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Chapter X

Contents

PART THREE

HOSPITALIZATION IN THE LATER WAR YEARS
MID-1943 TO 1946


CHAPTER X

Adjustments and Changes in the Zone of Interior Hospital System

As the tempo and extent of the war increased, changes and adjustments were made in the hospital system. Among the more important reasons for them were the necessity of using limited personnel resources-particularly doctors-more effectively than formerly; the continuing efforts of the Air Surgeon to gain greater control over hospitalization of Air Forces men; the necessity of caring for large numbers of prisoners of war; and the growing number of patients requiring specialized treatment and care. In the fall of 1943 several groups attempted to solve the problem of limited personnel resources. Among them were the "Kenner Board," a group of officers appointed by The Surgeon General and headed by Brig. Gen. Albert W. Kenner to study Medical Department personnel utilization; the Hospital and Control Divisions of the Surgeon General's Office; the ASF Control Division; and the Inspector General's Office. These groups agreed that certain steps were desirable: reduction in size and number of station hospitals; merger of neighboring hospitals to eliminate overlapping and duplication; and removal of convalescent patients from the wards of general hospitals. They disagreed on the question of how to operate two sets of hospitals (those of the Army Air Forces and those of the rest of the Army) with a minimum of duplication of facilities and waste of personnel. Subsequently their opinions were reflected in changes made in the hospital system.1

Closure of Surplus Station Hospital Facilities

The first adjustment needed was the closure of station hospital plants, or parts of them, to keep step with the shrinkage in military population as troops moved over-

1(1) Mins of Mtgs and Rpt of Bd of Off to Study the Util of MC Offs, 17 Sep 43-6 Nov 43. HD: 334 "Kenner Bd." (2) Memo, Dr. Eli Ginzberg, Control Div ASF for Chief Oprs Serv SGO thru Dir Control Div ASF, 30 Nov 43, sub: Surv of Gen Hosps. SG: 333.1-1. (3) Memo, Lt Col Basil C. MacLean, Hosp Admin Div SGO for Gen [Raymond W.] Bliss thru Col [Albert H.] Schwichtenberg, 6 Nov 43, sub: Observations Based on Recent Visits . . . to 9 Gen Hosps. Off file, Gen Bliss' Off SGO, "Util of MCs in ZI" (19)#1. (4) Notes on Visit to McCloskey, O'Reilly, and Percy Jones Gen Hosps, 11 Dec 43, by Col Tracy S. Voorhees, Control Div SGO. SG: 333.1-1. (5) Memo, WDCSA 333 (4 Nov 43), DepCofSA for IG, 4 Nov 43, sub: Util of Med Off Pers in ZI Instls. AG: 320.2 (18 Apr 44) (1).


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seas. When this was done doctors no longer needed to care for troops in training could be released for assignment either to hospitals scheduled for overseas service or to general hospitals in this country. In the fall of 1943 both the Surgeon General's and the Air Surgeon's Offices made surveys to this end.2 By the close of the year "considerable reductions" had been made in the sizes of AAF hospitals, and the Surgeon General's Office was planning a general procedure for adjusting capacities of all station hospitals to the troop populations which they served.3 To avoid overcrowding in hospital plants that were by then larger than needed, The Surgeon General's Hospital Administration Division proposed a resumption of the practice of placing beds in wards only and of allotting to each bed 100 square feet of floor space, a practice which had been abandoned earlier when the need for beds was greater. This Division also recommended that local commanders be held responsible for reducing the sizes of station hospitals to authorized capacities.4

ASF headquarters and the General Staff approved these proposals and published regulations to effect them early in 1944.5 Concurrently The Surgeon General's Facilities Utilization Branch began to urge service command surgeons to increase efforts to shrink station hospitals under their supervision.6 To judge the progress made, The Surgeon General changed the way in which station hospital beds were reported in the summer of 1944. Until that time hospitals reported "constructed capacities"-that is, the number of beds which plants were constructed to hold-and hence reports showed neither the number of beds actually in use nor the number currently authorized. Under the new system they reported "authorized beds"-that is, beds for which were allotted supplies and personnel. The first such reports revealed that considerable progress had been made in the contraction of station hospitals.7 On 26 May 1944 the reported capacity (constructed capacity) of all AAF and ASF station hospitals had been about 259,000, or 6.2 percent of the zone of interior troop strength. By 7 July 1944 the "authorized capacity" of station hospitals was reported to be about 134,000 (3.3 percent of the troop strength at that time) and of station and regional hospitals together about 198,000 (4.9 percent).8

Establishment of Regional Hospitals

Closure of surplus AAF and ASF station hospitals did not eliminate the problem of operating dual sets of hospitals (for the Air Forces and for the rest of the Army) without duplication of plants and

2(1) Ltr, Asst to Chief Med Br S&S Div Hq 9th SvC to COs ASF Hosps 9th SvC, 26 Oct 43, sub: Util of Hosp Fac. SG: 632.-1. (2) Ltr, SG to CG 2d SvC attn SvC Surg, 23 Dec 43, sub: Anal of Data Obtained in Recent Questionnaire of SG on Req Hosp. SG: 705.-1 (2d SvC)AA. (3) Tabs C and D of Memo, CG AAF (Air Surg) for CofSA attn G-4, 7 Oct 44, sub: Reduction of ZI Hosps. HRS: G-4 file, "Hosp and Evac Policy."
3Ltr, SG to Budget Off for WD, 27 Dec 43, sub: Sta Hosp Beds in ZI Instls. SG: 632.-2.
4(1) Diary, Hosp Admin Div SGO, 4 Jan 44. HD: 024.7-3. (2) Ltr, SG to Budget Off for WD, 27 Dec 43, sub: Sta Hosp Beds in ZI Instls. SG: 632.-2.
5(1) WD Cir 43, 1 Feb 44. (2) AR 40-1080, C 2, 9 Jun 44. (3) ASF Cir 196, 27 Jun 44.
6Ltr, CG ASF by SG (Oprs Serv Hosp Div, Fac Util Br) to CGs SvCs attn SvC Surg, 28 Apr 44, sub: Redesignation of Sta Hosp Bed Capacities. HD: Resources Anal Div file, "Hosp."
7Form SG-396, Weekly Health Report, was revised 1 May 1944. The revised version was first used in Report 27, vol. IV, for the week ending 7 July 1944. Weekly Rpts, AML.
8(1) Weekly Health Rpts, vol. IV, No 21, and No 27. AML. (2) ASF Monthly Progress Rpt, Sec 7, Health, 31 Jul 44, p. 34, compared bed capacities of ASF sta hosps as of 26 May 44 and 30 Jun 44.


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waste of personnel, and attempts to solve it led to a major change in the hospital system early in 1944. Although prohibited from operating general hospitals and caring for overseas patients, the Air Forces, it will be recalled, had built up station hospitals to the point where many were staffed and equipped to give general-hospital-type care, and the Air Surgeon opposed transferring Air Forces patients to general hospitals, operated by the Service Forces, when there were AAF station hospitals capable of treating and caring for them. On the other hand, Surgeon General Kirk opposed separate Air Forces station hospitals.9 If they were to continue, he contended, their staffs should be reduced in quantity and quality to the level required to care for only minor ills and injuries, and patients from the Air Forces as well as from the rest of the Army who required treatment for serious ills and injuries should be concentrated, along with specialists to treat them, in general hospitals. In the fall of 1943 he attempted to achieve this goal (1) by requesting the General Staff either to permit him to reassign doctors from AAF hospitals as he saw fit or to direct the Air Forces to release specialists for duty with the Service Forces10 and (2) by proposing a revision of the policy governing transfer of patients to general hospitals. ASF headquarters approved the latter suggestion and a revised policy was published in November 1943. In addition to establishing criteria for the selection of cases for transfer to general hospitals, this policy clearly limited station hospitals to such operations as appendectomies, herniotomies, and the treatment of simple fractures of the extremities.11 The inference was that specialists were not needed in station hospitals.

