AMEDD Corps History > Medical Specialist > Publication
Professional Services of Dietitians, World War II
Lieutenant Colonel Thelma A. Harman, AMSC, USA
The commanding officer of an Army hospital was responsible for the hospital mess just as he was responsible for the other departments. He designated an officer, known as mess officer or director of dietetics, to have immediate charge of the mess. This officer was responsible to him for the administration and functioning of all the hospital messes. The mess officer was also custodian of the hospital fund which even in small hospitals sometimes involved more than $20,000 a month.2 He collected all subsistence charges and handled accounts for all food used in the hospital messes. The dietitians were responsible to the mess officer for all details of food preparation and service, and these always included planning the patients` dietary modifications.
Early in the forties, hospital mess officers were usually medical officers extremely capable in administration who were potential hospital commanders. Thus, they had working familiarity with their mess duty requirements of high standard messing procedures for both patients and duty personnel. Eventually, medical officers were needed more in patient care areas and as a result they were no longer assigned as mess officers. Medical Administrative Corps officers, many of whom were former mess sergeants or recent graduates of an officer candidate school, assumed this responsibility.
The Army hospital mess functioned in accordance with standardized Army methods. This was a distinct advantage for it made possible the transfer of personnel from one organization to another without disrupting the operation of the units involved because of conflict of authority or differences in methods used.3 Under the mess officer, the mess sergeant was required to perform many administrative duties and was generally responsible for all details of food supply. He was an integral part of every Army hospital mess.
As the Army expanded in size, dietitians were authorized for duty in the larger hospitals. In many hospitals, they were given the food production responsibilities formerly assumed by the mess sergeant.
1Unless otherwise indicated, the primary source of information for this chapter is: Manchester, Katharine E.: History of the Army Dietitians. [Official record.]
2Viquers, R. T.: The Dietitian in a Small Hospital. J. Am. Dietet. A. 19: 282-284, April 1943.
3Johnson, W. M.: The Dietitian in a Large Army Hospital. J. Am. Dietet. A. 19: 284-286, April 1943.
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With the many problems in obtaining food supplies and qualified personnel for hospital messes, it became the responsibility of the mess sergeant to maintain personnel records and a food inventory and to supervise mess sanitation. Usually, a noncommissioned officer was responsible for preparing the work schedules of cooks, assistant cooks, vegetable men, dishwashers, and mess attendants. The mess sergeant did not supervise the dietitian, but when their duties overlapped she assisted him.
The civilian-trained dietitians had to adjust to Army procedures and, in some cases, work closely with a mess officer who had little or no training in mess management. The dietitians` duties included the preparation of diet menus; instruction of cooks in the preparation of food; supervision of the preparation, cooking, and serving of all diets; instruction of patients with diabetes in measuring and weighing food; and general supervision of the preparation of all food served to hospital patients. As a civilian employee, she did not ordinarily have control over mess personnel. However, in some of the larger hospitals, mess personnel specifically assigned to duty in the kitchens were under the authority of the dietitian in charge. In these cases, the authority was designated by the commanding officer.
The scope of the dietitians` responsibilities was increased in 1941. They were to plan balanced menus with consideration of the ration value, supervise the preparation and service of all food to bed and ambulatory patients, and inspect waste. Furthermore, they were to direct the employees in the preparation, service, and storage of food and assist in ordering food supplies and procuring kitchen equipment. The dietitians were also to give instructions in and demonstrate the preparation of special diets to patients when such diets were ordered by the physician in charge.4
The directive which further defined the dietitians` duties emphasized that the mess sergeant, in addition to his experience as a general cook and his fair knowledge of the different food values, had to possess the ability to handle men, knowledge of simple figures, ability to purchase supplies in quantity, some knowledge of records, and a thorough knowledge of cleanliness, sanitation, and food conservation.
The large Army hospital messes functioned most effectively when both a dietitian and a mess sergeant were assigned in each kitchen (fig. 46). This was particularly true in the training of mess personnel where close supervision and coordination were required. Before the war, mess personnel were experienced, well trained, and capable of planning work on their own initiative. With mobilization and the influx of inexperienced personnel, complete organization of the mess department had to be accomplished in a relatively short period of time. The dietitian and mess sergeant often worked together in on-the-job training of mess personnel in food production. The dietitian provided
4(1) Circular Letter No. 7, Office of The Surgeon General, 8 Feb. 1941. (2) Circular Letter No. 109, Office of The Surgeon General, 28 May 1943.
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FIGURE 46-Dietitian and mess sergeant checking the daily menu.
(U.S. Army photograph.)
additional standardized recipes, prepared work schedules, and made job analyses.5 They generally checked leftover food to provide for maximum utilization, maintained a constant check on food cost and waste, and charted the amount of food required for each ward so that the proper quantity could be loaded on the food carts and delivered just before the serving hours.6
At Billings General Hospital, Fort Benjamin Harrison, Ind., a large hospital with an average patient load of 1,500, mess personnel supervised by the dietitian and mess sergeant included military and civilian cooks, bakers, butchers, and mess attendants, German prisoners of war, and general prisoners. The head cook of the shift was responsible for carrying out the instructions of the dietitian or mess sergeant. He was accountable to them for the quality and quantity of food prepared on his shift, the organization of his shift, and the
5(1) Murray, E.: Duties of an Army Dietitian. J. Am. Dietet. A. 18: 676-678, October 1942. (2) The Quartermaster recipe book was not used in all hospital messes. This may have been due to a lack of awareness by some food service personnel that such an aid was available.
6Manchester, K. E.: The Dietitian in Army Service. J. Am. Dietet. A. 18: 30-31, January 1942.
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assignment of work to his assistants. He was responsible for loading the ward food carts and for plate service in the messhall. The bakers used standardized recipes in meeting the production requirements of the dietitians. The butchers processed meats according to the exacting requirements (requisitions with definite specifications) of the dietitians and mess sergeants. Mess attendants assisted the cooks, acted as table waiters, performed sanitation tasks, and assisted in loading and checking the ward food carts.7
Although the dietitians were commissioned in 1943, their duties and responsibilities continued to vary according to the type and size of hospital to which assigned, the whims of some hospital commanders, and the dietitian`s professional capability. This was general practice until about mid-1944.
In August 1944, a change in regulations more clearly defined the organization of the mess department.8 The hospital commander was enjoined to exercise every precaution in the prevention of waste and misuse of property or supplies in the messes. Personnel assigned to mess management would be only those of known probity and good habits. There was no change in the mess officer`s duties from earlier directives. Where dietitians were assigned, duties listed for them were more specific than formerly. They were to assist in the supervision of mess sanitation and were to have access to all mess records. Some dietitians had performed these tasks routinely before the change in regulations; however, this was done on a permissive basis in accordance with the desires of the hospital commander. Along with the general public, the military had also become waste and cost conscious. The regulation further stipulated that the mess sergeant would be directly responsible to the dietitian for the efficient management and operation of the patients` mess.
The manual on administration of fixed hospitals, published in November 1945,9 provided detailed guidance in the operation of Army hospital messes (chart 5). The presentation of procedures and the necessary forms to be followed aided immeasurably in instituting and maintaining the highest mess standards.
Menu Planning and Food Requisitioning
The dietitian planned menus with the objective of satisfying the food habits of the majority and at the same time offering an adequate diet. She had to consider mess personnel abilities, adequacy of equipment, food habits, climate, season, availability of foods, forced issues of subsistence items,10 and the subsistence income. The Army hospital
7History of Dietetic Department, Billings General Hospital, Fort Benjamin Harrison, Ind., 1944-46.
8Army Regulations No. 40-590, 29 Aug. 1944.
9War Department Technical Manual (TM) 8-262, 15 Nov. 1945, ch. VI.
10Forced issues were issues other than normal issues and were literally forced onto the using units. The issues included excess supplies of both perishable and nonperishable items. Generally, this measure was followed to avoid spoilage and to conserve storage space. Mission changes, as well as too high stock levels, resulted in forced issues.
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CHART 5-Organization of hospital dietetics division before 1947
menu was higher in calories than the civilian hospital menu for several reasons. The average military patient was younger than the average civilian patient, and had a longer hospitalization because he was discharged only when ready for duty. Finally, the master menu,11 known as the domestic menu, which was high in calories, was used as a guide in menu planning in hospitals. Usually the head dietitian wrote the weekly menu for regular, light, soft, and liquid diets. In larger hospitals, this duty was performed by the administrative dietitians in the various hospital messes in order to insure maximum variety of popular food items. The therapeutic dietitian wrote the special diet menus.12
Hospitals in all service commands had menu planning boards composed of the director of supply, the mess officer, the assistant mess officer, and the head dietitian. These boards met at regular intervals to discuss problems involved in planning menus for the entire hospital.
The dietitian planned skeletal menus weeks ahead of use-dates so that she could requisition meat, perishable fresh fruits and vegetables, and staple food items for the hospital patient messes. Some food items were purchased by the mess officer from specified local venders or obtained from the local quartermaster. In writing her skeletal menus, the dietitian planned for the use of all parts of the carcass, such as
11The master menu, issued by the Office of The Quartermaster General, was prepared as a guide for all troop feeding. It was published each month, 3 months in advance, and provided three meals a day each day of the month. Each menu was different.
12Burns, H. C.: The Army Dietitian and Her Duties. J. Am. Dietet. A. 18: 28-30, January 1942.
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meat for stew or hamburger. She also considered the probable patient census.
Army hospitals were allowed the money value of the garrison ration13 plus 50 percent for both subsistence and patient welfare expenditures. Hospital commanders could make expenditures for non-food items from the hospital fund but such purchases had to contribute directly to the welfare, comfort, and pleasure of the patients. Since the income available for subsistence varied each month, the dietitian had to check the mess account frequently to control food costs. Thus, adjustments could be made in the menus being served during a certain period to avoid an extreme gain or loss at the end of the month.
Problems were presented in the planning of oversea hospital menus. The type of ration issued depended upon availability of food supplies and the mission of the hospital. Personnel had to be instructed in the preparation and use of dried eggs, dried milk, Spam, and large quantities of certain types of food such as corned beef and canned stews, which became monotonous in the diet of the patient. The dietitian, mess sergeant, and cooks experimented with these items in order to add variety and make the products acceptable.
The oversea hospital ration menu14 was designated in 1942 for use in frigid and temperate or tropical zones and was based on the foods issued on the expeditionary force menus (processed, canned, and dehydrated food items). A substitution of items was required in every locality. The surgeon and the quartermaster had to work closely together to insure the best available issue of subsistence supplies. When perishable foods were available, they were substituted for nonperishable foods.
