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Chapter IV

Medical Statistics of the United States Army, Calendar Year 1954

CHAPTER IV

Medical Personnel and Facilities

ARMY MEDICAL SERVICE COMMISSIONED PERSONNEL

Between the 31st of December 1952 and the 31st of December 1954, total Army troop strength declined from 1,508,265 to 1,323,807.1 Concomitant with this decline, the authorizations of Medical Service commissioned personnel have been reduced during the past two years, as chart Q shows. Nevertheless, the actual strengths of Army Medical Service (AMEDS) commissioned personnel continued during 1954 to be below authorization levels. This persistent disparity between authorized and actual strengths emphasizes one of the most serious problems of the Army Medical Service: to maintain sufficient proffesional medical personnel to accomplish the mission of the Service.

The worldwide distribution of authorized and actual strength of the various corps of the AMEDS for 31 December 1953 and 31 December 1954 is indicated in source table 24. At the beginning of 1954 (31 December 1953), 18,864 commissioned personnel had been authorized for the Medical Service; the strength of all AMEDS corps then totaled 18,419—or 445 below the authorized strength. By the end of the calendar year (31 December 1954), the authorized strength had been reduced to 16,372. The actual strength (15,785) was still below the authorization, and the shortage had increased to 587 commissioned personnel.

Corps Strengths and Composition

As indicated in source table 24, the shortages at the beginning of the year were primarily in the Medical Service Corps, the Army Nurse Corps, and the Women’s Medical Specialist Corps. The reduction of 550 spaces in the Medical Service Corps authorization for the end of the year (31 December 1954) accounted for the elimination of the shortage in that corps. The shortages in the Nurse Corps and in the Women’s Medical Specialist Corps remained in approximately the same relationships with the respective authorizations at the end of the year as they had been at the beginning of the year—although

there were reductions in authorization for both of these corps during the calendar year. This continual fall in the actual strength of both these corps was attributable to the fact that, without the involuntary recall programs that were in effect in 1952 and 1953, these two corps were not able to maintain their strengths at the programmed authorization level by voluntary recruitment methods.

1SOURCE: Strength of the Army, STM-30.


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CHART Q.—AUTHORIZED AND ACTUAL STRENGTHS, ARMY MEDICAL SERVICE COMMISSIONED PERSONNEL, AS OF 31 DECEMBER 1952, 1953, AND 1954

An evaluation of the numbers of Regular Army and Reserve component officers serving in the corps of the Army Medical Service, as indicated in source tables 25 and 26, reveals the following percentage composition for the beginning and end of the year:

Corps

31 December 1953

31 December 1954

Regular Army

Reserve Component

Regular Army

Reserve Component

Medical Corps

29.3

70.7

32.5

67.5

Dental Corps

15.2

84.8

17.5

82.5

Veterinary Corps

30.4

69.6

34.8

65.2

Medical Service Corps

16.4

83.6

18.5

85.5

Army Nurse Corps

30.7

69.3

33.4

66.6

Women's Medical Specialist Corps

31.2

68.8

32.6

67.4

    

Total

24.4

75.6

26.8

73.2

As the strength of the Army declined during 1954 and the various corps of the Army Medical Service similarly declined, the Regular Army elements of these various corps progressively represented a larger element of each of the corps; conversely, the reserve elements progressively represented a smaller element of these corps. However, in the Medical Corps, the Dental Corps, the Army


93

Nurse Corps, and the Women’s Medical Specialist Corps, the actual Regular Army strengths in no way represented the potential attainable percentage of each of these corps, were they to procure the full Regular Army authorization

It can be readily ascertained from source table 24 that the Regular Army components of the Army Nurse Corps, Women’s Medical Specialist Corps, Medical Corps, and Dental Corps were considerably below strength during 1954.

Approximately 61 percent of the Medical Corps and 68 percent of the Dental Corps were on duty during the year, for all intents and purposes, in an involuntary capacity as a result of the direct or indirect suasion of Public Law 779, as amended. The Army Nurse Corps and the Women’s Medical Specialist Corps met most of their requirements for personnel that could not be recruited as military on a voluntary basis, by the hiring of civilian nurses, dietitians, and physical and occupational therapists as replacements.