Almost immediately the Air Forces protested that such restrictions would reduce their hospitals to dispensaries and would waste the skills and abilities of their staffs.12 Despite The Surgeon General's insistence that, on the contrary, Medical Corps officers would be used more effectively if specialists and patients requiring specialized care were concentrated rather than scattered,13 the Deputy Chief of Staff of the Army directed a compromise between the positions of the Air Surgeon and The Surgeon General. The Air Forces were to release some medical officers for ASF assignments but the policy on the transfer of patients to general hospitals was to be revised to permit AAF station hospitals to perform any operations, however complicated, for which they had adequate staffs.14

Early in 1944 The Inspector General reopened the question of the manning and use of AAF station hospitals. Reporting on a survey made by General Snyder, he

9Statement of Maj Gen Norman T. Kirk, Rpt, SGs Conf with Chiefs Med Br SvCs, 14-17 Jun 43, pp. 7-8. HD: 337.
10(1) Memo, SG for CofSA thru CG ASF, 13 Sep 43, with 1st ind, CG ASF to CofSA, 13 Sep 43. HRS: Hq ASF Gen Styer's files, "Med Dept." (2) Memo SPGAP 320.2 (8 Nov 43), Dir MPD ASF for ACofS G-l WDGS, 8 Nov 43, sub: Critical Shortage of Med Specialists in ASF. SG: 322.051-1.
11(1) Ltr SPMCR 300.5-5, SG to AG, 10 Nov 43, sub: Policy Regarding Trf of Pnts to Named Gen Hosps. AG: 704.11(10 Nov 43) (1). (2) WD Cir 304, 22 Nov 43.
12Memo, CG AAF for ACofS G-1 WDGS, 2 Dec 43, sub: Med Serv. AG: 704.00 (2 Dec 43).
13(1) Memo SPMC 701.-1, SG for Dir MPD ASF, 9 Dec 43, sub: Med Serv-AF. (2) T/S SPGAM 705 (Gen) (3 Dec 43)-31, CG ASF to ACofS G-1 WDGS, 13 Dec 43, same sub. (3) Ltr SPMCM 322.051-1, SG to CG ASF, 15 Dec 43, sub: MC Offs for Asgmt to ASF T/O Units. All in AG: 704.11 (2 Dec 43).
14(1) Memo WDCSA 705 (24 Dec 43) DepCofSA for ACofS G-1 WDGS, 24 Dec 43, sub: Sec 2, WD Cir 304, 22 Nov 43. AG: 704.11 (2 Dec 43). (2) WD Cir 12, 10 Jan 44.


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recommended on 13 January 1944 that AAF station hospitals that were staffed and equipped to serve as general hospitals should be used in that capacity for patients not only from the Air Forces but from the Service and Ground Forces as well. The Deputy Chief of Staff accordingly directed the commanding generals of the Air and Service Forces to prepare a combined plan for hospitalization "on a regional and military population basis, irrespective of command or service jurisdictional boundaries."15

To comply with this directive and still maintain the status quo, The Surgeon General drew up a plan based upon the Secretary of War's policy of permitting only the Service Forces to operate general hospitals and of assigning all overseas evacuees, with few exceptions, to their care. He proposed that general hospitals should be of two types, those staffed for specialized treatment and those staffed for "all work," and that station hospitals of both the Air and Service Forces should be staffed according to manning tables applicable to both alike.16 The Air Surgeon, on the other hand, attempted to use this opportunity to get authority to operate hospitals equal in all respects to those of the Service Forces. He proposed that hospitals be designated as specialized hospitals, regional hospitals, and station hospitals; and that they be staffed on the basis of their workloads and functions instead of by manning tables.17 Since none were to be called general hospitals, none would be restricted by the Secretary of War's policy and hospitals of all three types could presumably be operated by both the Air and Service Forces.

When representatives of the Air Surgeon and The Surgeon General could not agree upon a plan to submit to the Deputy Chief of Staff, the Air Forces designated certain of their installations as "regional hospitals" and called attention to this development as their way of complying with the directive.18 Subsequently, the entire problem of agreement upon a joint plan was referred to the Chiefs of Staff of the Air and Service Forces for solution.19

The outcome was a major change in the hospital system. Agreed upon by the AAF and ASF Chiefs of Staff, approved by the Deputy Chief of Staff of the Army, and authorized in April 1944, it represented a compromise between the proposals of The Surgeon General and the Air Surgeon. To the familiar station and general hospitals were now added the regional hospital, an entirely new species, and the convalescent hospital, an outgrowth of the convalescent centers and annexes already in use on a small scale. The Service Forces alone were to continue to operate general hospitals, but both the Air and Service Forces were to operate station, regional, and convales-

15(1) Ltr IG 333.-Med Pers, IG to DepCofSA, 13 Jan 44, sub: Util of Med Off Pers in ZI Instls. (2) Memo, DepCofSA for CGs ASF and AAF, 26 Jan 44, same sub. Both in Off file, Gen Bliss' Off SGO, "Util of MCs in ZI" (20)#2.
16Memo, SG for CG ASF, 29 Feb 44, sub: Util of Med Off Pers in ZI Instls, in Rpt to CG ASF from SG, Plan for Util of Med Off Pers in ZI, 29 Feb 44. HD: 322.051-1.
17(1) Memo, Hq AAF for SG, 26 Feb 44, sub: Proposed Plan, SGO, for the Util of MC Offs in ZI. Off file, Gen Bliss' Off SGO, "Util of MCs in ZI" (19) #1. (2) Draft Memo, CGs AAF and ASF for DepCofSA, [Feb 44], sub: Util of Med Off Pers in ZI Instls, prepared by Hq AAF. HD: Resources Anal Div files, "Hosp."
18(1) A History of Medical Administration and Practice in the Fourth Air Force (1945), vol. I, pp. 43-44. HD: TAS. (2) An Rpt, 1944, AAF Regional Hosp Maxwell Fld. HD. (3) Draft Memo, CGs AAF and ASF for DepCofSA, [Feb 44], sub: Util of Med Off Pers in ZI Instls, prepared by Hq AAF. HD: Resources Anal Div files, "Hosp."
19History of Control Division, ASF, 1942-45, App, p. 246. HD.


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cent hospitals. Regional hospitals were to be staffed not only to care for patients requiring merely the treatment usually given in station hospitals but also to serve as general hospitals for zone of interior patients. General hospitals were to have the most highly specialized staffs and to them were to be transferred all patients evacuated from theaters of operations, except those needing only convalescent care. General hospitals were also to accept patients from the zone of interior who needed specialized treatment not given in regional hospitals. Hospitals of all four types were to serve troops on an area basis, irrespective of the command to which the troops or the hospital belonged, and a hospital was to transfer patients to another having better qualified personnel only if patients needed treatment which the transferring hospital was not staffed to give.20 Thus, while the Service Forces retained the right to operate all general hospitals and in them to care for all theater of operations evacuees who needed further hospital treatment, the Air Forces gained the right to operate regional hospitals which were, in effect, general hospitals for zone of interior patients.

Although this change in the hospital system did not achieve integration of Air and Service Forces hospitalization, it did produce certain advantages. In June the War Department designated as regional hospitals thirty AAF and thirty ASF station hospitals agreed upon between The Surgeon General and the Air Surgeon.21 Soon afterward both The Surgeon General and the Air Surgeon issued directives covering the transfer of patients from station to regional hospitals.22 For several months ASF station hospitals had difficulty in adjusting to the idea of transferring complicated cases to regional instead of general hospitals, and there was little joint use of hospitals by the Air and Service Forces;23 but by the latter part of 1944 The Inspector General reported that the establishment of regional hospitals had eliminated much duplication.24 During 1945, when the patient load became heavy because of the influx of patients from theaters of operations, the care of the more serious and complicated cases from the zone of interior in regional hospitals permitted general hospitals to devote themselves almost entirely to the treatment of overseas evacuees.25

The question of whether regional hospitals could take over still more of the general hospital load-and perhaps become general hospitals themselves-came up early in 1945. When The Surgeon General asked for about 70,000 more beds in gen-

20WD Cir 140, 11 Apr 44.
21Memo, CG ASF for DepCofSA, 31 May 44, sub: Designation of Regional Hosps and Conv Hosps. AG: 705 (3 Apr 44)(1) "Util of Med Off Pers in ZI Instls." (2) WD Cir 228, 8 Jun 44. The number of regional hospitals was adjusted later as the need arose. For example, see WD Cirs 352, 30 Aug 44, and 115, 11 Apr 45.
22(1) Ltr, SG to CGs SvCs attn SvC Surg, 6 Jul 44, sub: Bed Credits in Regional and Gen Hosps, Tab G to IG Rpt, 28 Dec 44. (2) Ltr, CG AAF (Air Surg) to CG Tng Comd AAF, 2 Sep 44, sub: Bed Credits. (3) AAF Reg 25-17, 6 Jun 44, sub: AAF Hosp and Evac in Continental US. All in HRS: WDCSA 632 (25 Sep 44),"Hosp in ZI."
23(1) Ltr, CG ASF (Dep SG) to CG 9th SvC, 21 Sep 44, sub: Specialized Hosp. SG: 323.3 (9th SvC)AA. Similar letters found under same file number for different service commands. (2) Memo, 1st Lt Robert J. Myers, AUS, Med Stat Div SGO for Capt Edward A. Lew, 18 Sep 44, sub: Distr of Pnts in Regional Hosps as of 25 Aug 44. SG: 632.2.
24Memo, Act IG for DepCofSA, 28 Dec 44, sub: Hosp Fac in ZI. HRS: WDCSA 632 (25 Sep 44) Case No 28, "Hosp Fac in ZI."
25(1) Tab B of Memo, Dir Hosp Div and Dir Resources Anal Div SGO for Dir HD SGO thru Chief Oprs Serv SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. (2) Interv, MD Historian with Lt Col James T. McGibony, MC, formerly Chief Hosp Div SGO, 20 Feb 50. HD: 000.71.