The oversea hospital ration menu was written for a 10-day period. Menus were included for regular, light, soft, and liquid diets. The percentage (established figures, not based on experience factor) distribution was: regular, 85 percent; light, 3 percent; soft, 6 percent; liquid, 4 percent; and miscellaneous special diets, 2 percent. The quantities of food planned for the 15 percent of special diets were sufficient to allow for the variations of diet which a patient might require. Food high in vitamins and minerals included tomatoes, tomato juice, lemon and orange powder, dried whole milk, and enriched flour. Vitamin concentrates were provided for patients required to be on special diets for some time.
Inspection of Food Waste
Beginning early in the war, a check was made on all food waste in Army hospitals. The use of standardized recipes, careful training and supervision of cooks in preparing foods, uniform servings to patients
13The ration consists of 39 components, the quality of which is prescribed by Federal specifications (Army Regulations No. 30-2210, 15 Mar. 1940).
14The earliest official reference to the oversea hospital ration is contained in: War Department Technical Manual (TM) 8-500, March 1945, p. 78.
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FIGURE 47-Supervision of food service on a ward to assure uniform servings.
(fig. 47), and requisitioning proper quantities throughout the hospital contributed to reduction of food waste. By reducing food waste, the dietitian was able to serve higher quality food within the ration allowance.
Weighing all food waste was found to be one of the most effective methods of checking food losses. Both employees and patients were then more conscious of food waste as interpreted in dollars and cents value. Waste by individuals, both patients and staff, was checked regularly by many hospital commanders or executive officers. It was seldom necessary to remind the offending person a second time.
In a number of oversea units, hospital commanders eliminated individual waste through a variety of drastic measures. Several levied
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expensive fines. Others posted listings of offenders on all bulletin boards. Still others required that the individual would eat all food either before leaving the dining hall or at the next meal.15
Ward Rounds
The dietitian made regular ward rounds at mealtime to check the quantity and palatability of the food with the patients, to determine their likes and dislikes, and the appearance of the trays. She noted and planned corrective action for any faults in food preparation or menu planning. Through her patient contacts, she was able to prepare menus with foods that would be more readily acceptable to them. One mess officer felt that patient feeding problems vanished under the guidance of a capable, well-trained dietitian. The cheerful dietitian who made ward rounds consistently, spontaneously corrected errors in food service, and gave consideration to individual peculiarities in food preferences contributed to morale and recovery.
The dietitian posted daily menus and instructions for serving trays in the ward diet kitchens. Wherever patients were permitted to select their diets, the dietitian was required to check their choices. The ward surgeon was then assured that the patient was ordering an adequate diet. If inadequate diets were selected, the dietitian offered suggestions for improvement.
Generally, the Army nurse was responsible for the preparation and service of trays in ward diet kitchens.16 An early directive provided that the head nurse was accountable for the proper serving of all food on the ward and prompt delivery of diet orders to the hospital mess.17 Generally, the nurse prepared the diet card covering diet requirements of ward patients for the ensuing 24 hours although, by directive, the ward officer was charged with this responsibility.18
Early in 1947, a directive was published which listed the responsibilities of ward officers, nurses, and dietitians for patient tray service.19 The ward officer was to inspect routinely the food going to his patient, the manner in which it was served, and the ward diet kitchen. The nurse, in the absence of the dietitian, was to supervise the serving of all diets to insure that the prescribed food at the proper temperature was going to the patient. Also, the nurse was to insure that the amount of food ordered and received was correct. The dietitian assigned to a section of wards was responsible for assisting the nurse in the instruction of kitchen personnel and in securing food supplies needed
15Personal knowledge of the author.
16Army Regulations No. 40-20, 31 Dec. 1934.
17Later revisions of the directive did not specify the duties of the head nurse. The nursing responsibility for ward food service, in most instances, was still assumed throughout World War II on the basis of Circular Letter No. 7, Office of The Surgeon General, 8 February 1941, and Army Regulations No. 40-590, 2 February 1942. "Rules for the management of diet kitchens will be prescribed by the commanding officer * * * according to the particular needs of each case."
18See footnote 8, p. 186.
19Circular No. 3, Office of The Surgeon General, 3 Jan. 1947.
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for patients. The head dietitian was encouraged to attend the chief nurse`s meeting in order that problems arising in the administration of ward diet kitchens could be discussed and coordinated. Hospital commanding officers recommended that mess officers and dietitians attend professional staff conferences so that open discussion of problems of dietary service could result in improvement of service.
In order to provide the most palatable and attractive food possible within the ration allowance, dietitians furnished standardized recipes and careful instructions to cooks. Dietitians at Brooke General Hospital, Fort Sam Houston, Tex., prepared a "daily instruction sheet" for the regular diet menu.20 The purpose was to obtain uniform products of high quality in all messes. It contained specific instructions to cooks regarding recipes to be used, amount of food to be ordered, and the portion to be served. There was space for the dietitian to record amounts ordered, number of orders to be prepared, use of leftovers, and other information necessary for the individual mess. Some dietitians used similar procedures in their food production management while others were not given this responsibility.
The dietitians checked for avoidance of excess food losses in preparation such as in the peeling of potatoes or the handling of syrup from canned fruit. The butcher shop was closely supervised in order to utilize meat scraps and fat.
Two types of food service were used in Army hospitals--ward and mess. Mess service included cafeteria (fig. 48), family style, and waiter. Generally, waiter service was given to orthopedic patients, wheelchair patients, such as paraplegics, and to officer personnel. Adjustments were made in the height of tables to accommodate the wheelchairs. The change of surroundings from the ward environment improved the morale of these patients as well as those patients on therapeutic diets, who were served in the dining hall.
Usually, the patients on therapeutic diets presented their diet cards to the special diet cooks and mess attendants at the special diet line. The correct food items were then placed on their trays and the completed trays checked by the dietitian. In some hospitals, self-service by patients was followed by matching the patient`s colored diet card with the color-tagged diet food items. A selective menu was offered in some Army hospital officers` messes. The regular menu was followed in others.
Dietitians planned variations in food and food service in order to make them more pleasing. Hamburgers, steaks, and grilled sandwiches were prepared on the line and served promptly from the griddles. Hot roast beef sandwiches were a welcome alternate for the usual roast
20History and Organization of the Dietetic Department, Brooke General Hospital, Fort Sam Houston, Tex., 1944. [Official record.]
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beef, potatoes, and gravy. Where possible, patients were allowed to get ice cream after they had finished their meal.
Ward food service in most hospitals presented many difficulties. One was the food delivery system. Early in the war, only the Drinkwater type of cart was available; later, the stainless steel electric cart was used (fig. 49). Food was delivered to the wards by mess attendants or loaded into mess vehicles for distribution.
The Drinkwater cart consisted of one or two poorly insulated tin boxes placed on a 4-wheel chassis. Large cast aluminum inserts, holding regular food, were placed in the insulated boxes. With no source for added heat, food did not remain hot. Salvaged No. 10 tin cans were used to transport small quantities of unheated special diet food to the wards. The small stove in the ward diet kitchen was not suitable for reheating large quantities of regular food in aluminum containers or the many small containers of special diet food.
Another difficulty influencing the type of ward food service was that of untrained and disinterested personnel. Patients who requested permission to go to the mess hall, because they were told by other patients that "the chow was much better in the mess," verified the foregoing statement that untrained personnel were almost wholly responsible for inferior service. The same food was served in the mess as on the wards, prepared in the same manner, and was placed in conveyors
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immediately before being sent to the wards. There were often flaws, however, in the food conveyance system. Food was placed in the containers too early or the carts were insufficiently preheated.
Trays for patients were set up on racks in the ward diet kitchens. Cold food was placed on the trays first, and immediately before serving each tray, hot food was added. In some hospitals, the food cart was wheeled up and down the ward and the rack wheeled alongside. The patient could then specify his desires as to quantity and variety. The serving of hot beverages and ice cream separately permitted him to have hot coffee and unmelted ice cream.
Dining hall service was provided on the wards where the ward officer encouraged such a morale-improvement procedure. At Newton D. Baker General Hospital, Martinsburg, W. Va., several plastic surgery patients ate family style at a large table in the ward kitchen.
When possible, actual ward service was supervised by the dietitians who assisted and instructed nurses, nurses` aides, and ward kitchen personnel in the service of trays. The dietitians checked ward refrigerators and supplies to insure that all food necessary for nourishment and that miscellaneous items to enhance meal service were available. Often, patients` requests for items such as catsup were met with curt negative responses from ward attendants who had no desire to go back to the mess for additional supplies. Minor items of this type tended to influence the general opinion of food service and the ward dietitian took corrective action when necessary.
At most hospitals, food items for special diets (few in number, compared to the total regular diets ordered) were sent to the ward already prepared. These small amounts were reheated, if necessary. At Billings General Hospital, a most effective system of serving special diets was introduced.21 All therapeutic diet patients were concentrated on two wards. Special diet cooks in the ward kitchens prepared all items not on the regular menu and the dietitians supervised preparation and service of these trays. The diet cooks requisitioned food supplies once daily; these were delivered with the morning nourishment order.
The kitchens in Army hospitals during the peacetime period had been equipped with the latest laborsaving devices and mess equipment. With expansion, new temporary buildings were added to these hospitals and wartime equipment was installed. The hospitals being constructed were temporary cantonment type and the kitchens were equipped with many substitute items. As the war progressed, enamelware was used in many items that previously had been made of stainless steel or Monel metal.
The physical setup of the hospital remained unchanged throughout the war and greatly affected the type of food production and service
21See footnote 7, p. 186.
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in the hospital. Refinements in service for small groups could not be extended to large groups. Since the floor plans were different in the permanent-type hospitals, the operational procedures established in the organization of one dietetic department did not always apply in others.
The larger cantonment hospitals had at least two enlisted patients` messes and an officer patients` mess. In addition, there was at least one detachment mess for enlisted personnel assigned to the medical detachment, a nurses` mess, and a duty officers` mess. Generally, the larger patients` mess had a butcher shop and a storeroom (adjacent to the kitchen) which serviced all hospital messes. There were usually separate facilities for the baking area. For the most part, centralized baking was done in the larger patients` mess at night. Because of the personnel situation, the need for food conservation, and the necessity for standardized products, centralized pastry and meat cutting units were found to be most economical. In some places, central butcher shops and bakeshops were constructed. The distribution of meat and bakery products to the different mess halls was made in accordance with orders of dietitians in the various mess halls.
The provision of the most nutritious food served in the most palatable manner depended to some extent on the available mess equipment. During the war years, with the vital need for metals elsewhere, many messes had to improvise some equipment. Oversea units in the two World Wars fashioned tables and cafeteria counters from scrap materials. Bottles were used for rolling pins in World War I, whereas broom handles served this same purpose in World War II. A unit in France in World War I handwashed dishes under the trees with water heated on field ranges. Many units in World War II were without dishwashing machines for the metal compartmental trays or messkits. Sinks and GI garbage cans with improvised heating units were used in handwashing all mess equipment. At one time, when the 9th Evacuation Hospital was based in North Africa, mess equipment was washed in bathtubs.22 The GI garbage can was used in both wars as a storage bin, coffeepot, and sink. The meat cleaver became a can opener and wire cutter. It also cut fingers and hands.
