp. 170, 250; 1940 (Washington, 1941), p. 1 (cited hereafter as Annual Report. . .Surgeon General). Only Puerto Rico, with a mean annual strength of 1,312, had a slightly higher admission rate than Panama. Puerto Rico had no Army hospital in the middle of 1939.
2(1) Annual Report. . .Surgeon General, 1937 (1937), pp. 167-68; 1939 (1940), p. 253; 1940 (1941), p. 265. (2) Hearings before the Subcommittee of the Committee on Appropriations, House of Representatives, 76th Cong, 1st session [H. R. 6791] Supplemental Military Appropriation Bill for 1940 (Washington, 1939), pp. 157-58. (3) Statement of MD Activities by Maj Gen James C. Magee, SG, USA, for the Subcmtee of the House Cmtee on Mil Approps (1939). HD: 321.6-1. (4) Preliminary Estimates, QMC, FY 1941 (25 May 39). Off file, Hosp Cons Div, SGO. (5) An Rpts, CA Surgs. SG: 319.1-2. (6) C. M. Walson, "Observations at Army Hospitals," Army Medical Bulletin, No. 42 (1937), pp. 65-72.
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injured of surrounding areas. They returned some patients toduty after short periods of treatment, transferred others with prospect of earlyrecovery to convalescent hospitals, and prepared still others for transportationto general hospitals for continuation of treatment. Convalescent hospitals werenot staffed and equipped to perform major surgery. Their chief function was torestore to physical fitness patients received from evacuation hospitals, totreat cases of venereal disease, and to care for patients from units locatednear by.
For service in communications zones there were station andgeneral hospitals. The latter received patients not only from station hospitalsbut mainly from evacuation and surgical hospitals. They returned some to duty intheaters of operations and transferred others for further treatment to generalhospitals in the zone of interior. Since it was expected that hospitals incommunications zones would rarely need to be moved, station and generalhospitals were called "fixed hospitals." When several were grouped inone location they might be combined into a hospital center with a 1,000-bedconvalescent camp. All hospitals in theaters of operations, whether fixed ormobile, were designated by numbers rather than by names and locations, and hencewere called "numbered hospitals."3
Unlike named hospitals in the United States, numberedhospitals had standard capacities, staffs, and equipment that were establishedby tables of organization, tables of basic allowances, and equipment lists.Tables of organization for hospitals showed the capacities of installationswhich different units were designed to operate. While tables of basic allowanceslisted equipment authorized for units and their members, they did not itemizesuch articles as drugs and biologicals, surgical gauzes, surgical instruments,dental supplies and equipment, laboratory supplies and equipment, X-ray suppliesand equipment, and operating-room equipment. These were included under oneheading as an "assemblage." Items for hospital assemblages were listedindividually and by amounts in Medical Department equipment lists.
For use in theaters of operations in June 1939 the MedicalDepartment had little more than doctrine. Only five Medical Department fieldunits were in existence-four medical regiments (two of which were overseas)and one medical squadron. According to The Surgeon General, failure to haveother units in training resulted from a shortage of Medical Department enlistedmen. Congress limited their number to 5 percent of the strength of the Army, anduse of more than 4 percent in named hospitals and other peacetime installationsleft few for field units. Early in 1939 The Surgeon General had sought anincrease in the Medical Department's allowance of enlisted men, but withoutsuccess.4
To provide officers for wartime hospitals-physicians,dentists, and nurses-The Surgeon General had proposed in March 1939 therevival of "affiliated units." These were reserve units sponsored bycivilian hospitals and medical schools. Such units had been organized by theAmerican Red Cross during World War I and had contributed substantially to Armyhospital service in France. "I am convinced," wrote Surgeon GeneralCharles R. Reynolds, "that the Medical Department can have reserve hospital
3AR 40-580, MD, Hosps-Gen Provisions, 29 Jun 29.
4(1) Cmtee to Study the MD, 1942, Testimony of Col Albert G. Love, p. 2. HD. (2) Annual Report. . .Surgeon General, 1939 (1940), pp. 179-82.
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units ready to function as required . . . only by civilinstitutions sponsoring these units, especially those needed within the earlyperiods of mobilization. . . ."5 In August1939 the Secretary of War approved in principle The Surgeon General's plan toorganize affiliated units to staff 32 general, 17 evacuation, and 13 surgicalhospitals. Full approval was given several months later.6
The only reserve equipment which the Medical Department hadon hand was that stored after World War I. It was "of 1918 vintage,incomplete in modern operating-room equipment, wholly deficient in essentiallaboratory equipment, totally lacking in X-ray, physical therapy andhydrotherapy equipment, and stocked with scientific items now obsolete andrapidly becoming obsolescent."7 Moreover,with few exceptions, tables of organization and tables of basic allowances forfield medical units, including hospitals, had not been changed since 1929, andthe preparation of new equipment lists for them had just been begun in January1939.8 To prepare for war the MedicalDepartment had to start almost from scratch.