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eral and convalescent hospitals to handle the growing influx of patients from overseas, G-4 directed the Air Forces to investigate the possibility of caring for overseas patients in AAF regional hospitals.26 Taking the position that maximum use had to be made of all available beds in order to justify requests for additional beds in general and convalescent hospitals, G-4 later directed that overseas casualties should be placed in 4,000 beds in AAF regional hospitals which the Air Surgeon offered for that purpose. G-4 stated that this was an emergency measure and did not alter current policies (presumably the policy established by the Secretary of War in 1943 that all overseas patients, with minor exceptions, should be treated in general hospitals).27 The Air Surgeon, who formerly had attempted to get separate general hospitals for the Air Forces and wanted to care for overseas casualties in AAF hospitals, urged immediate compliance with G-4's directive.28

The Surgeon General opposed this move. Having previously estimated that there were 12,000 vacant beds in AAF and ASF regional hospitals, he agreed that regional hospitals could be used for the purpose proposed but held that there were certain objections to doing so and that the expedient should be resorted to only in an emergency which, he contended, had not yet arisen.29 ASF headquarters supported The Surgeon General and appealed G-4's directive to the Deputy Chief of Staff. The latter referred the question for investigation on 19 March 1945 to The Inspector General, who recommended two months later (14 May) that vacant beds in both ASF and AAF regional hospitals should be used in the manner proposed by G-4. G-4 then sought the Secretary of War's approval of a directive making this recommendation effective. On 20 June the Secretary met with G-4 and The Surgeon General, whose opinions on The Inspector General's report he had already received. By that time "events had overtaken this disagreement," G-4 reported, for the war in Europe had ended, and "there was no longer a necessity" of using regional hospital beds to take the load off the general hospital system. The Surgeon General concurred with this statement and the original demand was accordingly dropped.30

This development did not alter the fact that occupancy of general hospital beds at the end of June-despite provision of addi-

26MemoWDGDS 7486, ACofS G-4 WDGS for CG AAF, 11 Jan 45, sub: Care of Add Pnts at AAF Regional Hosps. HRS: G-4 file, "Hosp and Evac Policy."
27(1) Memo, CG AAF (Air Surg) for ACofS G-4 WDGS, 13 Feb 45, sub: Care of Overseas Casualties in AAF Regional Hosps. HRS: G-4 file, "Hosp and Evac Policy." (2) Memo WDGDS 9049, Dep ACofS G-4 for CG AAF and ASF, 27 Feb 45, same sub. HRS: G-4 file, "Hosp, vol. II." (3) Memo, Lt Col C. A. Dixon, G-4 for ACofS G-4 WDGS, 3 Mar 45, sub: Conf on Use of AAF Regional Hosp Beds. Same file.
28Memo, Air Surg for ACofS G-4 WDGS, 22 Mar 45, sub: Progress Rpt on Care of Overseas Casualties in AAF Regional Hosps. HD: TAS 210.72lb, "Care of Overseas Casualties in AAF Hosps." Other memorandums on this subject are in the same file.
29T/S, Act SG to ACofS G-4 WDGS thru CG ASF, 22 Feb 45, sub: Care of Overseas Casualties in AAF Regional Hosps. HRS: G-4 file, "Hosp, vol. II."
30(1) 1st ind SPOPG (27 Feb 45), CG ASF to DepCofSA, 5 Mar 45, on Memo WDGS 9049, Dep ACofS G-4 WDGS for CGs ASF and AAF, 27 Feb 45, sub: Care of Overseas Casualties in AAF Regional Hosps. HRS: Hq ASF Planning Div file, 700 "Hosp and Evac." (2) Memo, DepCofSA for IG, 19 Mar 45, sub: ZI Hosp. HRS: Hq ASF Lt Gen Lutes' files, "Hosp and Evac, Jun 43-Dec 46." (3) Memo WDSIG 333.9-Hosp Fac (2), IG for DepCofSA, 14 May 45, sub: Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (4) Memo, Chief Planning Br G-4 for ACofS G-4 WDGS, 21 Jun 45, sub: Conf with SecWar on Rpt of Surv of ZI Hosps, with incl, Memo, Col Kyle (aide to SecWar) for SecWar [31 May 45], sub: ZI Hosps. HRS: G-4 file, "Hosp, vol. IV."


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tional beds in the first half of 1945, placing large numbers of general hospital patients on leave and furlough for 90 days, and adoption of measures to speed the disposition of patients-ran above what was normally considered the saturation point (80 percent of capacity) while the occupancy of regional hospital beds was considerably lower.31 Whether this situation was preferable to redistributing the patient load depended on the cogency of arguments against the suitability of regional hospitals for handling overseas patients. Several were of doubtful weight, such as that the use of these hospitals would "not have facilitated" observance of the War Department's policy of hospitalizing patients near their homes. On this point the Inspector General's Office and indeed The Surgeon General's own Resources Analysis Division estimated that 15 to 20 percent of the beds available in regional hospitals were located in areas where population was dense but general hospital beds few in number. To the argument that existing space in general hospitals (that is, on 5 March 1945) was still adequate, the reply might have been that it was being kept so partly by establishing additional beds in general hospitals which The Surgeon General had requested. It was also argued that filling the beds of regional hospitals with long-term patients would use up excess capacity needed to provide extra hospitalization for troops that would be returned from Europe for redeployment to the Pacific. To this the Inspector General's Office replied that the need in the latter case would arise only after the peak load had been passed. Nor did the Inspector General's Office agree with The Surgeon General's contention that difficulties would result from mixing overseas patients with those from the zone of interior in regional hospitals. Greater importance may or may not be attached to The Surgeon General's argument that the administrative difficulties of adding a large number of hospitals to those already treating overseas patients would have outweighed the gain of 12,000 beds. But it could not be denied, of course, that "diversion of patients from the general hospital system would prevent control of treatment by the agency now charged with their care."32

This last argument perhaps held the key to the entire matter. After the establishment of regional hospitals to serve in effect as general hospitals for zone of interior patients, the chief remaining distinction between hospital systems of the Air and Service Forces was that ASF general hospitals, but no AAF hospitals at all, were authorized to care for patients returning from overseas areas for further medical

31See below, pp. 210-12. Normally a hospital was considered full when 80 percent of its beds were occupied, because some of its beds were always required for dispersion. In August 1944 the Facilities Utilization Branch, SGO, proposed reducing the "dispersion factor" in estimating requirements from 20 to 15 percent because of a "liberal furlough policy." (Memo, Eli Ginzberg for SG, 18 Aug 44. HD: Resources Anal Div file, "Hosp.") In estimating requirements in January 1945 no beds for dispersion were included "on the assumption that furloughs will provide the necessary number of empty beds." (Memo, Asst SG for Act Dir Plans and Oprs ASF, 8 Jan 45, sub: Gen Hosp Program, ZI. SG: 323.3.)
32(1) 1st ind SPOPG (27 Feb 45), CG ASF to DepCofSA, 5 Mar 45, on Memo WDGDS 9049, Dep ACofS G-4 WDGS for CGs ASF and AAF, 27 Feb 45, sub: Care of Overseas Casualties in AAF Regional Hosps. HRS: Hq ASF Planning Div file, 700 "Hosp and Evac." (2) T/S, Act SG to Dep ACofS G-4 WDGS thru CG ASF, 22 Feb 45, same sub. HRS: G-4 file, "Hosp, vol. II." (3) Memo WDSIG 333.9-Hosp Fac (2), IG for DepCofSA, 14 May 45, sub: Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (4) Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 20 Jan 45, sub: Sta and Regional Hosp Backup for Gen Hosp Syst. SG: 632.2.