Hospitals lacked small equipment for the preparation and service of food for therapeutic diets. The reuse of all sizes of tin cans was necessary in transporting and reheating small quantities of special diet food. The insulated food conveyor was unsatisfactory as it was difficult to transport and inadequate for maintaining food at the proper temperature.
One of the most important items of mess equipment for food preparation was the range--gas, oil, electric, or coal. Most commonly used was the gas range, ideal when complete with grill. Electric ranges were used extensively, particularly at smaller posts and in ward diet kitchens.
22Personal knowledge of Lt. Col. Helen M. Davis, dietitian, 9th Evacuation Hospital.
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There were few oil ranges in use. Coal-burning ranges were least desirable and required a great deal of time and attention. Kitchens with coal-burning ranges were most uncomfortable for mess personnel in hot weather. In oversea areas, the portable gasoline-burning M-1937 field range (fig. 50) was used.23 Its World War I predecessor used coal or wood and was mounted on a horse-drawn cart. This range was not only limited in the variety and desirability of food prepared, but the smoke it emitted enabled the enemy to ascertain troop locations. The M-1937 range had its limitations, too. Since white gasoline was not available, leaded motor fuel had to be used. This clogged the lines and required cleaning and changing of the filter at least every 6 hours. Frequently, this occurred at mealtime. Many oversea units found that parts were missing or worn out and replacement parts for the range unavailable. Serious accidents involving the use of this range did occur because of lack of training by early users and through carelessness in operation. Even so, the field range remained one of the more important items of development among those used in the storage, handling, and preparation of food. It consisted of one or more self-contained cabinets, was made of aluminum or stainless steel, and had a roast or bake pan, with griddle cover, and a steel cradle for supporting a large boiler and a fire unit.
Bake ovens were coal, gas, or electric. They were essential because kitchen range ovens often did not provide sufficient space for large quantity baking. Brooke General Hospital was fortunate in possessing a rotary type oven in its central bakeshop. Ovens in oversea areas were an important morale factor because of the hot breads and pastries they supplied.
Most messes were equipped with gas or electric deep-fat fryers in varying capacities. There were mixing machines complete with attachments for various types of preparation. Vegetable steamers, gas or steam, were distributed according to approximate mess capacity. Steam or gas-heated steam jacketed kettles made of aluminum, stainless steel, or cast iron were used in all hospital messes. The ease and efficiency of mechanical potato and vegetable peelers made life much happier for GI`s detailed to mess work. Coffee urns were of stainless steel with a steel jacket, or porcelain with a galvanized iron jacket. Batteries of urns were used in larger hospitals while single and twin urns were used in smaller hospitals. Gas or electric rotary toasters were placed behind serving lines and toast was served as quickly as it was prepared. Electric meat saws, slicers, and grinders were issued. Many hospitals purchased steak tenderizers and doughnut machines which were timesaving and provided a popular food item. Other mess equipment included racks of all types, mess trucks, bains-marie, and standard reach-in, pass-through, and prefabricated walk-in refrigerators.
23Risch, Erna: The Quartermaster Corps: Organization, Supply, and Services. Volume I. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1953, p. 146.
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As reported by Brooke General Hospital,24 other mess food service equipment included a long stainless steel cafeteria counter with a refrigerated water fountain, counter space with refrigerated cabinets for salads and desserts, three gas-heated grills with covers for griddle cakes, fried eggs, and so forth, a steam table containing three wells and three serving pans, a warming compartment for hot dishes in the space below the steamtable and grills, and three revolving toasters placed in such a manner that the patients could serve themselves. In back of the counter were a battery of coffee urns, an ice cream cabinet, and dish storage cabinets. Some units overseas were fortunate in having a similar setup while others had to improvise. Less desirable table equipment included the wooden picnic-style tables and tables with attached swinging seats accommodating 8 or 12 persons.
Ward kitchen facilities were minimal since the bulk of the food was prepared in the main kitchen before loading on food carts for delivery to the wards. Small skillets, griddles, toasters, and coffeepots were provided for the preparation of eggs, hot cakes, toast, hamburgers, and other items on the ward. Each kitchen had a small range and
24See footnote 20, p. 191.
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refrigerator. Cupboard and drawer space were provided for dry supplies, dishes, and silver. Unfortunately, unless precautions were taken, roaches multiplied in these places. Movable tray racks for setting up trays prior to meal service were most valuable. In some hospitals, wooden shelves were built to hold the trays. A number of hospitals supplemented china with steel and plastic compartment trays. The Drinkwater carts at some hospitals were equipped with balloon tires which made them noiseless and reduced the damaging effect of sharp wheels on corridor and ward floors.
The dishwasher was the most important item of mess sanitation equipment. Some were semi-automatic. Others required that racks of dishes be placed in the machine and removed by hand. Ward kitchens without dishwashers had to send dishes to a central dishwashing room, quite a transportation problem in old buildings without elevators. In some hospitals, dishes were handwashed and placed in a sterilizer, a laborious procedure. Other sanitation equipment included scullery sinks, pot racks, slop sinks, and grease interceptors.
At Birmingham General Hospital, Van Nuys, Calif., the problem of equipment to transport ward nourishments was solved in a unique manner. Bread racks were converted and used to convey nourishments to 16 wards twice daily, saving approximately 25 man-hours a day. Later, the engineers built two nourishment carts to specifications. These saved 40 man-hours per day as well as relieving congestion in the halls and main kitchens.25
A bread slicing and wrapping machine was purchased for the hospital bakery at McCloskey General Hospital, Temple, Tex., through the Post Hospital Fund. This purchase proved to be a very important conservation measure as well as a sanitary and esthetic improvement.26
Preventive maintenance was followed in all Army hospitals. Personnel were instructed in the use and care of all equipment. Since there were so many inexperienced and unskilled personnel, this instruction was invaluable. The user of kitchen equipment was the most important single factor in preventive maintenance. If he faithfully performed his daily services routinely, major repairs and overhaul were often avoided. The daily services included prevention of abuse of equipment and inspection checks.27
Before the preventive maintenance program became Army-wide, equipment shortage and breakdown problems in many messes were caused by misuse of equipment by inexperienced personnel, the employment of whom was necessary because of the rapid turnover of military personnel being shipped overseas. The Army insisted that the valuable equipment, so necessary to mess operation, should be properly employed and preserved and declared a financial liability for misuse of such equipment.
25Annual Report, Birmingham General Hospital, Van Nuys, Calif., 1945, p. 54.
26Annual Report, McCloskey General Hospital, Temple, Tex., 1944, pp. 30-31.
27War Department Technical Manual (TM) 5-637, July 1945.
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Special diets
Similarities existed in the handling of special diets in both wars; however, World War II variations in therapeutic management made lasting contributions to improved patient care.
In both World Wars dietitians planned and often cooked the special diets in oversea units (fig. 51). In World War II units without dietitians, nurses planned the special diet menus. Generally, the nurses underwent a few weeks` training under dietitians in order to renew and expand their knowledge in this area (fig. 52). 1st Lt. Lois S. Nelson, assigned to the 147th General Hospital, T.H., wrote of four nurses who assisted her and who "can do almost everything I can do." One Army
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hospital in Osaka, Japan, suffered such severe military cook losses that six nurses were assigned to cooking in the special diet section.
Small kitchen equipment needed in the cooking and serving of diet food overseas was often lacking. Tin cans of varying sizes were used successfully in both wars.
Ordinary foods such as gelatin, junket, cocoa, broth, and other items required for light and special diets were totally absent in World War I oversea units. In late World War II, these items plus canned fruit juices, powdered milk, both whole and nonfat, canned boned chicken, canned fruits, and canned soups were available in varying amounts.
In World War I, Miss Mary Foley, dietitian at Fort Riley Base Hospital, Kans., served approximately 20 different types of diets.28 In World War II, 1st Lt. Rosalind Mokray, dietitian at Camp Forrest Station Hospital, Tenn., planned menus and ordered food for two special diet messes feeding German prisoner-of-war bed patients. The average diet census was 180 ulcer diets, 24 diabetic diets, and about 35 salt-free diets. Ambulatory German prisoner-of-war patients cooked the food under the general supervision of enlisted supervisors. In another special diet mess for ambulatory German prisoners, the diets included 200 soft, 20 fat
28The Army Dietitian in World War I. J. Am. Dietet. A. 20: 398, June 1944.
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free, 50 salt free, 20 liquid, and 12 diabetic. A German medical officer worked out 12 different diabetic diets and ordered diets for each patient with diabetes by number. Lieutenant Mokray planned the menu while an interpreter wrote out the diets for those patients to weigh.
The diets commonly ordered by ward officers at Hammond General Hospital, Modesto, Calif., were regular, soft, light, liquid, convalescent ulcer, low fat, and high caloric. 1st Lt. Velma Harwood, the dietitian, wrote all of these on a large master-menu form for a week at a time.
Special diets in World War II oversea units were liberalized, in contrast to those served in the United States, because of limited variety in food items. This leniency, with medical approval, appeared to be the universal policy in all hospital messes. The dietitians of the 313th General Hospital, Southwest Pacific Area, reported that patients on low-fat diets were served such items as ice cream, chocolate milk, and frankfurters, which technically should not have been used.29 About 30 percent of the hospital patients were on special diets, the largest percentage being patients with hepatitis. They received the liberalized low-fat diet.
The 313th General Hospital used a standard high-caloric, 6-feeding diet for patients (recovered Allied military personnel as well as American) received from Japan. Some patients, unable to take a regular diet, were placed on this regime. Every effort was made to satisfy their hunger. Food was available in the kitchen for them 24 hours a day. The average weight increase of these patients was 30 pounds; the length of hospital stay, 3 to 4 weeks. Five of the recovered patients showed symptoms of diabetes and were placed on weighed diets. The medical staff was not convinced that these were patients with true diabetes, but were possibly suffering from malnutrition. One patient was started on insulin and a weighed diet. After 3 weeks, it was possible to stop the insulin and control the hypoglycemia with a 2,500-calorie diet.
