Contents

CHAPTER XI

Bed Requirements in the Zone of Interior

While most changes in the hospital system, discussed in the foregoing chapter, were expected to conserve medical resources, especially physicians, they obviously were not expected to reduce the total number of beds that would be needed. In some instances, such changes actually tended to increase bed requirements, for policies making it impossible to place patients of a particular type in any available vacant bed occasionally required the provision of more beds than otherwise needed. Under current policies, for example, vacant beds in regional hospitals could not be used for overseas patients to reduce the number of additional beds required in general hospitals. Also, vacant beds in station hospitals could not be used for prisoner-of-war patients requiring general-hospital-type care to avoid the establishment of special prisoner-of-war general hospitals. Furthermore, the practice of providing different types of hospitals for different types of patients complicated the calculation of requirements, since beds needed for different groups had to be estimated separately. Another factor which increased the difficulty of estimating bed requirements was the transition from the defensive to the offensive phase of the war. Because of uncertainty about the tempo and scope of combat operations and about the kind of warfare to be encountered it was always more difficult to predict numbers of combat casualties than numbers of patients resulting from the normal incidence of diseases and accidental injuries. Nevertheless, estimates had to be made and it was important to make them as accurate as possible. Failure to have enough beds at any particular moment would not only subject The Surgeon General and the Army to severe criticism but would also jeopardize the treatment of American casualties. To have more beds than were needed would waste personnel and might mean, in the face of the ceiling imposed upon Medical Corps officers, inadequate manning of the hospitals provided. The Surgeon General's Office, ASF headquarters, the General Staff, and other agencies of the Government participated in determining bed requirements, and differences of opinion that arose among them illustrated the complexity of the process.

Despite the restrictive personnel situation in the fall of 1943, The Surgeon General's Hospital Division continued to consider the problem of meeting bed requirements primarily in terms of construction. Following the former practice of figuring bed requirements on the basis of World War I experience, it estimated that the number of required station hospital beds would decrease from about 256,000 in December 1943 to about 80,000 in December 1945, but that the number of beds needed in general hospitals would increase

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from about 98,500 to over 122,000 in the same period.¹ To meet the anticipated need for general hospital beds, The Surgeon General in September 1943 requested ASF headquarters to earmark and retain funds that had been appropriated but not used for the construction of approximately fifteen additional general hospitals. The latter refused, insisting that any additional general hospital beds that would be needed could be established without further construction in station hospital buildings that would become surplus as troops moved overseas.²

First Attempt To Base Requirements on an Estimate of the Patient Load

Late in 1943 the prospect of the invasion of Europe, along with limited amounts of available personnel, and uncertainty about the patient load, necessitated a more realistic appraisal of requirements and resources than any formerly made. The Surgeon General borrowed personnel from ASF headquarters, it will be recalled, to establish a special group in his Office for this purpose. In the winter of 1943-44 this group, later known as the Facilities Utilization Branch, attempted to predict the size of the patient load throughout the world during 1944.³ It admitted that it was "up against the difficulty of working with figures that had little firmness,"⁴ and its calculations rested upon a series of estimates: the number of troops to be engaged in combat; the rate at which troops in theaters would suffer wounds, accidental injuries, and diseases; and the proportion of patients in theaters that would be evacuated to the United States. 

Some of the estimates were based on current World War II information while others rested primarily upon World War I experience. Projected troop strengths for theaters were known, but the proportion of troops to be engaged in combat had to be estimated. Records were available to show the rate at which disease and nonbattle injuries occurred, but information about World War II battle-injury rates was meager. To estimate these rates the experience of the Meuse-Argonne fighting in World War I was combined with that of the Tunisian campaign (1943), Tarawa operation (1943), and the German campaign in Russia (1941). Information about the German campaign, incidentally, was found in a study prepared by the Office of Strategic Services. The proportion of overseas patients who would be evacuated to the United States was estimated on the basis of World War I experience, "reinforced by the derived estimate of the German experience in the Russian campaign." This estimate-30 percent of estimated battle casualties and 3 percent of estimated disease and nonbattle-injury cases-differed only slightly from figures for World War I. These estimates were used to calculate the number of patients who would need beds in theaters of operations as well as the number who would be evacuated to the United States. To arrive at the number of patients from the zone of interior who