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and surgical treatment. To have placed some of them in AAF regional hospitals would have narrowed if not eliminated that distinction. An officer who participated in these transactions afterward interpreted the controversy in these terms-the desire of the Air Surgeon to eliminate that distinction and the determination of The Surgeon General to maintain it.33 This view seems plausible when the previous efforts of the Air Surgeon to secure a hospital system equal to that of the Service Forces are considered. It may also derive color from the fact that The Surgeon General, in tracing for the benefit of the Secretary of War the events leading up to the controversy, started with a reference to the Air Surgeon's attempt to secure general hospitals for AAF casualties in 1943.34 Further evidence to support such an interpretation is the accusation by the Air Surgeon and members of his staff that The Surgeon General was using delaying tactics. They charged that while he agreed to employ regional hospital beds for overseas casualties in an emergency he deliberately spun out negotiations in an effort to avoid taking that step at all.35 In any event, the distinction between general and regional hospitals remained, and it continued to be the official policy of the Army to treat overseas evacuees in general hospitals only.

Development of Convalescent Hospitals

Convalescent hospitals were first authorized as types of Army hospitals in the zone of interior in April 1944, but their origin lay in the early war years.36 Under authority granted by the Secretary of War in July 1943, the Air Forces announced the establishment of eight convalescent centers in September 1943. They were to operate in conjunction with station hospitals and were to rehabilitate AAF patients who had been treated in other hospitals or who had been evacuated from theaters of operations solely because of operational fatigue.37 In June 1943 the Service Forces began to establish convalescent annexes in hospital barracks, leased schools and inns, or vacated Army housing. Operated as parts of general hospitals, such annexes normally housed convalescent patients only from the hospitals to which they belonged, but one of them-the convalescent annex of England General Hospital, set up in leased hotels with a capacity for 2,600 patients-served as a convalescent center for patients from other general hospitals as well.38 Partly because of difficulties in finding suitable housing for annexes, the program was slow in getting under way and convalescent patients accounted for approximately 75 percent of the patient load of general hospitals in the fall of 1943. Groups studying the hospital system at that time agreed that convalescent patients should be removed from the wards

33Interv, MD Historian with Col John C. Fitzpatrick, MC, formerly MRO, SGO, 18 Apr 50. HD: 000.71.
34Memo, Chief Planning Br G-4 for ACofS G-4 WDGS, 21 Jun 45, sub: Conf with SecWar on Rpt of Surv of ZI Hosps. HRS: G-4 file, "Hosp, vol. IV."
35(1) Record of Tel Conv between [Maj] Gen [D. N. W.] Grant and [Brig] Gen Raymond W. Bliss, 7 Mar 45. HD: TAS 210.72lb "Care of Overseas Casualties in AAF Hosps." (2) Memo, [Lt Col Alonzo A. Towner, MC] for Gen Grant, n d. Same file.
36See above, pp. 117-20.
37AAF Memo 20-12, 18 Sep 43. HD: AAF Memo 5-20 series.
38(1) 1st ind SPRMC 322 (18 Jun 43), CG ASF to SG, 22 Jun 43, on unknown basic ltr. SG: 632.-1. (2) Res Adopted by Fed Bd of Hosp, incl to Memo SPRMC 632 (19 Oct 43), CG ASF for CofEngrs, 27 Oct 43, sub: Auth for Estab of Conv Retraining Units at Gen Hosps. CE: 683 Pt I. (3) Ltr, SG to CG ASF, 30 Oct 43, sub: Program for Providing Conv Fac. SG: 632.-1. (4) An Rpt, 1944, Surg 2d SvC. HD.


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of general hospitals to permit fuller use of the latter's highly specialized staffs.39

During 1944 the convalescent hospital program received impetus from several sources. Early that year, after his Office had estimated the patient load for 1944, The Surgeon General requested that additional beds be provided in convalescent "facilities," rather than in general hospitals, to save personnel and to permit the reconditioning of patients for return to duty in a nonhospital atmosphere. In March ASF headquarters approved this proposal, and during subsequent months service commands, acting under ASF authority, established convalescent centers in vacated barracks at Daytona Beach (Florida), Camp Lockett (California), Camp Carson (Colorado), Camp Atterbury (Indiana), Fort Sam Houston (Texas), Fort Custer (Michigan), and Fort Devens (Massachusetts).40

Meanwhile, a War Department circular authorized convalescent hospitals, as distinct from convalescent centers, annexes, and facilities. Accordingly, in June 1944 the War Department designated as convalescent hospitals two ASF and five AAF convalescent centers which The Surgeon General and the Air Surgeon selected for that purpose. Two months later, thirteen additional ASF convalescent centers were designated as hospitals, and subsequently other changes were made in the number in operation.41 These hospitals remained in an experimental stage for the rest of 1944. Those of ASF served as places for housing and feeding ambulatory patients and for preparing them through physical and military training for return to duty. Changes in barracks provided for such hospitals were held to a minimum. They therefore lacked classrooms, shops, and gymnasiums that were later-in 1945-considered essential. In addition, the scope of activities of convalescent hospitals was not clearly defined; their organization was not precisely outlined by higher authorities; and they had little personnel and equipment of their own.42

An exception to this general situation was the Old Farms Convalescent Hospital, in Avon, Conn. Established in May 1944 as a result of The Surgeon General's and the President's interest in the rehabilitation of blinded war casualties, this hospital soon afterward received personnel and equipment for a social-adjustment training program which continued throughout the war.43

In the fall and winter of 1944 several events brought the convalescent hospital program to full fruition. During a movement of higher authorities to reduce the numbers of beds in the United States, G-4 took up the matter of convalescent hospitals and in November, as a part of a compromise solution of the bed requirement problem, authorized 40,000 beds in AAF

39(1) Memo, unsigned and unaddressed, 23 Aug 43, sub: Status of Program for Estab of Conv Retraining Units. SG: 632.-1. (2) Memo, Dir Hosp Admin Div SGO for Chief Oprs Serv SGO, 4 Dec 43, sub: Rpt of Trip to . . . Gen Hosps. SG: 333.1-1.
40(1) See below, pp. 201-02. (2) Memo, SG for CG ASF, 10 Mar 44, sub: Conv Fac. Off file, Gen Bliss' Off SGO, "Med Clarification of Disposition Policy." (3) ASF Cir 93, 4 Apr 44. (4) An Rpts, 1944, Surg 1st, 4th, 5th, 6th, and 7th SvCs; and An Rpts, 1944, Brooke Gen and Conv Hosps and Mitchell Conv Hosp. HD.
41WD Cirs 140, 11 Apr 44; 228, 7 Jun 44; and 352, 30 Aug 44.
42(1) Memo, SG for Dir Pers ASF, 22 Jul 44, sub: Estab of Conv Hosps. HD: 322 "Estab of Conv Hosps." (2) Memo, Eli Ginzberg for Pres WDMB, 23 Aug 44. HRS: ASF Planning Div file, 700 "ZI Hosp." (3) ASF Monthly Progress Rpt, Sec 7, Health, 31 May 44. (4) An Rpts, 1944, Surg 2d, 4th, 5th, and 7th SvCs; An Rpt, 1944, Mitchell Conv Hosp; An Rpts, 1945, Brooke and Wakeman Hosp Ctrs. HD.
43(1) History, Old Farms Convalescent Hospital [1947]. HD: 319.1-2. (2) SG Ltr 162, 11 Sep 43.


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and ASF convalescent hospitals.44 This established a basis for the procurement of personnel and equipment for such installations. A few weeks later, on 4 December 1944, the President directed the Secretary of War to permit no overseas casualty to be discharged from the service until he had received "the maximum benefits of hospitalization and convalescent facilities," including "physical and psychological rehabilitation, vocational guidance, prevocational training and resocialization."45 Such unlimited support from the Commander in Chief helped the Medical Department to get necessary means for an elaborate convalescent program, which The Surgeon General's Reconditioning Consultants Division announced in December 1944.46

During the first half of 1945, ASF convalescent hospitals were supplied with personnel and equipment of their own; the barracks in which they were located were remodeled; shops, classrooms, gymnasiums and recreational facilities were provided; and elaborate programs consisting of technical and prevocational training, general education, vocational counseling, occupational therapy, recreation, athletics, and entertainment were set up.47 Thus, toward the end of the war, emphasis in the convalescent program shifted from the preparation of patients for return to duty to their preparation for return to civilian life.