In the European Theater of Operations, U.S. Army, therapeutic diets served to hospital patients averaged between 8 to 20 percent. These were mostly medical soft, dental soft, liquid, soft bland, and the low-fat, high-carbohydrate, high-protein diets. Diabetic, nephritic, meat-free, Sippy, and high-caloric diets were infrequent. The dietitian welcomed fresh eggs, used tenderloin steaks from the beef issue, and reserved liver from the chicken rations to get a little more variety. Purees were used only for ulcer, maxillofacial, and liquid diets. Custards, soft puddings, and nourishing milk drinks were devised from powdered milk and eggs, cocoa, malted milk, and other flavorings. Jello was an infrequent item of issue and ice cream was dependent upon the accessibility of ice cream freezers. 2d Lt. (later Maj.) Florence M. Berger, therapeutic dietitian, 300th General Hospital, Mediterranean (formerly North African) Theater of Operations,
29Walker, Florence S., and Hildenbrand, Shirley A.: History of Medical Department Dietitians, 313th General Hospital, Southwest Pacific Area, 12 Dec. 1945.
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U.S. Army, made ice cream for very ill patients by placing evaporated milk, eggs, and sugar in a small tin can and then immersing this in crushed ice. The diabetic diet was the most monotonous. Canned fruits had to be washed free of syrup and little could be done to improve the flavor of the food or to give more variety.
When the number of patients with hepatitis increased (12 to 15 percent of patients fed), the dietitian had to coordinate with the quartermaster in ration adjustments. The diet increase required permission for increasing dietary food items and a corresponding decrease in regular diet items. Issues of pork, ham, butter, whole milk, and meats canned in gravy were changed to lean meat, skim milk powder, additional bread, and jam. Many disliked skim milk, and as a result some doctors permitted the use of whole milk powder. These patients gradually progressed to regular diets.
Insulin therapy for patients suffering from combat exhaustion presented a problem involving quantity of food. This was solved by giving them a regular diet with extra bread, jam, juices, cereals, and larger portions of other foods to furnish the extra calories required for the insulin dosage. The patients gained weight, slept better, became less tense, and had fewer nightmares and battle dreams.
The Rhine crossing in March 1945 resulted in some severe cases of malnutrition among recovered Allied military personnel. The Chief Surgeon`s Office, European theater, issued directives to orient these recovered personnel and the people responsible for their welfare in the treatment of acute malnutrition. One soldier ate 17 doughnuts and had to be hospitalized. Many hospitalized patients were placed on a bland diet for 48 hours, warned of the dangers of overeating, and advised to avoid such items as candy, peanuts, doughnuts, and raw fruits and vegetables. In hospitals, they had to be guarded against the kindnesses of their friends and buddies. The American National Red Cross canteens and Army post exchanges were temporarily restricted to them. It was necessary to check them closely to prevent their going to the regular mess or eating a second meal.
In the Mediterranean theater, when hospitals were admitting the wounded directly from the battlefield, the largest percentage of diets was regular and liquid. If the frontline was stable and the hospitals more or less stationary, a great variety of diets was ordered. During an active campaign, however, most of the patients required immediate surgery and therefore could ingest little more than liquids. Furthermore, until the quartermaster supply depots were established only emergency rations were obtainable, making it difficult to attempt diet therapy regimes.
Special diets were modifications of the regular menu in order to save supplies, equipment, and the time of personnel. Because of possible changes in the menu, the dietitian did not plan meals for the following day until the rations and issue chart had arrived. Purees were not eaten; therefore, soft diet was actually a modified light diet.
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In the Middle (formerly Central) Pacific area, a low- or non-residue diet was generally used for patients with amebic and bacillary dysentery. Ward surgeons, in collaboration with the dietitian, frequently planned formulas for forced feedings. The dietitian`s ingenuity was challenged in improvising food combinations for the many patients with maxillofacial wounds to prevent weight loss and to stimulate the normal healing process. As patients with soft tissue loss could take only fluids, by means of a syringe or nasal tube, special formulas were devised and offered in addition to the liquids. A minimum of six feedings a day was given.
Special diets ordered included the hepatitis, bland (also with variations), low residue, Sippy, convalescent ulcer, high caloric, diabetic, typhoid, salt poor, tonsillectomy, and test.
In planning special diets, many World War II dietitians were guided by the manual on hospital diets published in October 1941.30 World War I dietitians did not have this authoritative, standardized, and invaluable aid. The manual was designed to "simplify the diet problems for ward and mess officers, dietitians, mess sergeants, and cooks in ordering and preparing diets suitable not only for the average patient under usual conditions but also for almost any specific case which may be encountered." Diet instruction and menus were included. Some interesting dietary foods used were ox kidney, rabbit, and brains. One of the diets, for which the need no longer exists, was the pellagra preventive diet.
The manual was revised in March 1945 and included a list of definitions and descriptions of food items which could be used in adapting and supplementing Army rations for the seriously ill. The oversea hospital ration was discussed and a section was included on the preparation of nonperishable foods (canned, dehydrated, and dried). The nutritional importance of certain items such as enriched flour, lemon and orange powder, milk (all types), liquids from canned fruits and vegetables, and dried eggs was stressed.
Hepatitis study
Undoubtedly, the special diet most frequently ordered in any hospital was the high-protein, high-carbohydrate, low-fat (rancid) or hepatitis diet. This diet proved to be of inestimable value in the therapeutic regime of patients with infectious hepatitis. Results proved it to be far superior to the high-carbohydrate, medium-protein, low-fat diet used in Africa, Sicily, and the early phases of the Italian campaign. The food which had been offered to patients with hepatitis had been so nutritionally poor and unpalatable that the amount ingested by the average patient was insufficient to promote, or even sustain, a gain in weight, so important in recovery from this disease. Likewise, the protein in the diet (particularly the amino acid methionine), already
30War Department Technical Manual (TM) 8-500, 13 Oct. 1941.
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too low to facilitate the regeneration of liver cells, was inhibited by the high-fat (cholesterol) content of the diet.31 An analysis of the diet served in a station hospital during the months of March and April 1944 revealed that the protein averaged 84 gm.; carbohydrate, 346 gm.; fat, 43 gm.; and calories approximated 2,100.32 When further studies demonstrated the inadequacy of this diet, a series of experiments with allowances increased for protein and decreased for fat were conducted to determine to what degree the high-protein, low-fat diet might be instrumental in shortening the disease and lessening its severity. The evidence was so favorable that all hospitals in the Mediterranean theater were instructed to employ it in treating patients ill with hepatitis.
Part of the success for the study was due to the teamwork of mess and professional personnel. Dietitians at the 300th General Hospital conducted experiments to determine the most popular foods and methods for making those which were less popular more palatable. The special diet cooks willingly devoted extra time to the study. Col. Marion H. Barker, MC, head of the Hepatitis Commission, Mediterranean theater, encouraged professional personnel to take special interest in the efforts of mess personnel. At the instigation of Colonel Barker and the dietitians, the quartermaster made available for the study food items such as extra allowances of lean beef and canned chicken.
In the experimental stages, the hepatitis diet provided approximately 185 gm. of protein, 320 gm. of carbohydrate, and a minimum of 25 gm. of fat.33 However, when followup studies disclosed that nonrancid fats, such as butter, considerably improved the palatability of the diet and could be ingested by the majority of patients without harmful effects, the fat content was increased to 75 grams. The other constituents were also increased, providing 225 gm. of protein, 500 gm. of carbohydrate, and approximately 3,500 calories. The high-protein figure was achieved by offering a minimum of one pound of lean meat and one quart of skim milk (200 gm. of skim milk powder) daily. Skim milk was invaluable in evacuation hospitals, as it was frequently impossible to procure fresh lean meat, and in treating the acutely ill, who, surprisingly, could not take or retain anything but this beverage. The fats employed in the daily menu were egg yolks, fresh and canned butter, and corn oil. Because of the high-cholesterol content of the egg yolk, only one fresh egg a day was permitted and that for morale purposes. If available, one pat of fresh butter was served with each meal and about two pats were used in preparation. If the supply was limited, canned butter or corn oil was substituted.
31Report, Col. Marion H. Barker, MC, to the Surgeon, Mediterranean Theater of Operations, 23 July 1945, subject: Final Report on Infectious Hepatitis in MTOUSA.
32Report, Col. Marion H. Barker, MC, 1944, subject: Report on Infectious Hepatitis in NATOUSA.
33Circular Letter No. 37, Office of the Surgeon, Headquarters, North African Theater of Operations, U.S. Army, 8 July 1944, p. 12.
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TABLE 12-Food constituents of hepatitis diet, July 1944 to March 1945
Tables 12 and 13 compare the constituents of the diet as employed from July 1944 to March 1945 and the new diet initiated in March 1945. Although the two most important components, lean meat and skim milk, were included in both, the more recently developed procedure (table 13) was more commendable from the patients` viewpoint. This was because foods generally disliked were omitted, seasoning was used freely, the diet was made more palatable through the introduction of dairy products, and a greater variety of items was offered. These improvements resulted in an increased intake which in turn promoted a weight gain and an early return to duty.
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TABLE 13-Food constituents of hepatitis diet initiated in March 1945
Dietitians were first used on hospital ships in World War II (fig. 53). Their work was so new that the conditions under which they
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FIGURE 53-Continued. C. Ward. D. Living quarters. (U.S. Army photographs.)
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worked varied on each ship. The ships usually were manned by U.S. Navy or U.S. merchant marine crews and where the dietitian, as a member of the Army medical complement, stood in relation to each was not explained for her in the ships` regulations. It soon became quite clear to her that this was one place where she would have to sell herself and her profession. There had been stewards on ships for many years, just as there had been mess sergeants in the Army, and they were a little hesitant in having a woman run any part of a galley.
Unlike most Army hospitals, the hospital-ship complement was not always furnished with either a mess officer or a mess sergeant for the Navy operated the mess in the three Navy-manned ships. On the Army hospital ships, the crews consisted of merchant marines plus the medical-detachment complement.
The first dietitian to serve on a hospital ship was 2d Lt. (later 1st) Edna Stephany, aboard the USAHS Acadia, the first U.S. Army hospital ship. She said that doctors, nurses, and detachment personnel were skeptical of the necessity for a dietitian aboard such a vessel. The merchant marine stewards were suspicious of any "new fangled" ideas that she presented.
2d Lt. (later Capt.) Audre E. Pawlicki was assigned to the USAHS Charles A. Stafford and later to the USAHS John J. Meany and the USAHS Wisteria. She wrote that she enjoyed her ship assignments very much and had excellent working relationships. Her duties included the ordering of food for bed patients through the chief steward and responsibility for special diets and nourishments. The Stafford was well staffed and had good equipment. There was always sufficient frozen milk on board for the patients, and several times a week, eggnog with whisky was served to them. Neuropsychiatric patients received plain eggnog. When the weather was rough, the cooks were very good about estimating how many passengers would be seasick, and prepared the food accordingly. Refrigerator space on the Meany and Wisteria was limited. Often some of the frozen milk had to be stored in the morgue. Diets for patients with diabetes were always measured instead of weighed, because constant motion of the ship rendered scales inaccurate.34
1st Lt. (later Capt.) Marie L. Averill, dietitian aboard the USAHS Frances Y. Slanger, praised the work and cooperation of the merchant marine personnel. The merchant marines cooked the food while Army personnel served it. The steward wrote the menus while the dietitian wrote her diets from his menus. The steward was always able to get any food items she required. Fresh eggs were never scrambled for combat patients because scrambled eggs were a reminder of powdered eggs.