Procurement

The main effort in the field of personnel during 1954 was procurement. The principal plans were designed, first, to increase the Regular Army strengths of the Medical and Dental Corps. This included major efforts to reduce resignation losses (table XLI) in both of these corps and to procure new officers for the corps. A second objective was to increase the number of military nurses on duty with the Army, either as voluntary career reservists, or as Regular Army nurses The need to maintain a high proportion of military nurses on duty results from the fact that only military nurses can be made available for oversea duty. Since civilian nurses have been employed almost exclusively in continental United States operating installations, military nurses have been forced into more frequent tours of oversea duty and less frequent tours of duty in continental United States.

Some of the measures taken during this year to improve the voluntary procurement and retention of medical manpower are as follows:

Medical Corps and Dental corps. Additional emphasis was placed upon advertising the advantage of Army residencies and internships in professional journals This particular emphasis was employed because the professional training programs have represented virtually the only source of input into the Regular Army Medical and Dental Corps over the past several years.

Secondly, increased efforts were expended to secure the interest of doctors and dentists serving on active duty, as a result of Public Law 779, in a military career.. Toward this end, five young board-qualified Medical Corps officers made visits to virtually all class I medical installations throughout continental United States to promote interest in the Regular Army and in residency training.

A clinical clerkship training program was instituted to improve liaison with approved medical and dental schools in the United States. This program was instituted to familiarize junior and senior medical students with the high standard of medicine practiced in Army hospitals and to interest these medical


94

students in commissions in the Army Medical Service. The deans of the 73 medical schools in the United States were advised of this program and were requested to nominate a principal and alternate from their junior and senior medical students for participation in the program. The program consisted of 6 weeks of instruction, basically 40 hours per week, divided into two 3-week periods. Student participation in the program was voluntary. They neither accrued additional obligations nor liquidated any existing legal obligation for military service by participating in the program. Students participating were carried on a “student employee” status of the Civil Service.

Finally, a voluminous mail campaign was instituted to solicit the aid of Medical Corps commanders, the Society of World War II consultants, and other prominent Reserve officers in the recruitment of volunteers for the Regular Army.
 

TABLE XLI.—REGULAR ARMY LOSSES, BY CAUSE, 1954

Cause

Medical Corps

Dental Corps

Veterinary Corps

Medical Service Corps

Army Nurse Corps

Women's Medical Specialist Corps

Total

284

52

5

24

107

21

    

Reverted to retired status

9

1

1

-

-

-

    

Retired

22

4

3

4

14

5

    

Resigned

240

43

-

2

71

13

    

Died

7

1

1

3

-

-

    

Honorable discharge

5

2

-

2

22

3

    

Other

1

1

-

13

-

-

Army Nnrse Corps and Women’s Medical Specialist Corps. A maximum 2-year oversea tour for Army Nurse Corps and Women’s Medical Specialist Corps officers, without dependents, was announced for the Far East Command during the year. A similar policy for all commands was planned. The 3-year oversea tour had been considered a major factor unfavorably affecting procurement and retention of female Army Medical Service officers. Further, DA Circular 135, Section II, 30 November 1954, urged commanders to take all possible means within the provisions of regulations to provide attractive desirable quarters for all women officers at their installations. Adverse living conditions had been considered to be another factor affecting recruitment and retention of Army Nurse Corps and Women’s Medical Specialist Corps officers. Considerable effort was put forth to effect an improvement in this field. A policy was also established at the beginning of the year to recommend the approval of all requests for retirement received from Army Nurse Corps and Women’s Medical Specialist Corps officers who had completed at least 20 years of active federal service.

A Registered Nurse Student Program (SR 605-60-53) was instituted at the beginning of the year. This program provided for formal training leading to a bachelor’s or mastor’s degree in one of the nursing fields. Those applicants


95

selected were commissioned 2nd lieutenants, Army Nurse Corps, and were obligated for a period of 3 years of military service, which included the time spent in their formal training.