The operation of convalescent hospitals was a major factor in enabling the Medical Department to care for the peak load of patients in the summer of 1945. It contributed to maximum use of specialists in general hospitals. Furthermore, convalescent hospitals provided a better psychological environment for the care of many patients, especially those suffering from neuropsychiatric disorders, than did general hospitals.48 Their value in the treatment of medical and minor surgical cases, however, was questioned in the middle of 1945,49 and general hospitals gradually adopted a practice of discharging patients of those types directly to civilian life.

Merger of Adjacent Hospitals

Besides suggesting the removal of convalescent patients from general hospitals, groups studying the hospital system in the fall of 1943 proposed the merger of adjacent hospitals into single installations. The establishment of regional hospitals accomplished this in part, for in some cases nearby station hospitals were either wholly or partially merged with regional hospitals.50 In the same period the Ninth Service Command consolidated the Vancouver Barracks Station Hospital with Barnes General Hospital, which was located on the same post.51 The next April The Sur-

44Memo, ACofS G-4 WDGS for CGs ASF and AAF, 17 Nov 44, sub: ZI Hosps. SG: 322 "Hosp Misc."
45Ltr, Franklin D. Roosevelt to SecWar, 4 Dec 44. HRS: ASF Control Div file, 705 "Cut-back in Gen and Conv Fac."
46(1) ASF Cir 419, 22 Dec 44, sub: Conv Hosp Revised Program. (2) TM 8-290, Educ Reconditioning, Dec 44. (3) TM 8-291, Occupational Therapy, Dec 44. (4) TM 8-292, Physical Reconditioning, Dec 44.
47(1) An Rpt, FY 1945, SG. HD. (2) Richard L. Loughlin, [History of] Reconditioning [in the U. S. Army in World War II], (1946), HD. (3) Memo WDSIG 333.9 Hosp Fac (2), IG for DepCofSA, 14 May 45, sub: Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (4) An Rpts of Conv Hosps for 1945. HD. (5) Memo, Lt Col Gerard R. Gessner for Chief Hosp Div SGO, 4 Jun 45. HD: 333. 1-1.
48An Rpt, FY 1945, SG; and An Rpt, FY 1945, Hosp and Dom Oprs, SGO. HD.
49Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 7 Jun 45, sub: Criteria for Reduction in Hosp Fac. SG: 323.3 "Hosp."
50Memo, IG for DepCofSA, 28 Dec 44, sub: Hosp Fac in ZI. HRS: WDCSA 632 (25 Sep 44).
511st ind, CG 9th SvC to CG ASF attn SG, 22 Sep 43, on Ltr, SG to CG 9th SvC, 24 Aug 43, sub: Combination of Sta Hosp with Gen Hosp. SG: 323.7-5 (Barnes GH)K.


191

geon General's Facilities Utilization Branch made a study of other sets of general and station hospitals located on the same Army posts, comparing personnel required to operate them as separate installations with that needed for their operation as consolidated hospitals. It appeared that fewer Medical Corps officers, particularly specialists, and fewer nurses would be needed if station hospitals were merged with near-by general hospitals.52 The Surgeon General's Office anticipated more efficient operation from the supervision of the activities of two installations by one rather than two commanding officers. Moreover, the commanders of general hospitals were subject to less control by post commanders than were those of station hospitals-an advantage from The Surgeon General's viewpoint. The mergers were not expected to increase the number of general hospital beds immediately, because general hospitals thus enlarged would still have to care for troops stationed on their posts. Later as troops moved overseas, beds formerly used for station hospital patients could be transferred to general hospital use.53 Accordingly, five station hospitals were consolidated with five general hospitals in the summer of 1944, as follows: Fort Devens Station Hospital with Lovell General Hospital, Fort Dix Station Hospital with Tilton General Hospital, Fort Bliss Station Hospital with William Beaumont General Hospital, Fort Benjamin Harrison Station Hospital with Billings General Hospital, and Dante Hospital in San Francisco with Letterman General Hospital.54

Attempts To Limit the Use of General Hospitals as Debarkation Hospitals

Another change in the hospital system occurred when The Surgeon General modified the existing practice of using general hospitals located near ports as receiving and evacuation hospitals. Throughout the later war years Halloran, Stark, and Letterman General Hospitals continued to serve as debarkation hospitals, the latter two being devoted almost exclusively to that function as the evacuation load grew heavier. At various times during 1944 and 1945 other general hospitals-Lovell, Barnes, McGuire, Birmingham, LaGarde, Madigan, and Mason-served also in that way.55 General hospitals accepted their roles as receiving and evacuation, or debarkation hospitals reluctantly because the processing of patients in transit did not require the fullest use of specialized equipment and staffs and because hospitals engaged in that function had alternating periods of activity and idleness, depending upon the arrival of ships with patients.56 Several officers in the Surgeon General's Office were also dissatisfied with the practice of having

52Memo, Chief Fac Util Br SGO for Chief Oprs Serv SGO, 24 Apr 44, sub: Pers Study of Five Contiguous Sets of Sta and Gen Hosps. HD: Resources Anal Div file, "Hosp."
53(1) Ltr, SG to Fed Bd Hosp, 27 Jun 44, sub: Combination of Named Gen Hosp and Adj Sta Hosp. SG: 323.7-5. (2) Draft Ltr, SecWar (prepared by SGO) to Fed Bd Hosp, 12 Jul 44. SG: 322 "Hosp." (3) Interv, MD Historian with Maj Gen Norman T. Kirk, 20 Nov 51. HD: 314 (Correspondence on MS)V.
54Diary, Hosp Cons Br SGO, 15 and 20 Jul 44. HD: 024.7-3.
55(1) Weekly Health Rpts, vol. IV, No 1, 7 Jan 44; No 24, 16 Jun 44; No 32, 11 Aug 44; No 34, 25 Aug 44; and No 40, 6 Oct 44. AML. (2) An Rpt, FY 1945, Hosp and Dom Oprs, SGO. HD. (3) Memo, Dir Resources Anal Div SGO for Dir HD SGO, 25 Sep 45, sub: Operational Problems and Accomplishments in Med Serv, World War II. HD: 319 "Hosp." (4) Memo, SG for WDMB, 4 Oct 44, sub: Debarkation Hosps. SG: 322 "Hosp."
56(1) Memo, CO Halloran Gen Hosp for CG 2d SvC attn Surg, 21 Feb 44, sub: Increased Bed Capacity. SG: 632.2 (Halloran GH)K. (2) Diary, Hosp Admin Div SGO, 11 Jan 44. HD: 024.7-3. (3) S/S, SG to CG ASF, 25 Nov 44, sub: 300-Bed Expansion by Conversion, McGuire Gen Hosp, with inds. SG: 632.-1 (McGuire GH)K.


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general hospitals perform dual functions. The Medical Regulating Officer, for example, thought that this practice interfered with efficient operation of the evacuation system, and others agreed with hospital commanders that it was wasteful of both personnel and equipment.57 When changes in the hospital system were being considered early in 1944. The Surgeon General proposed establishment of a new type of hospital, to be known as a receiving and evacuation hospital and to be manned and equipped to perform only the processing of patients in transit.58 This proposal was not accepted, and the circular outlining the revised hospital system in April 1944 provided for the continued use of existing types of hospitals-station, general, or regional -for debarkation purposes.59 After that, in the summer of 1944, Stark, Letterman, and Halloran separated general hospital functions from debarkation work, becoming to that extent two hospitals in one.60

As the need for beds in both general and debarkation hospitals increased, The Surgeon General attempted to keep to a minimum the use of general hospitals for debarkation processing. In the summer of 1944 he secured approval of ASF headquarters to use the Camp Edwards Station Hospital, instead of Lovell General Hospital, as a debarkation hospital for the port of Boston. This action, he explained, would make available more general hospital beds in New England, a heavily populated section with only two general hospitals. It would also help to economize in the use of Medical Corps officers, since debarkation hospitals required less elaborate staffs than general hospitals.61 In the winter of 1944, as he planned to meet higher bed requirements which his Office had estimated for 1945, The Surgeon General proposed to use other station hospitals-those located at staging areas and operated by the Chief of Transportation-to free some general hospitals of debarkation work and to provide additional debarkation beds that would be needed for the anticipated load of casualties.62 A survey made by the Inspector General's Office had already shown that staging area hospitals were being used only slightly, since few troops were being moved overseas.63 The Chief of Transportation agreed to convert hospitals in the staging areas of the ports of Boston (Camp Myles Standish), New York (Camp Kilmer and Camp Shanks), and Hampton Roads (Camp Patrick Henry) into debarkation hospitals.64 This action made it