One dietitian wrote of her trips to Scotland, England, North Africa, Sicily, and Italy, and her one claim to fame, being a member of the
34Report, 1st Lt. Audre E. Pawlicki, USAHS`s Charles A. Stafford, John J. Meany, and Wisteria, subject: Hospital Ships` Food Service, August 1944.
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USAHS Chateau Thierry which was part of the armada in the invasion of southern France. Treating the patients evacuated from the beachheads meant really pitching in and helping where help was needed.
1st Lt. Edna M. Raybourn was aboard the U.S.S. Comfort when it was bombed near Okinawa by a Japanese suicide plane. The 63 casualties on the brightly lighted ship included 29 killed, 33 wounded, and 1 missing. Damage was quite extensive. Lieutenant Raybourn remarked that immediately following the bombing her thoughts were far from food. The entire crew turned to putting out the fire and assisted in the saving of lives. She said, "At a time like that you can do things you never dreamed you would be able to do, put broken arms in place, administer first aid to open wounds, and even assist in giving plasma."
The problem of food service was very grave for the main diet kitchen had been destroyed, leaving only two from which to serve all patients. Lieutenant Raybourn and her staff, minus her competent mess sergeant who had been badly burned, turned one of the diet kitchens into a special diet kitchen and the other into a cafeteria to serve those who could walk.
The dietitian on duty as a civilian in an oversea theater found that her work presented problems different from those in the Zone of Interior. Her ingenuity was challenged in presenting menu items acceptable to patients and staff and in utilizing field equipment. Miss (later Capt.) Irene Boelts of the 298th General Hospital in England described an after-Christmas economy meal as follows: "I boiled the clean turkey bones and rinsed all the roasting pans for stock for soup base. I had the boys grind some left-over scrambled dried eggs and Vienna sausages and added to this chopped celery leaves. With a few dehydrated onions, some left-over turkey gravy, peas and juice, and a pailful of hominy and juice, we had 30 gallons of delectable turkey soup, from material we could and would formerly have thrown away."35
The hospitals in which dietitians served ranged from the open tent of an evacuation hospital where cooking was done on various types of field equipment to the permanent-type installations belonging to other countries (fig. 54). Some hospitals in England had excellent kitchens where most of the cooking was done by steam or electricity. There were electric mixers, built-in roasting and pastry ovens, modern steamers, steam kettles, and walk-in refrigerators. On the wards there were electric stoves with grills.
The foods issued had to be used whether or not they were desired by the hospital. Some of the dietitians in North Africa, the Southwest Pacific, and in China, Burma, and India not only had the problem of working in temporary buildings and in tents, but, in addition, were
35The Dietitian Overseas. J. Am. Dietet. A. 19: 250-252, March 1943.
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subjected to intermittent supplies of food as well as the rigors of climate to which they were unaccustomed. Wherever native patients were cared for, as in China, Burma, and India, there was the added problem of supplying native food.
Dietitians in many areas spoke of the need and shortage of can openers. With so much of the ration furnished in cans, plentiful heavy-duty can openers were top priority. The very small can openers, which were later provided in the various ration packs, took an excessive amount of time to use and also left traces of tin in the food.
When dietitians were commissioned, the work of the dietitian overseas was marked with greater authority over mess personnel and more responsibility in food preparation and service. Often the oversea dietitian was the only dietitian assigned to her unit and had to work out her problems alone. Other dietitians were so few and scattered that they were seldom able to get together to discuss their work and to benefit by an exchange of experiences and ideas. The dietitian, therefore, was required to use all her ingenuity, experience, and training to provide patients with palatable and nourishing food.
As the war progressed, each oversea area arranged meetings for dietitians on a voluntary basis so that they would have an opportunity to discuss mutual problems. It was usually the theater nutrition officer who recognized the dietitian`s problems and supported her with the resources available to him through command headquarters.
European Theater of Operations
The 5th General Hospital, the first affiliated general hospital unit, sailed on 19 February 1942 from New York with the first two dietitians to serve in the European theater. The ship developed mechanical trouble and returned to the United States. Several months later, the group reembarked (12 May), landed in Northern Ireland, and marked the arrival of the first U.S. dietitians on European soil to take an active part in feeding the hospitalized soldiers of World War II.
Their civilian status resulted in their names being omitted from the sailing list, confusion at embarking and debarking, and assignment to an unused English barracks without luggage or bathing facilities. Being civilians, they also had no uniform but a heterogeneous collection of clothing. In cold Northern Ireland, they were permitted to wear the nurses` blue winter uniform without insignia. The standardized complete civilian uniform did not reach the dietitians and physical therapists before commissioning.v
Early in the war, the Commanding General of the United States Army Northern Ireland Force requested that the dietitian of the 5th General Hospital assist the quartermaster menu branch in planning the menu for the troops stationed there. This work was in addition to her other duties and was done in an advisory capacity to secure variety and provide a more balanced menu from the foodstuffs supplied by the
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quartermaster. In September 1943, Miss (later Capt.) Cathryn R. VerMurlen was transferred from the 298th General Hospital in England to the Subsistence Division, Office of the Chief Quartermaster, also in England, to act as menu planner for the European theater. While assigned to that office, she planned menus for U.S. and French soldiers as well as the Irish laborers under the jurisdiction of the U.S. Army. Since the French Colonial soldiers did not eat pork, lamb was substituted. Corn and peanut butter were not accepted by foreign troops so these were replaced with extra rations of potatoes and bread.
Another outstanding job performance was that of Lieutenant Boelts who was assigned to the Consolidated Officers` Mess in London, England. The smoothness and speed of food service gave it the name of "Willow Run." What was formerly a great ballroom became a cafeteria seating 928 people and a generals` and colonels` dining room seating 75. The main kitchen had been a serving kitchen only and had to be adapted to its new function. The dietitian wrote the menus with suggestions on preparation and counter service which eliminated food shortages and excessive leftovers. Because of the variable numbers served at each meal, rations were drawn on a "by-the-meal" basis and followed the quartermaster field menu, supplemented by rolls, fresh fruit, vegetables, and condiments which were purchased from British sources without coupons or points. Both U.S. military and British civilian mess personnel contributed to the smooth operation of "Willow Run."
Another dietitian, 2d Lt. Ida K. Samuelson, was assigned to Supreme Headquarters, Allied Expeditionary Force. Her duties were writing menus for the generals` messes, checking the adequacy of diets served in the officers` and enlisted men`s messes, advising when called upon, teaching proper methods of preparation of dehydrated foods to cooks and mess sergeants, and teaching a weekly nutrition class to mess officers and mess sergeants. She assisted in setting up a new officers` mess, unique in that it was a snack bar open 24 hours a day.
Finally, after V-E Day, 1st Lt. (later Maj.) Myrtle Aldrich was assigned to the Chief Surgeon`s Office, European theater, Paris, France, as a consultant dietitian. This move resulted from the requests of dietitians and the recommendation of Maj. Helen C. Burns36 following her visit to Europe. Lieutenant Aldrich was attached to the Nutrition Branch to help supervise hospital patient`s rations. Later, reassignment of dietitians resulting from redeployment became her problem. She visited hospitals in the Normandy, Channel, Seine, and United Kingdom Base Sections, inspected dietetic departments, and met with dietitians to discuss their problems. She made recommendations concerning improvements in patient food service, control of food waste, better utilization of dietitians, and recordkeeping by dietitians.
Dietitians in England operated not only in messes of permanent brick construction with equipment similar to that in the United
36Later Maj. Helen B. Gearin, WMSC.
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States but also in nissen huts with minimal equipment. Mess personnel had to adjust to the British coal-burning range, farm boilers, wooden sinks, and widely dispersed hospital wards.
In France, dietitians in tent hospitals wore long underwear, fatigues, and four-buckle overshoes. The entire area was often a sea of mud. Tents over concrete or earthen foundations housed kitchens, mess halls, storage areas, and offices. Messkit washups were installed. Wooden tables and benches were used in the mess halls as in World War I.
One Army hospital in France had a unique bakery arrangement. Since rolls and hot breads were so important for morale, it was essential that a way be found to heat the bakery tent so that dough would rise properly. A French hot-air heating unit of the portable type, obtained by the commanding officer, was set up just outside the bakery. The unit contained a firebox with several pipes attached and a motor and fan for blowing hot air into the tent. The bakery was then heated to the desired temperature. After the rolls were placed in tins, they were put into the proof box to rise in moist heat. The proof box was a cupboard made with grooves to hold the tins. A small gasoline stove in the bottom of the cupboard held two No. 10 cans filled with water which completed the proofing arrangement.
1st Lt. Lois Shumaker, head dietitian of the 108th General Hospital near Paris, and her personnel served 4,000 to 7,000 meals daily with giant steam vats as their only cooking equipment. Meats were roasted by increasing the pressure. Since the vats were also used for other cooking purposes, the roasting had to be done at night. Therefore, roasts could not be served hot. Puddings and canned fruits were the standard desserts since there were no ovens to bake pies and cakes. Other popular food items which could not be served because of lack of equipment were steaks, chops, toast, and hotcakes. The rations of their menu ingredients were still drawn, so ways had to be found to prepare them. Fortunately, can openers were plentiful. Over 4,000 cans were opened in 1 day with everyone participating.37
In northern France, Belgium, and Germany, most hospital units took over permanent buildings such as hospitals, schools, and military barracks. The hospitals were very well equipped except for the lack of gas and electricity in some of the German hospitals because of destruction of gas mains and electrical lines.
As in other oversea areas, the dietitians in Europe faced the problem of variety in the quartermaster field ration menu. Equipment limited variety in preparation. Fresh fruits and vegetables were missed most by the troops. Because of inadequate transportation and storage facilities, frozen meats,38 canned meats, dehydrated eggs, powdered milk, and dehydrated or canned vegetables were substituted for fresh meats, vegetables, milk, eggs, and butter. C, D, and K rations were used when
37The Dietitian`s Column. The Army Nurse 2: 14-15, March 1945.
38Frozen meats were obtained from the depots daily or three times weekly and required 24 to 48 hours to thaw before use.
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units were in staging areas or in transit.39 Purchase of food on the open market was prohibited except as contracted by the quartermaster when excesses were available. For sanitation purposes, fresh vegetables in France had to be soaked in Mikroklene for 30 minutes or cooked before serving. Unit gardens were valuable in supplementing the supply of fresh vegetables such as lettuce, radishes, onions, tomatoes, peas, carrots, string beans, spinach, and corn.