During 1954, the Army continued its own long-term courses for Women’s Medical Specialist officers in an effort to meet the requirements for occupational therapists, physical therapists, and dietitians. Procurement from outside sources was negligible

Seventeen Army Nurse Corps and 6 Women’s Medical Specialist Corps procurement officers were assigned in various locations in the six continental Armies early in the year. Placement of these officers in cities with large populations, in military districts, or in main recruiting stations proved advantageous for personal contacts and follow-up in both active duty and reserve procurement.

In order to expedite the processing of applicants for active duty or training programs, the following actions were taken to amend existing regulations or policies:

1. The commissioning of nurses prior to state registration was authorized.

2. The age limitation for appointment in the grade of 2nd lieutenant was raised to 30 years, and the waiver of maximum age limits for appointment in the Army Nurse Corps with concurrent active duty was. increased to 38 years for 2nd lieutenants, and to 40 years for 1st lieutenants.

3. Applicants were authorized to submit physical examinations performed by civilian physicians without cost to the government for appointment purposes. Final physical examinations in these instances were given at the first duty station.

4. Graduates of foreign schools of nursing who were otherwise qualified for appointment and were citizens of the United States were accepted.

5. Simplified abbreviated commissioning forms were provided for Army Nurse Corps and Women’s Medical Specialist Corps applicants. Completion of all unabbreviated forms was to be deferred until the individual reported to first duty station.

Utilization

Continued emphasis was placed upon increased utilization of Medical Corps officers in strictly professional functions. This emphasis resulted in part from limitations upon the number of physicians the Army was permitted to have on active duty. This number was fixed by a static ratio of 3 physicians (Medical Corps officers) for each 1,000 troop strength, plus the number of interns and one-half of the residents in training. The Secretary of Defense, by a memorandum dated 18 May 1953, directed the Army to attain this limiting authorization by 30 June 1954. This ceiling represented a substantial reduction in physician strength over that previously experienced by the Army Medical Service

As the strength of the Army continued to decline, relatively fixed functional areas such as research, training, administration, and the general reserve


96

progressively continued to consume a greater portion of the total physicians available, whereas the unfixed “professional care” functional area consumed a smaller portion of the total (table XLII). In an effort to counteract this tendency toward a limitation upon professional care—because of a shortage of Medical Corps officers for that purpose—further reductions in physician utilization were made in other areas, thus curtailing these functions. Staffing of General Reserve units with Medical Corps officers, for example, was reduced to less than 25 percent of their full TOE organizational requirements. This same staffing limitation, to a somewhat lesser extent, had to be applied in oversea areas. These calculated risks introduced into Army Medical Service plans the concept that, during the initial phases of any conflict requiring the immediate dispatch of American forces, continental United States operating units would have to be drastically reduced to provide even minimum coverage of Medical Corps officers to the force committed.

TABLE XLII.—UTILIZATION OF MEDICAL CORPS PERSONNEL, BY FUNCTION

(Estimated)

Function

December 1953

December 1954

Number

Percent

Number

Percent

Strength served

1,508,265

1,323,807

Total Medical Corps personnel

5,528

100.0

4,238

100.0

    

Professional care

3,913

70.8

2,738

64.6

         

Patient care

3,663

66.3

2,533

59.8

         

Separate laboratories

60

1.1

45

1.0

         

Consultants

30

0.5

25

0.6

         

Preventive medicine

90

1.6

80

1.9

         

Induction and separation

70

1.3

55

1.3

    

Interns and residents

495

9.0

415

9.8

    

Research and development

150

2.7

125

3.0

    

Administration and supply

105

1.9

95

2.2

    

Instructors and training overhead

105

1.9

60

1.4

    

General Reserve training

250

4.5

335

7.9

    

Students, en route, and detachments of patients

510

9.2

470

11.1

 SOURCE: "Report on Medical Corps Strength and Military Population Served," DD-AFMPC(M) 76, 15 January 1953.

Authorizations

Authorizations as reflected in source table 24 were predicated upon the following bases:

Medical Corps. Established as 3 Medical Corps officers per 1,000 troop strength, plus the interns and one-half of the residents (effective 30 June 1954).