¹(1) Memo, SG (Hosp Cons Br) for CofEngrs, 24 Aug 43, sub: Review of Est for FY 1944. SG: 632.-2. (2) Ltr, SG (Hosp Cons Br) to CofEngrs, 18 Nov 43, sub: MD Cons Reqmts for FY 1945. SG: 632.-1. (3) 1st ind, SG (Hosp Cons Br) to CofEngrs, 24 Jan 44, on Ltr, CofEngrs to SG, 18 Jan 44, sub: Engr . . . Estimates, FY 1945. SG: 632.-1.
²Ltr, SG to CG ASF, 2 Sep 43, sub: Retention of Appropriated Funds for Gen Hosp Cons, with 1st ind, Reqmts Div ASF to SG, 19 Sep 43. SG: 632.-1.
³(1) An Rpt, FY 1944, Dep Chief Hosp and Dom Oprs SGO. HD. (2) Tab A, sub: Estab of a Statistical Management Unit in the Oprs Serv, to Memo, Dir Hosp Div SGO and Dir Resources Anal Div SGO for Dir HD SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. (3) Ltr, [Dr.] Eli Ginzberg to Col Calvin H. Goddard, 2 Jan 52. HD: 314 (Correspondence on MS)V.
⁴Hosp and Evac: A Re-estimate of the Pnt Load and Fac, Feb 44, Introduction, p. 1. HD: 705.-1.

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would need beds in general hospitals, recent experience in transfers from station hospitals (0.5 percent of the troop population) was applied to the projected strength for 1944.

From the calculations and interpretations of this study the Surgeon General's Office estimated that 140,000 beds would be required during 1944 to accommodate patients evacuated from theaters of operations and transferred from zone of interior hospitals. Such patients would normally have been provided for in general hospitals, but on this occasion The Surgeon General did not ask for an increase in general hospital beds to 140,000 or even to the 115,000 which, according to his previous calculations on the old percentage basis, would be needed by the end of 1944. Instead, in view of the limited number of physicians available and the fact that about 75 percent of the patients in general hospitals were convalescent, he accepted the existing authorization of 100,000 general hospital beds and proposed in February 1944 that an additional 40,000 beds be provided in convalescent "facilities." Such facilities could be operated either as annexes of general hospitals or as separate installations and would require lower ratios of personnel (especially physicians) to patients than did general hospitals.⁵

Suspecting that The Surgeon General's figures were too high, ASF headquarters made a thoroughgoing study of its own. Its Planning Division conferred with representatives of the Surgeon General's Office, the Office of the Chief of Transportation, and other interested staff divisions of ASF headquarters. It also communicated with the chief surgeons of the European and North African theaters. Different agencies, using battle-casualty admission rates that varied widely, arrived nonetheless at similar estimates of the patient load, particularly for the first ninety days of operations on the European continent.⁶ In March 1944, therefore, ASF headquarters for the most part approved The Surgeon General's recommendation. It authorized the conversion of vacant barracks to provide 25,000 beds for convalescent patients and agreed to earmark space for 25,000 more if needed.⁷ The Surgeon General then began to establish convalescent facilities thus authorized but ASF headquarters apparently did not seek approval of the General Staff (G-4) for the expansion. As a result the Medical Department failed to get adequate personnel and equipment for the facilities that were established until the approval of G-4 was finally obtained in the fall of 1944.

Movement To Reduce the Number of Hospital Beds in the United States

During the spring and summer of 1944 other problems, such as changes in the hospital system and the provision of medical support for theaters of operations,⁸ demanded more attention than zone of

⁵The above two paragraphs are based on the following: (1) Hosp and Evac: A Re-estimate of the Pnt Load and Fac, Feb 44. HD: 705.-1. (2) Memo, SG for Dir Plans and Oprs ASF, 22 Feb 44, sub: Hosp and Evac. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3." (3) Ltr, Eli Ginzberg to Col Calvin H. Goddard, 2 Jan 52, HD: 314 (Correspondence on MS)V.
⁶(1) Memo, Dir Plans and Oprs ASF for Dir Planning Div ASF, 28 Feb 44, sub: Hosp and Evac. HRS: Hq ASF Gen Lutes' files, "Hosp and Evac, 1943-46." (2) Memo, Dir Planning Div ASF for Dir Plans and Oprs ASF, 1 Mar 44, sub: Hosp and Evac. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3." (3) Memo, Dir Planning Div ASF for Chief ZI Br Planning Div ASF, 2 Mar 44, same sub. Same file. (4) Hosp and Evac: An Anal, Mar 44. HRS: Hq ASF Planning Div Program Br file.
⁷Memo, CofS ASF for Dir Plans and Oprs ASF, 28 Mar 44, sub: Conf on Hosp and Evac. HRS: ASF Planning Div Program Br file, "Hosp and Evac, vol. 3."
⁸See above, pp. 181-99, and below, pp. 214-37.

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interior bed requirements, but gradually a tendency developed among many agencies to question the need for all of the beds previously authorized. By the fall of 1944 this tendency developed into a general movement to reduce their number.