The baking facilities of many units prohibited following a menu where two baked products appeared in the same meal or even the same day. Where field ranges were the available equipment and in operation around the clock, the dietitian had to consider workload and servicing of the ranges when she planned menus. She also considered the preferences of the nurses for less starchy meals. She used the heavier food items in feeding sudden influxes of combat patients with insatiable appetites.
Most dietitians, cooks, and bakers were unfamiliar with dehydrated vegetables and eggs and powdered milk. The wide unpopularity of their experiments resulted in a training program in the United States which did much to improve acceptability of these products.
Dietitians and mess sergeants struggled to devise ways to use the frequent issues of corned beef, Spam, and Vienna sausage. They were served baked, fried, dipped in dehydrated egg batter, rolled in dough, pickled, and in salads, sandwiches, or fritters. Units without ice cream freezers used the issued mixes for puddings which were varied with the addition of fruit.
The mess personnel of the 130th Station Hospital in England earned continuous praise for their enterprising efforts from their staff and the thousands of patients who had been hospitalized there.40 The bakers made gaily decorated cakes using wrapping paper and onionskin paper for decorating tools and spinach puree, beet puree, Nescafé (instant coffee), and powdered eggs for colors. The universally disliked orange marmalade was heated and strained by the cooks and became a delicious syrup for hotcakes and french toast. (This also saved sugar for baking.) Rations were always plentiful. The mess corporal always brought back more from the ration dump than he was entitled to. He was very short, had an innocent and honest face, and parked his truck carefully in the supply dump area where he could add rations after his truck had been checked. The only time he was caught he promised never to juggle rations again. After that he was always careful to supply the ration dump personnel with samples of the hospital bakers` work!
Actually, the food items obtained by that method were never used illegally. During the long period from the Battle of Saint-Lô to the Battle of the Bulge casualties received were far greater in number than the hospital had expected. Originally, hospital personnel had been instructed that the routine would be 48 hours of work and 24 hours of
39See footnote 23, p. 196.
40Personal knowledge of the author.
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rest. It never worked out that way. Patients at one meal averaged 15. The number rose to 1,300 or 1,500 the next meal. The hospital was a 15-minute drive from the airfield. The dietitian looked at the sky each morning before breakfast to check for favorable flying weather and then predicted how many patients would be arriving. The cooks were then instructed as to the food items and the amount to prepare. Since the airfield gave the hospital less than a half hour`s notice of patient arrivals, this made a good deal of difference in the menu. For those patients it was impossible to prepare the popular boiled navy beans as these required hours of soaking followed by hours of cooking. Patients had to be fed promptly so they could be cleaned up, evacuated to the next hospital in the evacuation chain, and the station hospital prepared for the next day`s (or rarely, twice in 1 day) influx of casualties.
The butcher, of Chinese extraction, contributed his bit by using old rendered fat in making soap. The mess was always clean. The wooden dining tables were not quite so spotless after the dietitian stopped the mess personnel from using lemon crystals as a bleach.
In European theater hospitals, mess personnel were all military early in the war. Later, training programs had to be started by dietitians and mess sergeants because of the loss of keymen to combat units. Cooks`s helpers were elevated to cooks, and kitchen police became cook`s helpers. Newly assigned unit personnel were responsible for kitchen-police duty.
German prisoners of war and later French civilians were utilized by the hospitals. Problems arose from differences in language, standards, and training. These personnel performed useful services and were amenable to instruction. A dietitian often had to exercise her college German and her limited knowledge of German cooking. The use of French civilians brought problems in attendance, conformance, and personal sanitation.
By July 1946, in Germany, nearly all employees in hospital messes were displaced persons or German civilians. Some of the cooks were very good. Others had sanitation habits which were not pleasing to Americans. It required continual vigilance to produce good food, well-cooked and properly served, especially on the wards.
With the war`s end and redeployment of dietitians came the problem of staffing the hospitals of the army of occupation. An estimate of 44 dietitians was made. 1st Lt. Roberta Mack (fig. 55) became the new dietetic coordinator in the Chief Surgeon`s Office, European theater. By mid-July 1946, every general and station hospital in the European theater had at least one dietitian assigned, the larger hospitals had the requisite number according to the table of organization while the smaller ones were assigned only one.
Mediterranean (formerly North African) Theater of Operations
The dietitian in the Mediterranean theater quickly discovered that her chief responsibility, the patients` mess, entailed much more than
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the preparation and service of food. She was directly affected by the location and type of physical setup of the mess, the quota of buildings, prefabricated huts, tents, or combination of these. Her training and experience were invaluable in these situations when working with mess personnel who were totally unfamiliar with the food service field. One dietitian wrote, "We handle every kind of problem from training Italian waitresses who speak no English to organizing storerooms, making ice cream freezers, experimenting with recipes, and planning mess halls with regard to the way the wind blows and where the rain will drain."
The 21st General Hospital in Italy found a central patients` mess quite satisfactory until additional kitchens could be erected. The information that the mess would be located in a former restaurant was most deceiving, for upon arrival it was discovered that the building was in very poor condition. Before repair work could be started, signal company equipment had to be removed from the dining room. With the aid of an attached engineer platoon, pieces of wall were replaced with tar paper, sinks and plumbing were installed, the drainage system was rebuilt, and heat and lights were added. By enclosing the porch
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off the main dining room and installing necessary utilities, 300 more people were accommodated. At its peak, the mess served 2,000 at a time, including 550 orthopedic patients and 150 on special diets. Since the orthopedic patients were handicapped by crutches and arm slings, they were served at special tables by civilian waiters who reset places when their number became too large to accommodate all at one sitting.
From 600 to 1,000 ambulatory patients passed a double serving line using messkits and canteen cups. Special diet and orthopedic patients were provided with dishes and cups. A short-order service was inaugurated by moving field ranges to the serving line shortly before mealtime. Pancakes, fried eggs, and hamburgers were served hot from the griddle.
To add variety to the field ration menu, the dietitian made trips to local markets for perishables. If there was no hospital fund, she assisted in planning and maintaining a garden. Visits to the ration tent (fig. 56) and the class I officer (quartermaster officer responsible for the ration dump, maintaining stock levels, and requisitioning subsistence) meant time lost but proved of much value in correcting inconsistencies in the issue.
Dietitians contributed to therapeutics through experimental studies on the dietary treatment of patients with hepatitis. The contribution of the dietitian to improved food service for patients and personnel was well recognized in the Mediterranean theater. This was demonstrated by a mess officers` conference which asked that a traveling dietitian visit all installations not provided with such personnel, that at least one permanent dietitian be assigned in smaller hospital units, and that dietitians be allowed to attend future conferences of that type.
Shortly after the invasion of Italy, a survey of troops was made in forward areas and evacuation hospitals to determine the extent of adequacy of the ration. The nutrition experts soon realized that malnutrition was partly caused by difficulties in distribution of supplies, tactical situations, and increased nutritional requirements entailed by cold, wet weather. As a result, improvements effected included the addition of fresh meat, butter, and, occasionally, eggs. Surplus fresh fruits and vegetables were substituted for the canned and dehydrated varieties. Troops who had had to subsist on emergency rations for extended periods were permitted some supplements such as fresh bread, coffee, cocoa, tea, evaporated milk, and sugar.
The Expeditionary Force ration41 as issued in 1944 and 1945 was a great improvement over that of earlier days. Formerly, the foods available to hospitals in the early months of the war were identical with those issued to troops. However, the oversea hospital ration menus, as planned for use with the Expeditionary Force rations, provided a more liberal diet for oversea hospital patients. Issue charts included certain foods, such as boned chicken and canned soups for patients on special diets. It was necessary for all hospital mess per-
41See footnote 14, p. 188.
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sonnel to become familiar with the amount of each food which should be issued, the type of patient for which each food was intended, and the preparation of the food.
Problems in the distribution of the Expeditionary Force ration appeared minimal when contrasted with those encountered in Africa and Sicily during 1942 and 1943. There the movement of supply was so restricted that hospitals, as well as other organizations, were issued C rations for 30 days at a time. Furthermore, the planned ration, when issued, was often so depleted it was hardly recognizable. This was caused by improper loading in ships; divergence or loss of vehicles; interference in supply because of enemy action; spoilage of food and breakage of cans as a result of frequent handling in shipment and storing; and misappropriation of food, particularly the most delectable items.
Originally, the oversea hospital ration in the North African Theater of Operations consisted of the basic B ration plus special components. But because the needs for these special items varied within each hospital, either an excess or an insufficient quantity was received. Therefore, hospitals were authorized 35 cents per patient per day to purchase any food desired (except fresh meat, butter, fruits, and vegetables), provided quartermaster stores had them.
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The consequences of improper distribution were shown in a study made of the caloric value of the ration by an evacuation hospital in Bizerte, North Africa, during July, August, September, October, and November, 1943.
Month | Low | High | Average |
|
July | 1,800 | 2,700 | 2,400 |
|
August | 1,900 | 2,800 | 2,600 |
|
September | 1,800 | 2,700 | 2,400 |
|
October | 1,900 | 2,700 | 2,400 |
|
November | 1,800 | 3,000 | 2,500 |
This caloric deficiency was clinically reflected by an average loss in weight of 15 pounds by the organization personnel. This weight loss was probably caused by the monotony of the diet rather than to failure to offer sufficient quantities of food.
During the war period, foodstuffs were drawn each day from the nearest railhead or ration dump. The amount and type required were requested in a daily listing which included the units for which foodstuffs were being drawn, the average number fed the preceding day, and the morning report strength as of the previous midnight.
Every conceivable method was used to secure local foods in Africa, Sicily, and Italy. In the first echelon, the method most commonly used was bartering. As necessities and luxuries were extremely scarce, money was of no value to the natives. Combat troops supplemented their emergency rations with a surprising number of domestic animals that had been killed by mines. In Africa, lemons, oranges, eggs, purple carrots, and fennel were purchased.
The 300th General Hospital in which the hepatitis study was conducted in 1944 and 1945 reported that the average cost per patient per day was approximately 65 cents, almost double the amount allowed for the supplementary ration. This demonstrated the need for an increase in the diet without using food indicated for other patients, although only 50 cents of the B ration was used each day for the hepatitis patients.
By March 1945, all hospitals were authorized to draw food essential to the hepatitis diet within an authorized monetary value of 55 cents per hepatitis patient per day. The unit commander had to certify that the items ordered were indispensible for the patients` recuperation.