97

Dental Corps. Based upon the more or less self-imposed 2 dentists per 1,000 troop strength for both the beginning and end of the year.

Veterinary and Medical Service Corps. Reasonably closely reflecting actual requirements at the end of the year.

Army Nurse Corps and Women’s Medical Specialist Corps. Based upon an estimated procurement capability, rather than on any actual requirement for military nurses.

INPATIENT MEDICAL WORKLOAD IN ARMY MEDICAL TREATMENT FACILITIES

The continuing decline in the Army Medical Service workload resulted in a further reduction in the number of medical treatment facilities and the number of hospital beds in operation. The decline in workload was, of course, the result of the several factors discussed elsewhere in this report—continued decline in noneffective rates, new low levels of morbidity, elimination of battle injury and wound patients as an important factor—as well as of the reduction in the strength of the Army.

At the beginning of 1954 there were 117 Army hospitals and infirmaries, worldwide, with a total of 42,604 operating beds; by the end of the year these numbers had been reduced to 98 and 29,284, respectively. In addition there were 552 Army dispensaries at the start of the year and only 472 at the year’s end. While the number of class II Army hospitals, offering definitive care in a range of specialized treatment categories, remained constant (9) throughout the year, the number of class I hospitals designated as specialized treatment hospitals rose from 9 to 10 and then dropped to 4.

Admissions

Continuing a downward trend begun in mid-1951 and accelerated by the termination of the Korean Conflict, the total admissions to Army hospitals and infirmaries dropped from 729,301 in 1953 to 547,928 in 1954, a decrease of 25 percent. Nearly two-thirds of the admissions in 1954 were originally to facilities located in continental United States. This decrease occurred in all categories of personnel except dependents of military personnel, retired military personnel, Veterans Administration beneficiaries, and U. S. Bureau of Employment Compensation beneficiaries, each of which increased. As would be expected, active duty Army personnel accounted for the majority, or 55 percent, of inpatient admissions. Dependents of military personnel comprised 34 percent (26 percent Army, 2 percent Navy and Marine Corps, and 5 percent Air Force) and other active duty military personnel (Air Force, and Navy and Marine Corps) another 5 percent. The largest numerical increase in admissions occurred for Army dependents. Numerous factors are involved in the explanation of this increase. Since entitlement to such care is on a “when adequate facilities are available” basis, some of the needed care has to be obtained elsewhere at times but can be provided by the Army Medical


98

Service as declining military patient loads increase the availability of facilities. Then too, the number of military dependents in oversea areas had increased, and under these circumstances the likelihood that any medical care received will be provided by the Army is increased.

The data on admissions in source table 27 represent all admissions to hospital or infirmary, whether they are initial admissions or admissions by transfer from another hospital or infirmary. About one-eighth (37,378) of the approximately 300,000 admissions of active duty Army personnel to hospitals or infirmaries in 1954 were transfers. As in the previous year, about 95 percent of the total initial admissions of Army personnel to military hospitals or infirmaries took place in Army facilities. Of the remaining, 11,182 were in Air Force facilities and 3,225 in those of the Navy. These latter figures were about the same as in the previous year. The total 1954 figure for initial admissions to military hospitals, 278,176, constituted about 60 percent of the admissions of Army personnel for medical treatment on an excused-from-duty basis (hospital or quarters).

Census

The patient census data in source table 27 are for all patients admitted to hospital and infirmaries and still continuing as an excused-from-duty patient or inpatient, whether or not occupying a bed. The census data shown represent not only the daily average for the entire year but also the number at the end of 1953 and 1954. The difference between the census and bed occupancy figures for facilities in the United States is almost entirely in the active duty military segment, largely Army. This is mainly due to patients remaining on the rolls who have been ordered home or to a Veterans Administration hospital on permanent change of station (PCS) pending final action on separation or retirement for disability. Other patients not occupying beds, but included in the census are patients subsisting elsewhere, patients on leave, persons AWOL from patient status, and patients who have been placed on special duty with the hospital duty detachment or a nearby military installation.