57(1) Memo, Lt Col John C. Fitzpatrick, MRO, for Col A. H. Schwichtenberg, Hosp Div SGO, 23 May 44. TC: 370.05. (2) Memo, Same for Chief Oprs Serv SGO, 1 Sep 44, sub: Rpt of Visit to San Francisco. HD: 705 (MRO, Fitzpatrick Stayback). (3) Memo, Lt Col Basil C. MacLean for Brig Gen R. W. Bliss, Chief Oprs Serv SGO thru Col A. H. Schwichtenberg, Dir Hosp Admin Div, 2 Feb 44, sub: The More Efficient Util of Army Hosp Fac. Off file, Gen Bliss' Off SGO, "Util of Army Hosp Fac." 
58Classification of Med Instls, Tab B to SGs Plan for the Util of Med Off Pers in ZI, 29 Feb 44. HD: 322.051-1.
59WD Cir 140, 11 Apr 44.
60An Rpts, 1944, Stark, Halloran, and Letterman Gen Hosps. HD.
61(1) Memo, Dep SG for CG ASF, 1 Jun 44, sub: Util of Comd Fac: Designation of Cp Edwards a Gen Hosp. Off file, Gen Bliss' Off SGO, "Util of Army Hosp Fac." (2) Ltr, CG 1st SvC to CG ASF attn SG, 7 Jun 44, sub: Instls for Debarkation Hosp. SG: 322.15-1. (3) An Rpt, 1944, Cp Edwards Sta Hosp. HD.
62Memo, SG for Act Dir Plans and Oprs ASF, 8 Jan 45, sub: Gen Hosp Program, ZI. SG: 323.3. 
63Memo, Act IG for DepCofSA, 28 Dec 44, sub: Hosp Fac in ZI. HRS: OCS 632 (25 Sep 44) Case No 28, "Hosp Fac in ZI."
64(1) 1st ind SPTOM 632, CofT to SG, 17 Jan 45, on Memo, SG for Med Liaison Off, OCofT, 9 Jan 45. SG: 632. (2) Diary, Lt Col H. A. Huncilman, Planning Div ASF, 25, 27, and 29 Jan 45. HRS: Hq ASF Planning Div file, 700 "ZI Hosps." (3) Diary, Hosp Div SGO, 31 Jan 45. HD: 024.7-3.


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TABLE 12-ASF DEBARKATION HOSPITALS

Port and Hospital

October 1944

March 1945

June 1945

August 1945

Total Beds

Dbktn Beds

Gen Hosp Beds

Total Beds

Dbktn Beds

Gen Hosp Beds

Total Beds

Dbktn Beds

Gen Hosp Beds

Total Beds

Dbktn Beds

Gen Hosp Beds

Boston

Edwards

2,128

2,128

0

a3,200

800

2,400

2,950

900

2,050

(b)

---

---

Boston POE

---

---

---

1,700

1,700

0

1,700

1,700

0

---

---

---

New York

Halloran

4,134

2,799

1,335

5,350

2,700

2,650

5,350

2,700

2,650

5,350

2,700

2,650

Kilmer

---

---

---

2,000

2,000

0

2,000

2,000

0

2,000

2,000

0

Shanks

---

---

---

2,300

2,300

0

2,300

2,300

0

---

---

---

Mason

---

---

---

3,032

1,000

2,032

2,532

500

2,032

3,032

500

2,532

Hampton Roads

McGuire

1,777

1,577

200

---

---

---

---

---

---

---

---

---

Patrick Henry

---

---

---

1,100

1,100

0

1,100

1,100

0

---

---

---

Charleston

Stark

2,400

2,162

238

2,400

2,125

275

2,400

2,125

275

2,400

2,125

275

New Orleans

LaGarde

926

150

776

1,176

0

1,176

1,300

0

1,300

---

---

---

Los Angeles

Birmingham

1,727

717

1,010

1,777

800

977

---

---

---

---

---

---

Camp Haan

---

---

---

---

---

---

800

800

0

800

800

0

San Francisco

Letterman

2,338

2,000

338

3,500

3,140

360

3,500

3,140

360

3,500

3,140

360

Seattle

Madigan

3,880

500

3,380

4,300

1,000

3,300

4,300

1,000

3,300

4,380

1,000

3,380

Total

19,310

12,033

7,277

31,835

18,665

13,170

30,232

18,265

11,967

21,462

12,265

9,197

All Sta Hosps Used for Debarkation purposes

2,128

2,128

0

7,100

7,100

0

7,900

7,900

0

2,800

2,800

0

All Gen Hosps Used for Debarkation purposes

17,182

9,905

7,277

24,735

11,565

13,170

22,332

10,365

11,967

18,662

9,465

9,197

aCamp Edwards Station Hospital was designated a General Hospital in February 1945.
bIn this table no figures are listed for beds in hospitals at the times when those hospitals were not being used for debarkation purposes.

Sources: (1) Memo SPMCH, SG for WDMB, 4 Oct 44, sub: Debarkation Hosp. SG: 322 Hosp. (2) Weekly Hosp Rpts, vol. II, No. 13, 30 Mar 45; No. 25, 22 Jun 45; and No. 35, 31 Aug 45.

unnecessary to devote more space in Halloran General Hospital to debarkation work and made it possible to free all of McGuire General Hospital and the Camp Edwards Station Hospital, which was converted into a general hospital, for specialized medical and surgical treatment. (Table 12) Later in 1945 the Camp Haan Regional Hospital took over from Birmingham General Hospital the processing of patients debarked at Los Angeles.65 Thus, the Surgeon General's Office tried gradually to limit the practice of using general hospital facilities for debarkation work.

As the evacuation of patients by air increased during 1944 and 1945 the Air Forces selected certain station and regional hospitals located near important landing fields to receive and process patients

65(1) Memo, Dir Resources Anal Div SGO for Maj [James J.] Souder, 22 Mar 45, sub: Debarkation Beds. HD: Resources Anal Div file, "Hosp." (2) Diary, Hosp Div SGO, 7 and 11 Apr 45. HD: 024.7-3. (3) Memo, CG ASF for CofEngrs, 11 Apr 45, sub: Pnt Unloading Fac, Cp Haan Hosp. SG: 322 "Hosp."


194

brought to them. By October 1944 beds were set aside in eleven AAF hospitals for this purpose.66 Six were used for debarking patients in emergencies only. The other five, located at Mitchel Field (New York), Coral Gables (Florida), Hamilton Field (California), Great Falls (Montana), and Portland (Oregon), were devoted almost exclusively to processing patients evacuated by air.67 In the late spring of 1945 the Air Forces, with the concurrence of The Surgeon General, planned to establish a new type of zone of interior installation, called a holding facility, at the Fairfield-Suisun Field (California). It was designed to perform only one function-the processing of patients who were in transit to other hospitals for definitive treatment.68 Although the war ended before it was constructed, its approval represented a further development in the movement toward the use of less elaborate facilities than general hospitals for debarkation purposes.

Extension of the Practice of Establishing Specialized Centers

Extension and further development of the practice of establishing centers for specialized treatment in general hospitals constituted another adjustment in the hospital system during the later war years. Until the middle of 1944 specialty centers in general hospitals took up only a small proportion of their total beds and were established piecemeal to meet needs as they arose, without regard to eventual requirements for beds for specialized treatment. This situation came about because an army in training needed less specialized care than one in combat, because it was difficult to predict types and amount of specialized treatment that would be needed, and because hospitals themselves opened successively rather than all together. By the time of the invasion of Europe, the peak patient load had been estimated and the last of the general hospitals, with the exception of four temporary ones authorized in 1945, were about to begin operation. Enough experience in hospital admissions had accumulated to permit a breakdown of the anticipated patient load in terms of types of wounds, diseases, and injuries. Furthermore, an increasing shortage of specialists made their concentration for maximum use more imperative than ever. Thus, whatever the need for a thoroughgoing program earlier, it became more important and easier to formulate one by the middle of 1944. Therefore, in the summer of that year The Surgeon General's Facilities Utilization Branch collaborated with his professional consultants in a study of the need for specialized centers and in the preparation of a comprehensive plan to meet it.69

The general features of this plan, announced in a War Department circular in August 1944, remained unchanged through the remainder of the war. Related

66AAF Debarkation Hosp, incl to Memo, SG for WDMB, 4 Oct 44, sub: Debarkation Hosp. SG: 322 "Hosp."
67Memo, Act IG for DepCofSA, 28 Dec 44, sub; Hosp Fac in ZI. HRS: OCS 632 (25 Sep 44) Case No 28, "Hosp Fac in ZI."
68(1) S/S, CG AAF to ACofS G-4 WDGS, CofSA, and SecWar, 27 Apr 45, sub: Debarkation Hosp, Fairfield-Suisun Army Air Fld. (2) DF WDGDS 12801, ACofS G-4 WDGS to CofSA, 10 May 45, same sub. (3) Ltr, SecWar to Brig Gen Frank T. Hines, Chairman Fed Bd Hosp, 15 May 45. All in HRS: OCS 632.
69(1) Ltr, SG to CG 4th SvC attn SvC Surg, 14 Jun 44, sub: Specialized Gen Hosp. SG: 323.7-5 (4th SvC)AA. Similar letters were sent to the rest of the service commands. (2) Plan for Specialized Hosp, by [Dr.] Eli Ginzberg, Spec Asst to Dir Hosp Div SGO, 27 Jul 44. HD: Resources Anal Div file, "Hosp." (3) ASF Monthly Progress Rpt, Sec 7, Health, 31 Jul 44, pp. 29-31.