An interesting example of bartering was reported by 2d Lt. Helen F. Boswell, while assigned with the 56th Evacuation Hospital in Bizerte. Eggs were obtained by trading tea with the natives. She and her mess sergeant would go out to one of the tribes, stand around an entire afternoon, and perhaps get 15 dozen eggs. They were a little smaller than American eggs.42
The greatest problem encountered in serving fresh fruits raw was a
42Interview, 2d Lt. Helen F. Boswell, 56th Evacuation Hospital, subject: Report of Medical Department Activities in North Africa and Italy, 28 June 1944.
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sanitary one; an epidemic of dysentery was often traced to improper cleansing of fruits and vegetables. The appearance of a disinfectant, Mikroklene, in 1945 may have been partially responsible for the decrease in the number and severity of cases of diarrhea in Italy as compared to a similar period in Africa during 1943.
The Pacific and Asia
The only item of importance lacking was fresh milk in the general diets of Army hospital patients in Hawaii. Hospital patients were allowed a prescribed amount of fresh milk when the request was accompanied by a signed prescription from the ward officer. The scarcity was caused by antibiological warfare security and an inadequate local supply. Canned milk, powdered milk, and cheese were substitutes. In 1945, commercially reconstituted milk became available. This product was prepared in approved local creameries. It was made by pasteurizing, homogenizing, and then rapidly chilling a mixture of fresh unsalted sweet cream butter, skim milk powder, and water. Many unaware of its true nature, liked it. This same procedure, with minor variations, is followed today [1966] in supplying U.S. troops stationed in the Far East.
Dietitians at the 313th General Hospital reported that local food issues were bananas, camotes, pineapples, limes, native oranges, string beans, papaya, sayotes (similar to sweet potatoes), radishes, okra, cucumbers, eggplant, avocados, upo (native squash), coconuts, and rimas. Patients were rather suspicious of the unfamiliar native foods. Upo and sayotes, served in a creole sauce, were fairly acceptable. The purple camotes were drier than the American sweet potato. Rimas were prepared similar to a watermelon rind pickle and were served with roast meats. They were considered quite delicious. The patients thought that the green-skin native oranges were not ripe, but once eaten, these oranges were well liked. Papayas and coconuts were not too popular. Avocados were a little more acceptable. They were mashed with sugar and milk or used in flavoring ice cream. The familiar bananas and pineapple were most popular.43
Dietitians and mess personnel planted gardens in far flung corners of the globe. 1st Lt. (later Maj.) Helena D. Quinn, assigned to the 49th General Hospital, Milne Bay, New Guinea, and her office-clerk sergeant planted tomatoes, lettuce, peas, green beans, and melons. Lettuce was their only successful crop. The hospital enjoyed one meal of green beans; the other crops went to seed.44
Lieutenant Quinn found that getting things done depended upon a trade basis. The hospital made ice cream once a week for other outfits in return for like favors. Air Corps personnel ground the meat when fresh meat started arriving from the United States and Australia.
43See footnote 29, p. 201.
44Report, 1st Lt. Helena D. Quinn, Somewhere in the Southwest Pacific, January 1944 to November 1945.
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The water supply, furnished from Base A, was the biggest problem. In the midst of the meal, the water supply would be exhausted and the mess personnel would have to use water saved for reconstituting dehydrated food items. After several months, the water problem was remedied.
Lieutenant Quinn had an unusual supply experience at Christmas 1944. It was customary for all units to send details to unload ships whenever they were laden with food. Such a call came through on Christmas Eve; the hospital enlisted personnel went down immediately and unloaded all night. "There were fresh apples, oranges, frozen asparagus, and many other things--eggs, in particular. We were so happy to receive them but the Q.M. called and said it was a mistake--that they were supposed to be shipped forward. It was like parting with diamonds, but after much persuasion and excuses were finally told to keep them as we had been the only hospital that had sent the detail down the night before. We really feasted for the next weeks."
A dietitian in New Guinea (fig. 57) wrote of the difficulties with the food received from Australia:45
Australia has expanded and improved her food products to meet with the demand of feeding the American armed forces. In many instances her attempts have been highly successful. Such foods as canned fruits and corn beef can be used interchangeably with American foods but the highly scented chocolate, butterscotch and vanilla puddings which are shipped to us in large quantities and issued on ration basis, the gelatin, baking powder, fruit juices, canned vegetables, dehydrated vegetables, yeast, and condiments are almost one hundred percent wasted.
There is only one brand of Australian cheese and it lacks the flavor and palatability of American processed cheese.
There is nothing issued to replace these unconsumed foods, as a result patients in many instances are found to be actually hungry. They can not satisfy this hunger by feeding on more staple items such as bread, jams, and peanut butter since bread is an item that varies in the quantity issued from day to day. For the past three months three ounces per day per man has been the basis for issue. To alleviate this situation as much as possible, crackers, cookies, canned soups, pickles and candy have been purchased through the Army Exchange Service, using the hospital fund * * *. Flour is issued in place of bread however, due to lack of bake ovens and adequate number of field ranges it cannot be utilized for baking purposes. Substitutes for potatoes such as rice, noodles, macaroni, spaghetti, tapioca are seldom available. The canned meats are limited to three kinds: hash, stew and corn beef. * * * We would like to suggest that dehydrated ground meat, luncheon meat, spam, vienna sausage, and ham could be substituted for the * * * foods now being sent. Dehydrated eggs have been used successfully in cooking and baking only. The large quantities of sweetened milk can not be used in cooking of soups and cream sauces. They are very poor substitutes for evaporated milk when served as cream for coffee.
The dietitian in New Guinea concluded her report with a résumé of her equipment problems. Of 15 field ranges, 10 were usable. Re-
45Report, Dietary Department Conditions in a Hospital in New Guinea, July 1944.
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placement parts were needed as well as bake ovens, meat slicers, meat grinders, small-sized saucepans and can openers.
Before early 1944, U.S. Army Forces, China-Burma-India, were required to subsist on the British Field Service Troop Ration supplemented by local purchase and by use of excess reserve stocks of B-ration items. The British ration was considered to be inadequate nutritionally and contained many items which U.S. troops rejected. Milk was limited because of unsanitary local conditions. Fresh fruits and vegetables were scarce and of poor quality. The flour was not enriched but old and weevily. There was confusion in the various headquarters as to how the B rations were to be used. Canned meats and fruit juices were in short supply. In one area, the purchase of desirable items of the supplemental hospital ration by one unit quickly depleted the stocks on hand so that other hospital units were unable to procure items needed for special diets.46
The situation was corrected in January 1945. A dietitian assisted the Nutrition Consultant to the Surgeon, U.S. Forces, India-Burma Theater, in working with a quartermaster representative. They drew up a new ration scale in the form of a basic subsistence chart for India and Burma and also a uniform ration system for hospitals. More liberal allowance of canned meats, milk, fruit juices, and canned vegetables were given. The quantities of dehydrated soups and vegetable purees were reduced.47
Army hospitals in India had many Chinese patients. As the hospitals expanded, the Chinese Army provided their own messes. Early experience demonstrated the difficulty of satisfying Chinese patients with special diets and food items included in the American ration. It was impossible to prevail upon them to abandon their habits of foraging for themselves in and around the hospital, then stabling, and finally cleaning and cooking their forage in the wards. The Chinese mess detachment cooked rice in separate mess areas. Greens, meats, and seasonings were added to suit the individual taste.
2d Lt. Elizabeth James soon became familiar with Filipino food habits at the 4th General Hospital, Fort McKinley, Philippine Islands. She served them rice as often as it was available, warm orange juice (warmed through standing), and fried cornmeal mush. She resorted to individual meal cards for them when she found them going through the cafeteria line several times one morning. The Filipinos had exhausted a double issue of fresh eggs.48
At the 4th General Hospital, the main issue of beef was ground, stewing, and boiling. This situation improved after the dietitian protested to the quartermaster. Steak sandwiches were being served at
46Stone, James H.: History of the Army Nurses, Physical Therapists, and Hospital Dietitians in India and Burma, October 1945. [Official record.]
47Medical Department, United States Army. Preventive Medicine in World War II. Volume III. Personal Health Measures and Immunization. Washington: U.S. Government Printing Office, 1955, pp. 148-149.
48Letter, 2d Lt. Elizabeth James, 4th General Hospital, to Capt. Helen A. Dautrich, 24 July 1946.
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the Army post exchange snackbars. The dietitians felt that it would be far better for patients and duty personnel to eat steaks at their own organization messes, than to be served canned meats and patronize the snackbars at their own expense.49
Capt. (later Lt. Col.) Eleanor L. Mitchell in her 1945-inspection report of food service activities in the Pacific Ocean Area noted that the low-fat, high-protein diets for patients with hepatitis continued to present a difficult problem because of the scant issue of fresh fruits and vegetables, as well as the small variety of canned and frozen fruits. There was sufficient meat available for the protein source.
Food supply problems existed at one Army hospital in Japan. A 4,500-calorie menu was offered but not eaten. Hospital reports noted shortages of potatoes and bread. The dietitians wanted these included in the hospital supplement. Many items and food combinations on the menu were impractical for ward service, therefore, the patient did not eat 4,500 calories. Patients with hepatitis consumed much bread if they could get it.
Dietetic consultants were appointed to the Surgeon`s Office, Headquarters, U.S. Army Forces, Middle Pacific, and to the Philippines. There were no dietetic consultants in Australia, New Guinea, New Zealand, or in India and Burma although dietitians in these locations often expressed their need for such support.
In Hawaii several dietitians had nonhospital assignments. In July 1944, 1st Lt. (later Capt.) Mabel E. Hogan was placed on temporary duty with the School for Cooks and Bakers to instruct in applied nutrition, to act as assistant mess officer of the school, and supervise 10 kitchens operated by the school. 1st Lt. (later Capt.) Evelyn M. Girard was assigned to the quartermaster service in July 1945, to assist at the School for Cooks and Bakers and head the Menu Planning Section, Food Service, Central Pacific Base Command. She acted as a liaison between the Quartermaster Corps and hospital dietitians. Her initial duty was to plan a new 15-day menu for the Hawaiian Department on the basis of food limitations as imposed by the Commanding General, Army Service Forces.
Prisoners of War of the Japanese
Among the Americans in the Philippines who surrendered to the Japanese were the civilian dietitians serving with the Medical Department. Experiencing bombardment at Bataan and in the tunnel hospital of Corregidor, faced with the ever-present fear of abuse by Japanese troops, they suffered more privations and hardships than any dietitians had previously endured. The captured dietitians were Miss (later 1st Lt.) Ruby F. Motley, on an extended tour of duty in the Philippine Islands, and two Manila residents who volunteered to help in the emer-
49Report, Capt. Eleanor L. Mitchell, subject: Inspection Report of the 4th General Hospital, Fort McKinley, P.I., November 1945 to February 1946.