Occupied Beds

The year 1954 was the third successive year in which bed occupancy declined in Army facilities. (See table XLIII.) On the average day in 1954 there were 22,472 patients occupying beds in Army hospitals and infirmaries; approximately two-thirds of these patients were in Army hospitals in the United States. The 1954 average represents 12,760 fewer beds than in the previous year and is almost half the corresponding figure for 1952. Army patients and enemy prisoner of war patients accounted for nearly all of the 1954 decrease. All of the latter had been returned to the custody of the North Korean government by the end of January. Except for a slight decrease in the Air Force patients and VA beneficiaries, the other groups were relatively unchanged. Of the total number of patients worldwide occupying beds during 1954, 15,439


99

TABLE XLIII.—DAILY AVERAGE NUMBER OF PATIENTS OCCUPYING BEDS IN U.S. ARMY HOSPITALS AND INFIRMARIES, BY TYPE OF PATIENT, 1952-1954

Type of patient

1952

1953

1954

Worldwide

United States

Overseas

Worldwide

United States

Overseas

Worldwide

United States Overseas

All patients

46,955

26,615

20,340

35,232

20,151

15,081

22,472

14,725 7,747
    

Active duty military

33,222

22,623

10,599

25,306

16,280

9,026

17,015

11,017 5,998
         

Army

30,861

21,146

9,715

23,373

15,241

8,132

15,439

10,187 5,252
         

Navy and Marine Corps

481

74

407

508

67

441

508

47 461
         

Air Force

1,880

1,403

477

1,425

972

453

1,068

783 285
    

Dependents of military

3,493

2,827

666

3,622

2,799

823

3,706

2,780 926
         

Army

2,540

2,055

485

2,599

1,984

615

2,736

2,016 720
         

Navy and Marine Corps

222

133

89

265

158

107

253

143 110
         

Air Force

731

639

92

758

657

101

717

621 96
    

Retired military

308

298

10

325

312

13

330

312 18
    

Allied and neutral

466

27

439

451

31

420

177

10 167
    

Veterans Administration beneficiaries

628

460

168

551

384

167

441

297 144
    

Enemy prisoners of war

6,698

-

6,698

3,425

-

3,425

74

- 74
    

All other

2,140

380

1,760

1,552

345

1,207

729

309 420

SOURCE: Beds and Patients Report, DD Form 443.


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(69 percent) were active duty Army personnel; 1,068 (4.8 percent) Air Force; 508 (2.3 percent) Navy and Marine Corps; 3,706 (17 percent) dependents of military; 331 (1.5 percent) retired military; 441 (2.0 percent) Veterans Administration beneficiaries; and 74 (0.3 percent) enemy prisoners of war (table XLIII). The only personnel category showing a marked rise were dependents of military; in the preceding year this group had accounted for 10 percent of the total beds occupied.

Among the various indexes related to Army health and provision of medical care, the ratio of the number of occupied beds to the mean strength is sometimes used and, expressed as a percent, is called the hospitalization ratio. This ratio is, of course, similar to the noneffective rate except that it is based only on patients noneffective and occupying hospital beds and is expressed per 100 rather than per 1,000. The hospitalization ratio for all nonbattle causes for the total Army in 1954 was 1.1 percent; that is, on the average day there were 1.1 beds occupied by disease or nonbattle injury patients for each 100 persons in the Army. The nonbattle noneffective rate for all persons excused from duty in hospital or quarters, shown elsewhere in this report, was 14 per 1,000 on the average day in 1954; this is, of course, equivalent to 1.4 per 100. The difference between these two ratios is largely accounted for by patients who are still carried in the hospital census but are not occupying a bed (i. e., on leave, assigned home or to a Veterans Administration hospital pending disability separation, etc.). A ratio computed on the basis of all Army hospital patients remaining (and thus including those on leave, etc.) would be about 1.3 percent, rather than 1.1 percent; the 1.4 per 100 noneffective rate is still higher by 0.1 per 100, which represents the effect of cases excused from duty in quarters.

The hospitalization ratio declined in 1954 as it had in 1953. The 1954 ratio of 1.1 per 100 strength was nearly 40 percent below the 1952 ratio.