Effect of the War in Europe
The period of the emergency in the United States was for theMedical Department a time of partial preparation for war through the provisionof the hospitalization actually required for an expanding Army. Its steps inthis direction were sometimes painful and often halting. Several factorsaccounted for this. Formal mobilization planning of the Medical Department, likethat of the rest of the Army, was based upon a belief that the anticipated forceof 1,000,000 to 1,200,000 men would be called up only if the United States orits possessions were attacked. It was therefore essentially defensive in nature.Moreover, there was uncertainty about the nature of increases of the Army-whetherrises in the authorized strength of the Regular Army were temporary or permanentand whether or not the mobilization that finally occurred was for a year oftraining only, as it purported to be. Furthermore, funds which the General Staffcould secure for the entire Army, let alone the Medical Department, were limitedby the caution of the President and the sentiment of Congress. Finally, TheSurgeon General and his associates, like many others in the Army and theGovernment at large, found it difficult to break peacetime habits of thought andaction in order to plan imaginatively for a second World War.9
5(1) Ltr, SG to TAG, 17 Mar 39, sub: Affiliation of MD Units with Civ Insts. HD: 326.01-1 (Affiliated Units). (2) The Medical Department of the United States Army in the World War (Washington, 1923), vol. I, p. 102 (cited hereafter as The Medical Department . . . in the World War).
6(1) Cmtee to Study the MD, 1942, Testimony, pp. 8-10. HD. (2) Annual Report . . . Surgeon General, 1940 (1941). pp. 177-78. (3) For a full discussion of the revival of affiliated units see John H. McMinn and Max Levin, Personnel (manuscript for a companion volume in this series). HD.
7Ltr, SG to TAG, 6 Apr 40, sub: Status of MD for War. AG: 381 (4-6-40) (1).
8(1) Tables of organization and tables of basic allowances that were available in June 1939 are on file in HD. (2) Incl 2, Ltr, Brig Gen Harry D. Offutt to Col H. W. Doan, 10 Jun 48. HD: 322. (3) Interv, MD Historians with Gen Offutt, 10 Nov 49. HD: 000.71.
9Mark S. Watson, Chief of Staff: Prewar Plans and Preparations (Washington, 1950), pp. 15-56, 126-71, in UNITED STATES ARMY IN WORLD WAR II, discusses plans and preparations of the General Staff, along with limiting factors and influences, in considerable detail. Robert E. Sherwood, Roosevelt and Hopkins: An Intimate History (New York, 1950), pp. 157-62, discusses the difficulty Government Departments displayed in adjusting to planning for a global war.
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The war in Europe had almost immediate effects upon the Armyand the Medical Department. In September 1939 the authorized enlisted strengthof the Regular Army was increased from 210,000 to 227,000. The next spring, asthe Nazi war machine rolled toward the English Channel, it was again raised-to280,000 in May and to 375,000 in June. Then, in the latter part of 1940, afterthe fall of France, Congress approved a peacetime mobilization. From Septemberof that year until December 1941, the Army's strength grew from 438,254officers and enlisted men to 1,686,403. The Medical Department had to expand itsoperations accordingly. This involved mainly building up facilities in theUnited States, where 85 to 90 percent of the troops were stationed, buthospitals in overseas possessions also had to be expanded and additional onesprovided for new Atlantic defense bases. While a regular system of fieldhospitalization and evacuation was as yet unnecessary, medical units had to beorganized and prepared for such service.10
The expansion of hospital facilities in the United Statesinvolved many considerations. Decisions had to be made as to the types ofhousing to be used and the number of beds that would be needed. Means had to befound for providing suitable hospital plants in as short a time as possible. Newhospitals had to be manned and the staffs of old ones augmented."Green" officers had to organize hospitals and establish proceduresfor their administration. Supplies and equipment had to be placed in hospitalplants at appropriate times. Finally, it was necessary to develop procedures forthe operation of the greatly expanded hospital system.
The preparation of hospital units for field service sometimesconflicted with these activities, for such units also demanded personnel andequipment. The amount they should be given while in training was a mootquestion. The number of such units to be activated had to be determined. Afterthey were organized they needed to be trained. Before most of these steps couldbe taken, tables and lists governing their organization, manning, and equipmenthad to be revised and modernized.
The challenge of an expanding Regular Army and a peacetimemobilization affected only slightly the organizational structure of the Army forhospitalization. Yet this structure and its changes must be understood beforethe actions of various agencies in providing hospitalization are discussed.
10Biennial Report of the Chief of Staff of the United States Army, July 1, 1939 to June 30, 1941, to the Secretary of War (Washington, 1941) (cited hereafter as Biennial Report . . . Chief of Staff, 1939-41). Figures on strength of the Army were supplied by the Strength Accounting Branch, AGO.