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FIGURE 58-Map of Manila Bay area with inset of Luzon Island, Philippines.
gency, Mrs. (later 1st Lt.) Vivian G. Weissblatt, whose husband was a United Press correspondent, and Mrs. (later 1st Lt.) Anna Bonner Pardew, a former Army-trained dietitian.
Miss Motley had arrived at Sternberg General Hospital, Manila, on 14 February 1940 and was the only assigned dietitian in the Philippine Islands. She planned menus for all hospital patients and was responsible for all food preparation in the officers` mess which served officer patients, officer dependents, enlisted dependents, and all special diet patients. The mess sergeant operated the enlisted mess which took care of the enlisted staff and enlisted hospital patients on regular diets. Food supplies were obtained from the quartermaster and through local purchase of native foods. Enlisted men and a few civilians worked in the enlisted mess. Chinese cooks and Filipino mess attendants were employed in the officers` mess.
When bombing of the military installations near Manila (fig. 58) began on 8 December 1941,50 casualties poured into Sternberg General Hospital and some of its annexes. To assist in the care of the increased
50United States Army in World War II. The War in the Pacific. The Fall of the Philippines. Washington: U.S. Government Printing Office, 1953, pp. 84-96.
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FIGURE 59-Malinta Tunnel. A. Schemata of Malinta Tunnel with inset of Corregidor.
patient load, Mrs. Weissblatt was employed to assist Miss Motley at Sternberg and Mrs. Pardew was hired to direct the food service at Fort McKinley Station Hospital. Because of the proximity of this hospital to Nichols Field, which had already been heavily bombed, the majority of the medical staff and all patients were transferred on 13 December to Annex B in Manila. Mrs. Weissblatt was assigned to General Hospital No. 2 when the evacuation of patients and personnel from Sternberg was begun on 24 December. Mrs. Pardew remained in Manila and was interned at Santo Tomas Internment Camp after the Japanese occupied the city.
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Malinta Tunnel Hospital, Corregidor
Miss Motley was transferred to Corregidor on 30 December 1941, the day after that island had received its first heavy bombing. The Topside Hospital had been hit several times and the whole installation had been moved into a section of the Malinta Tunnel (fig. 59). The hospital section was overflowing with patients. Miss Motley was a welcome addition to the kitchen for this released a nurse who was greatly needed on the wards.
The tunnel hospital kitchen equipment, which provided for about 300 patients, consisted of two family size electric ranges, one icebox, and a cook`s table. With an increase to approximately 1,500 patients, personnel, and attached individuals, it was necessary to set up field ranges outside the tunnel entrance to the hospital section. Cooking outside was a hazardous undertaking during the shelling and bombing which were frequent occurrences on Corregidor during two phases of the Japanese effort to gain control of Manila Bay.51
Since it was not known how long the available food supplies would have to last, soon after Miss Motley`s arrival, it was decided to serve
51Cooper, Wibb E.: Medical Department Activities in the Philippines From 1941 to 6 May 1942, and Including Medical Activities in Japanese Prisoner of War Camps. [Official record.]
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only two meals a day. There was a supplement of hot soup and sometimes bread at noon. Sick patients still received special foods.
A day`s menu in January 1941 consisted of the following:
Breakfast | Noon | Supper |
|
Canned fruit |
Soup |
Meat |
|
Cereal, with milk and sugar |
Bread |
Canned vegetables |
|
Bread and butter |
|
Hot rolls and butter |
|
Coffee |
|
Canned fruit |
General Hospital No. 2, Bataan
Miss Motley was transferred on 6 March 1942 to General Hospital No. 2 and Mrs. Weissblatt replaced her at Corregidor. The Bataan hospital at this time was operating 6 messes and feeding about 4,000 people on half rations. The mess officer and Miss Motley made trips to the quartermaster food dumps to get canned milk, meat, and fruit juices for the patients. Horses and carabaos served as part of the meat supply. There was no refrigeration so warm meat from the slaughterhouse had to be cooked immediately upon arrival at the hospital. Canned meat items consisted of salmon and sardines; one can of salmon had to serve 10 persons. The pattern of two meals served each day was similar to that at the Corregidor hospital.
Miss Motley described the kitchen equipment in General Hospital No. 2 as "the poorest in the world." Each mess had a field range or two but most of the food, particularly rice, was cooked over firepits dug in the earth. There was no small equipment and any kind of cans that were available were used to take food to the bed patients. Flies were the greatest sanitation problem since the hospital was out in the open under the trees.
The hospital was camouflaged but concealment of the long mess lines was a constant problem. Strafing by the enemy was always feared but never materialized even when the lines increased to 1,000 or more men. Because of the blackout requirement, meals were cooked and served only during the daylight hours.
Because General Hospital No. 2 with its 6,000 patients lay directly in the path of the advancing enemy, all female personnel were transferred during the night of 8 April 1942 to Corregidor. By the next morning, the front was less than 4 miles from the hospital.
Return to Corregidor
In the tunnel hospital at Corregidor, bombs could not hurt patients and personnel but all were constantly aware of these from the concussions and reverberations. The blowers supplying fresh air were almost always out of order. Much of the time the electric lights were out because of shellfire hitting the power lines. Messing problems were intensified and greater than before because of increased enemy action and the high patient census.
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In addition to battle injuries, patients had upper respiratory infections, malaria, and diarrhea. Dysentery was rarely seen. Before the war, there was no malaria on Corregidor; the troops brought this disease with them from Bataan. There were few neurospsychiatric cases. Vitamin deficiency diseases were beginning at the time of capitulation with a few cases of wet and neuritic beriberi.
Strict food rationing was enforced at the Corregidor hospital. The two dietitians made ward rounds before each meal to get the patient count. From the total census the dietitians partially determined the size of serving for each patient. The amount given was also dependent upon the food supply and the number of interruptions in cooking at the entrance to the tunnel. Only the duty personnel ate in the small messhall; all patients had to be served on the wards. Everyone who could helped to maintain food service.
Capitulation
With the fall of Corregidor, on 6 May 1942, came great relief that the month of continual bombing was over. The medical personnel had been working steadily with little opportunity for sleep or rest.
The Japanese confiscated most of the U.S. Army commissary food but did issue small amounts of a cereal product, canned meat, canned tomatoes, and other canned foods. The dietitians were able to get canned soup and milk for sick patients about once a week. The mess officer and dietitian, being familiar with different places food had been stored in the tunnel, made occasional looting trips. Much of the food had been removed but their raids did produce corned beef hash and tomatoes. Later, it was learned that the Japanese did not like canned tomatoes.
The women were restricted to the tunnel for nearly 6 weeks except for an hour each evening when they were permitted to go outside. The women serving in the Medical Department were never mistreated by the Japanese. They were interrogated, however, in minute detail about their personal histories. The Japanese were surprised to find women officers in the U.S. Army and being unable to grasp just what a dietitian was, they classified Miss Motley as a nurse.
On 25 June, the hospital was moved above ground to the renovated old hospital. The women, under constant guard, were permitted to continue their duties.
The ration at this time was inadequate and barely enough for existence. The Japanese paid little attention to what was requested and would usually issue rice, canned meat, salmon, and tomatoes. Out of the wheat flour on hand the baker made hot bread once each day.
On 2 July, with no advance notice, the patients and most of the male personnel were moved to Manila. The remainder of the hospital staff including the women were moved the next day. The women were
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taken to the University of Santo Tomas, and the men, both patients and personnel, were interned elsewhere.
Santo Tomas Internment Camp
Santo Tomas was a civilian internment center of about 4,000 people, largely American, British, Dutch, and Polish who resided in the Philippine Islands and were caught there with their families. Because of the warm welcome accorded the newcomers by their friends in the camp, the women from Corregidor were taken to another building outside of Santo Tomas. Here they were restricted to two rooms. The larger was used as a bedroom and the smaller as a dining room. They were allowed outside twice a day for 1 hour.
In the latter part of August 1942, these Army women were moved to Santo Tomas and allowed the privileges of the camp. Their quarters were former classrooms which were alive with bedbugs. There were 400 women for each bathroom (4 showers and 4 toilets). There was plenty of cold water but no hot water.
Men in the camp were responsible for the sanitary details while the women cleaned rice (full of worms and small rocks) and prepared vegetables for cooking. All work in the camp was done by the inmates. Everyone was expected to contribute at least 2 hours of work each day. Miss Motley, unwell and not assigned a definite detail the first few months in camp, volunteered and cleaned rice every morning.
The three camp kitchens were staffed with volunteer workers. When a fourth kitchen was opened for children under 3 years of age, Miss Motley and Mrs. Weissblatt helped with this project. Both dietitians did so well in the smooth operation of this kitchen that the chairman of the food committee requested that they take over the operation of the older children`s kitchen. Then, in February 1944, Miss Motley took over the hospital kitchen.
The Japanese authorities allowed so much per capita for camp feeding which was supplemented by the American National Red Cross. A Filipino woman known as the "Angel of Santo Tomas" did the daily buying. For nearly 2 years she was able to procure food of high nutritive value for both the hospital`s and children`s kitchens. Money and personal valuables were used by those eating from the central kitchen to augment their meager diets with purchases from Filipino vendors, through the black market, or from friends.
The problem then was to distribute the food evenly for even a few grains of rice were of great importance. When people are hungry their attitude toward food is not entirely rational and the small supply had to be stretched to feed 4,000 people. Generally, only two meals a day were served. It was agreed that the heavy workers, those caring for the sick, and those involved in sanitation and other camp duties, should receive extra food. When it was possible to provide a thin soup or mush at noon, this was done because it helped the morale of the camp so much.
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Also contributing to the morale were the homegrown vegetables from the camp garden. Tomatoes, okra, eggplant, and talinum, a fast-growing vegetable, were grown on a mass production basis. The menu on Thanksgiving Day, 1944, was typical of the daily ration:
Breakfast: Cornmeal mush (no milk, no sugar)
Lunch: Luago (thin rice mush)
Dinner: Rice and camote tops vegetable stew
During the last 6 months of internment, Miss Motley reported that the average diet was deficient in minerals, vitamins, and proteins in particular. There were many cases of beriberi. Many deaths resulted from malnutrition and starvation which occurred more among the older men and women. The average weight loss was from 30 to 50 pounds. Many people fainted in mess lines. At one time, Miss Motley submitted a report to the Japanese military staff on the general decline in the health and weight of the prisoners in the hope that pity would be shown and the rations increased. The report was brushed aside.
The end of the long struggle began early in February 1945 when the U.S. Army moved into Manila. The camp was in its usual blackout but the smell of U.S. gasoline from the tank at the gate made the prisoners realize that their days of being locked up without freedom, living under very crowded conditions, existing on a sub marginal diet, and exposure to the hazards of war were over. In the ensuing mop up engagement, Mrs. Weissblatt was seriously injured by shell fragments but recovered satisfactorily.