The number of battle casualty patients in Army medical treatment


101

facilities fell steadily during 1954; they occupied an average of 244 beds during year as compared with 2,635 in 1953. Army patients constituted nearly all (94 percent) of those occupying beds during the report year.

The important role played by the specialized treatment centers located in the United States in providing medical care to military patients and other categories of eligible beneficiaries may be seen from table XLIV, which shows the average number occupying beds in 1954 by type of treatment received at the 9 class II hospitals and the 10 class I hospitals designated as specialized treatment hospitals. These two groups accounted for more than one-third of the total beds occupied worldwide during the year. In these hospitals Army patients occupied about the same proportion (two-thirds) of beds as in all

hospitals, while dependents of military personnel (19 percent) and Air Force (7 percent) comprised the largest percentage of the non-Army categories of personnel.

Of the total number of occupied beds in specialized treatment hospitals, general medicine patients made up the highest proportion, about 20 percent, followed by orthopedic surgery, 17.0 percent; tuberculosis, 16 percent; general surgery, 15 percent; neuropsychiatric, 14 percent; and obstetrical and gynecological, 6 percent.

These overall proportions did not apply, of course, to each of the separate personnel categories. For both Air Force active duty personnel and for military dependents the proportion requiring treatment for tuberculosis (21 and 16 percent, respectively) was higher than for Army active duty personnel (14 percent). The percentage receiving this type of treatment was even higher for Veterans Administration beneficiaries, about 50 percent. About one-fifth of Army personnel occupying beds in these specialized treatment hospitals required orthopedic surgery. Besides tuberculosis, other specialties reported for substantial numbers of military dependents were: obstetrics and gynecology (29 percent), general medicine (24 percent), and general surgery (15 percent).


102

TABLE XLIV.—AVERAGE NUMBER OF PATIENTSa OCCUPYING BEDS IN U.S. ARMY SPECIALIZED TREATMENT HOSPITALS, BY TYPE OF TREATMENT AND TYPE OF PATIENT, 1954

Type of treatment

Type of patient

Total

U.S. Army

Navy

Air Force

Dependents of
military personnel

Others

U.S. origin

Oversea origin

Transfer from hospital
and infirmary

Other local origin

Battle injury and wound

Other

Total

8,857

1,708

2,611

193

1,292

26

643

1,673

711

     Medicine:

 

 

 

 

 

 

 

 

 

          General medicine

1,782

217

698

2

179

8

79

394

205

          Arthritis

80

16

22

-

30

-

4

4

4

          Dermatology

105

22

48

0

17

-

8

4

6

          Hepatic metabolic

63

9

27

0

14

0

4

5

4

          Trench foot

7

0

2

-

5

-

0

-

-

          Tuberculosis

1,379

402

43

1

355

-

135

263

180

     Surgery:

 

 

 

 

 

 

 

 

 

          General surgery

1,316

117

631

16

78

8

90

252

124

          Orthopedic

1,508

224

721

76

183

6

136

105

57

          Amputations

87

18

7

28

17

1

10

1

5

          Blind

0

0

-

-

0

-

0

-

-

          Deaf

63

29

4

0

12

-

17

0

1

          Hand surgery

54

16

10

12

13

-

3

0

0

          Neurosurgery

279

84

39

30

49

1

33

28

15

          Obstetrics and gynecology

498

1

8

-

3

-

1

479

6

          Ophthalmologic

117

25

33

2

21

0

13

12

11

          Plastic

126

29

29

21

21

1

12

9

4

          Thoracic

102

27

5

3

17

-

12

21

17

          Vascular

12

3

2

0

2

-

1

3

1

     Neuropsychiatric:

 

 

 

 

 

 

 

 

 

          Neurosyphilis

1

1

0

-

0

-

-

0

0

          Neurology

208

74

46

1

46

0

14

10

17

          Closed ward neuropsychiatric

743

273

123

1

169

1

51

76

49

          Open ward neuropsychiatric

327

121

113

-

61

0

20

7

5

aBased on end-of-month numbers of patients occupying beds. "0" indicates that average is less than 0.5.
SOURCE: Report of Patients by Type of Specialized Treatment, DA Form 8-131.