195

specialties were grouped in the same hospital to improve the quality of professional care. For example, neurosurgical and neurologic centers were established together, and centers for general medicine were set up in hospitals specializing in the treatment of arthritis, tuberculosis, and rheumatic fever. Attempts were made to locate specialty centers in relation to population density, to permit compliance as far as possible with the policy of hospitalizing patients near their homes. Success in such attempts was limited by at least two factors: (1) there were proportionately fewer general hospitals in densely populated areas such as the Northeast than there were in the South and Southwest, where they had been located initially to serve large concentrations of troops in training, and (2) it was either possible or desirable to establish only a limited number of centers-in some instances as few as two-in certain specialties such as tuberculosis, arthritis, and treatment of the blind.

The size of centers increased as the patient load grew. Although professional consultants of the Surgeon General's Office believed that they should be kept reasonably small, the Facilities Utilization Branch considered it more economical of personnel, particularly specialists, to limit the number but increase the size of centers. In the fall of 1944, for example, amputation centers were increased from 500 to 750 beds each and neurosurgical centers from 250 to 500. Subsequently, to care for the peak patient load, capacities were further increased, some centers having 2,000 or more beds.

Centers for additional specialties were established to meet new needs and achieve fuller use of specialists of all kinds. For example, patients suffering from tropical diseases and trench foot became so numerous as to warrant the designation of centers for the treatment of those conditions, and a shortage of internists prompted the establishment of general medicine as a specialty. General and orthopedic surgery also became specialties as the field of surgery was narrowed by the establishment of centers for various surgical specialties. As a result, the major portion of beds in general hospitals was gradually given over to specialized treatment, and general hospitals became in effect specialized hospitals. By the time the peak patient load was reached in June 1945, there were 234 centers for 21 specialties with a total of 132,178 beds in 65 general hospitals in the United States.70

General Hospitals for Prisoners of War

A further change in the hospital system resulted from the capture by American forces of large numbers of prisoners of war. For German and Italian prisoners who became sick or were injured while in internment camps in this country, the system of hospitalization formerly established was changed only slightly during the latter half of the war. Such prisoners continued to be treated in station hospitals located either in internment camps or on near-by Army posts and, when they needed a higher type of care, in general

70(1) See last note above. (2) WD Cir 347, 25 Aug 44. (3) ASF Cir 284, 30 Aug 44. (4) Ltr SPMCH 323.3 (7th SvC)AA, SG to CG 7th SvC attn Surg, 10 Aug 44, sub: Specialized Gen Hosps. HD: Resources Anal Div file, "Hosp." (5) Tab B to Memo, Dir Hosp Div and Dir Resources Anal Div for Dir HD SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. (6) Table entitled "Authorized Patient Capacities in General Hospitals by Specialty as of 30 June 1945," prepared by Resources Analysis Division, 30 June 1945. Off file, Resources Analysis Div, SGO.


196

hospitals operated for U. S. Army patients. All Japanese prisoners were concentrated, since they were few in number, in the station hospital at Camp McCoy, Wis.71

In the second half of 1943 the offices of The Surgeon General and The Provost Marshal General collaborated in establishing procedures for the reception, examination, and transportation of a new category of prisoners -those evacuated as patients from theaters of operations.72 Early the next year they restated these procedures and designated five general hospitals located near ports to receive and sort such patients and to transfer them to other hospitals for further treatment. At the same time, they specified certain general hospitals for the care of tuberculous, insane, blind, and deaf prisoners; and, in order to simplify the observance of security and administrative regulations, they adopted a practice of concentrating all prisoners who needed general-hospital-type care-those evacuated as patients from theaters of operations as well as those transferred from internment camps-in one general hospital if possible, and in not more than three in any instance, in each service command.73 These steps did not solve all problems. Some general hospitals continued to be inadequately prepared to carry out security measures; and even though prisoners were concentrated more than formerly, they were still scattered among hospitals in nine service commands. Such dispersal made difficult the work of a commission charged with determining the eligibility of some prisoners for repatriation as well as that of a group responsible for certifying others for "protected status" as medical personnel, under the terms of the Geneva Convention.74

In anticipation of an influx of prisoner-of-war patients after the invasion of Europe and in the hope of solving some of the administrative problems caused by the existing system of hospitalization, The Surgeon General's liaison officer with The Provost Marshal General proposed in July 1944 that at least one general hospital be devoted exclusively to German prisoners of war. It could be used to sort incoming patients, to treat those needing general-hospital-type care, to process those eligible for repatriation, and to hold others awaiting certification as protected personnel.75 His superior, the Deputy Chief for Hospitals and Domestic Operations, adopted this idea and announced on 21 July 1944 that The Surgeon General was designating Glennan General Hospital as a German prisoner-of-war general hospital.76  

Two months later The Surgeon General asked for an entire Army post for use as a second hospital of this type. Because of

71(1) WD Cirs 235, 12 Jun 44, and 347, 25 Aug 44. (2) PW Cirs 18, 29 Mar 44; 20, 7 Apr 44; and 38, 15 Jul 44. Off file, PW Off, OPMC. (3) TWX, PMG to CG each SvC, 4 Jan 45, in An Rpt, FY 1945, PW Liaison Unit SGO. HD. (4) Diary, Hosp Div SGO, 7 Oct 44. HD: 024.7-3. (5) Hosp, Evac, and Disposition of PW Pnts in US, by Lt Col James T. McGibony, MC. HD: 383.6.
72WD Cir 214, 15 Sep 43.
73PW Cir 11, 8 Feb 44. Off file, PW Off, OPMG. 
74(1) Memo SPMGA 383.6 (59), Maj Rene H. Juchli for Act Dir PW Div OPMG, 23 Feb 44, sub: Rpt of Second Repatriation of German PW. (2) Memo SPMGA 383.6 (59), same for Asst PMG, 10 Apr 44, sub: Immed Designation of Cp for Reception of Protected Pers and Repatriable PW. (3) Ltr, same to PMG, 13 May 44, sub: Rpt of Third Repatriation Move, German PW. (4) Ltr, same to Dir Hosp Admin Div SGO, 13 Aug 44, sub: Rpt of Handling PW as Observed at NYPE and Halloran Gen Hosp. All in HD: 319.1-2.
75Memo, Chief PW Liaison Unit SGO for SG attn Col A. H. Schwichtenberg, 17 Jul 44, sub: Reception, Hosp, Treatment, and Disposition of Pnts among PW and Protected Pers. HD: 319.1-2.
76Memo, Dep Chief for Hosp and Dom Oprs SGO for PMG, 21 Jul 44, sub: Hosp Fac for PW. HD: Resources Anal Div file, "Hosp."


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pressure at this time to reduce the number of beds in hospitals in the United States, ASF headquarters suggested the use of vacant beds in existing hospitals instead. The Surgeon General objected to this proposal, averring that all existing general hospital beds-according to his estimates-would be needed by the end of the year for American patients, that the treatment of prisoner-of-war patients who needed general-hospital-type care in station hospitals would violate the terms of the Geneva Convention, and that the dispersion of prisoner-patients among many regional and station hospitals was wasteful of both medical and police personnel. Early in October, therefore, ASF headquarters and G-4 approved the designation of the station hospital at Camp Forrest (Tennessee) as Prisoner of War General Hospital No. 2.77 The establishment of a third prisoner-of-war general hospital was made unnecessary by a change in policy. At the end of October 1944 the Chief of Staff directed the European theater not to transfer prisoner-of-war patients to the United States except rabid Nazis and those desired for questioning for intelligence purposes.78 After V-E Day, the repatriation of prisoners made it possible to return Glennan General Hospital to the treatment of Americans in June 1945, to discontinue the general hospital at Camp Forrest in December 1945, and to close that camp itself in April 1946.79

The operation of two general hospitals devoted exclusively to the care of prisoner-of-war patients simplified administrative and security problems and ultimately saved American medical personnel. Prisoner-patients arriving at ports in this country were transferred to either Glennan or Camp Forrest. There they were sorted into three groups. Those who were convalescent were transferred to convalescent annexes; those requiring care for only minor ills or injuries were sent to near-by prisoner-of-war station hospitals; and those requiring more specialized treatment were kept at one of the prisoner-of-war general hospitals. In addition, prisoners who were eligible for repatriation or for certification as protected personnel were held in special facilities at these hospitals. After their eligibility had been verified, the former were returned to Germany and the latter were assigned to the staffs of prisoner-of-war hospitals to care for their compatriots.80 For a time, prisoner-of- war general hospitals had duplicate staffs of American and German personnel. In January 1945 the chief of The Surgeon General's Prisoner of War Liaison Unit reported that the German staffs of such hospitals were requesting repatriation because they were given little opportunity to do actual medical and surgical work. He recommended the removal of all American medical personnel except the minimum required for key supervisory positions. The next month the Surgeon General's Office issued directives

77(1) Memo, SG for CG ASF, 13 Sep 44, sub: Add Hosp Fac for PW Pnts. SG: 383.6. (2) Memo, SG for CofS ASF, 4 Oct 44, sub: Hosp Fac for German PW Pnts. SG: 322 "Hosp." (3) Diary, Hosp Div SGO, 6 Oct 44. HD: 024.7-3.
78(1) Rad CM-OUT-53129, Marshall to Eisenhower, 27 Oct 44. SG: 383.6. (2) Memo SPMOC 383.6 (30 Oct 44), CG ASF for SG, n d, sub: Hosp Fac for German PW Pnts. Same file.
79(1) Diary, Hosp Admin Br Hosp Div SGO, 8 May 45. HD: 024.7-3. (2) Diary, PW Liaison Unit SGO, 24 May 45. Same file. (3) Hosp, Evac, and Disposition of PW Pnts in the US, by Col McGibony, MC. HD: 383.6.
80(1) Diary, Hosp Div SGO, 7 Oct 44. HD: 024.7-3. (2) Memo, Chief Med Liaison Br for Asst PMG, 27 Jan 45, sub: Study of Enemy Repatriation. HD: 319.1-2. (3) Ltr, Chief PW Med Liaison Unit SGO to SG and PMG, 7 Apr 45, sub: Rpt of Visit to PW Gen Hosp No 2, Cp Forrest, Tenn. Same file.


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to require compliance with this recommendation.81

Establishment of Hospital Centers

A final change in the hospital system was the establishment of hospital centers. During 1944 convalescent hospitals were opened in several instances on the same posts as general hospitals. With the expansions of 1945 these hospitals grew beyond all previous expectations. For example, by April 1945 the Percy Jones General and Convalescent Hospitals, with their annexes, had a strength, including both patients and operating personnel, of more than 16,500. This was greater than that of an infantry division. These installations occupied not only the Percy Jones General Hospital building, located in Battle Creek, Mich., but also almost all of Fort Custer, which was situated near by. In most instances such installations operated under separate commanders. Each had its own administrative organization for activities such as receiving and disposing of patients; feeding, clothing, and paying both patients and operating personnel; and handling mail, personnel records, and legal problems. Each exercised administrative control over its own patients, requiring the transfer of records and a change of command every time a patient was transferred from one to the other.82

Early in 1945, the chief of the Surgeon General's Operations Service decided that combination of such installations under a hospital center commander would simplify the administration of supply and service activities and would permit the transfer of patients between adjacent general and convalescent hospitals without red tape. This had proved to be true when hospital centers were established overseas. Meanwhile, the Percy Jones General Hospital had already begun to centralize under a single head each activity common to both hospitals. Therefore the Operations Service sent representatives to observe its organization and operations, and to discuss with its commander plans for establishing hospital centers. These representatives found merit in such centralization, and the Surgeon General's Office decided to apply it to other installations.83

In establishing hospital centers the Medical Department encountered several difficulties. There was opposition in the General Staff, because G-3 feared that additional personnel would be requested to man hospital center headquarters.84 The Surgeon General's Office believed that the integration of activities common to both general and convalescent hospitals under a single command would actually save personnel and therefore agreed to a condition imposed by the General Staff in approving hospital centers. Personnel for center headquarters would be a part of, and not an addition to, that already provided for general and convalescent hospitals.85 On 11 April 1945 the War Depart-

81(1) Memo SPMGO(4)383.6, Chief Med Liaison Br SGO for Dep Chief Hosp and Dom Oprs SGO, 8 Jan 45, sub: Util of Enemy Protected Pers. HD: 319.1-2. (2) Rad, Lull (SGO) to CGs 4th, 7th, 8th, and 9th SvCs, 5 Feb 45. HD: 319.1-2. (3) An Rpt, FY 1945, Hosp and Dom Oprs SGO. HD.
82An Rpts, 1945, Percy Jones, Wakeman, and Cps Butner and Carson Conv Ctrs. HD.
83Interv, MD Historian with Col McGibony, MC, 20 Feb 50. HD: 000.71.
84Diary, Hosp Div SGO, 31 Mar and 2 Apr 45. HD: 024.7-3.
85(1) WD AGO Form No 026, Request and Justification for Publication, prepared by SGO, 24 Feb 45, sub: Hosp Ctr (ZI). (2) Memo SPMCH 300.5 (WD Cir), SG for TAG thru CG ASF, 6 Mar 45, sub: Proposed Amendment to WD Cir 140, 1944. (3) Memo, SG for ACofS G-4 WDGS, 31 Mar 45, same sub. (4) DF WDGDS 11065, ACofS G-4 WDGS to TAG, 2 Apr 45, same sub. All in AG: 705 (4-3-44) (1). (5) WD Cir 105, 4 Apr 45.


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ment announced that nine hospital centers, each composed of a general and a convalescent hospital, would be established at Camp Pickett, Va.; Camp Butner, N. C.; Camp Edwards, Mass.; Camp Carson, Colo.; Camp Atterbury, Ind.; Fort Custer, Mich.; Fort Sam Houston, Tex.; Fort Lewis, Wash.; and Camp Forrest, Tenn.86 Local commanders then ran into problems in consolidating and reorganizing general and convalescent hospitals into hospital centers. Lacking authoritative standard guides, center commanders proceeded according to their own ideas or the demands of the local situation to set up organizations, establish administrative procedures, and work out relationships with subordinate components, on the one hand, and with post headquarters, on the other.87

Despite these difficulties the establishment and operation of hospital centers proved advantageous. The administration of supply and service activities by center headquarters freed hospital commanders of administrative detail, saved personnel, and avoided duplication of effort in those fields. Centralization also made it easy to shift personnel between hospitals as it was needed. Finally, the operation of a single registrar's office for both general and convalescent hospitals made it possible to move patients from one to the other by simple inter-ward transfers, rather than by the complicated procedures required when they were moved between separate installations.88

The establishment of hospital centers represented the last of a succession of adjustments in the hospital system during the war. While most of them were prompted primarily by the necessity of using limited resources effectively, other considerations entered in. For example regional hospitals developed partially from attempts of the Air Forces to establish a completely separate medical service while convalescent hospitals received an additional impetus from a belief that convalescent patients could best be restored to physical condition for full duty or prepared for return to civilian life in an installation with a nonhospital atmosphere. Some of the changes made in the latter part of the war, such as specialization in general hospitals, had their origins earlier and were designed to improve the quality of hospital care. Others, such as the merger of adjacent station and general hospitals and the establishment of hospital centers, were expected to improve administration. Since most of the changes were the result of wartime demands, when peace came the need for them no longer existed and the hospital system in the United States reverted to its prewar form.

86WD Cir 115, 11 Apr 45.
87(1) An Rpt, FY 1945, Percy Jones Hosp Ctr; and An Rpt, FY 1945, Hosp and Dom Oprs SGO. HD. (2) Edward J. Morgan and Donald O. Wagner, The Organization of the Medical Department in the Zone of the Interior (1946), pp. 162-64. HD.
88An Rpts, 1945, Percy Jones, Wakeman, and Cps Carson and Butner Hosp Ctrs; and An Rpt, FY 1945, Hosp and Dom Oprs SGO. HD.

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