The demand to reduce the number of beds in zone of interior hospitals arose at first from observation of the low rate of occupancy. Statistics published by the Surgeon General's Office showed that only about half of the beds in all hospitals in the United States were used during most of 1944.⁹ (Chart 8.) Furthermore, optimism about an early end of the war made it seem unlikely to officers in ASF headquarters and the General Staff that the occupancy rate would increase appreciably.¹⁰ Meanwhile various expedients were being used to supply theaters with their quotas of beds, among them the shipment of hospital units without full complements of professional personnel.¹¹ The Deputy Chief of Staff expressed the opinion that this practice would be unnecessary if medical personnel and facilities were properly used. He therefore directed The Inspector General in September 1944 to investigate duplication of hospitalization in the United States.¹² By that time ASF headquarters, the War Department Manpower Board, and divisions of the General Staff had already begun to make their own estimates of bed requirements in the zone of interior.

A reduction in the authorized ratio of station hospital beds had been made several days before the Deputy Chief of Staff criticized the use of medical resources. As early as May 1944, in the course of discussions with the General Staff about nurse requirements, The Surgeon General's Facilities Utilization Branch had informally proposed a reduction from 4 to 3.6 percent of troop strength.¹³ The General Staff accepted this suggestion immediately, but it was not until 20 September 1944 that a new ratio of 3.5 percent-formally proposed by The Surgeon General in August-was established by War Department directive.¹⁴ The same directive, however, authorized for the first time a ratio for regional hospital beds: 0.5 percent of troop strength. Formerly used to estimate the number of beds in general hospitals needed to care for zone of interior patients transferred from station hospitals, this figure was adopted because such patients were eventually to be transferred to regional instead of general hospitals. Since no corresponding reduction was made in the number of beds authorized for general hospitals it is difficult to see that the reduction in the station hospital bed ratio meant any reduction in the total number of beds authorized. In any event, this action must have seemed to authorities higher than The Surgeon General as only a step in the right direction.

The ASF Director of Plans and Operations proposed a reduction in the number

⁹(1) Weekly Health Rpts, vol. IV, Nos 1-39, 1944. AML. (2) ASF Monthly Progress Rpts, Sec 7, Health, Mar-Aug 44.
¹⁰(1) Remarks by Col Albert H. Schwichtenberg, MC, in Notes on Conf of AAF Comd Surgs, Off of Air Surg, 16-20 Apr 45. SG: 337. (2) Interv, MD Historian with Lt Col James T. McGibony, MC, 20 Feb 50. HD: 000.71.
¹¹See below, pp. 218-28.
¹²(1) Mins, Mtg of Gen Council, 25 Sep 44. HRS: AGO Reference Collection. (2) Memo WDCSA 632 (25 Sep 44), DepCofSA for IG, 25 Sep 44, sub: Hosp Fac in ZI. HRS: WDCSA 632 (25 Sep 44), Case 28, "Hosp Fac in ZI."
¹³Memo SPMCH 211 Nurses, Eli Ginzberg for Maj Armour, G-3 WDGS, 25 May 44, sub: Almt of Nurses. HRS: G-3 files, 210-219 incl, "vol. II."
¹⁴(1) DF, Dep ACofS G-3 WDGS to WDMB, G-1 and G-4, 10 Jun 44, sub: Almt of Nurses. HRS: G-3 files, 210-219 incl, "vol. II." (2) Memo, SG (init E. G[inzberg]) for ACofS G-3 and G-4 WDGS thru CG ASF, 29 Aug 44. SG: 632.2. (3) Memo WDGCT 211 (26 May 44), Dep ACofS G-3 WDGS for CG ASF, 18 Sep 44, sub: Almt of Nurses. Same file. (4) AR 40-1080, C 3, 20 Sep 44.

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CHART 8-HOSPITAL BEDS AUTHORIZED AND OCCUPIED BY TYPE OF HOSPITAL IN CONTINENTAL UNITED STATES 1943 AND 1944

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of beds in all hospitals on 4 September 1944. Pointing to the low occupancy rate, to the expectation that regional hospitals would relieve general hospitals of zone of interior patients, and to the fact that battle casualties and their evacuation from overseas had been less than estimated, he called upon The Surgeon General to analyze the entire hospital program with a view to reducing the number of beds in station and regional hospitals by 25 percent and in general hospitals to 80,000.¹⁵ To effect this reduction would have meant closing from twelve to twenty general hospitals-a proposal made verbally by the War Department Manpower Board during the same month.¹⁶

The Surgeon General agreed that too many station hospital beds had been provided, but he pointed out that he had already begun to reduce their number. In opposing other reductions he emphasized future possibilities. He called attention to the tendency of sick rates and hospital occupancy to be higher in winter than in summer, to the likelihood of heavier battle casualties, to the prolongation of the war beyond what had been expected, to the expectation that patients from overseas would need longer periods of hospitalization in the United States than anticipated, and to the prospect that more beds would be needed in all types of zone of interior hospitals when the war in Europe ended and redeployment to the Pacific began. He also pointed out that the transfer of patients from Europe and North Africa had hardly begun because of the European theater's opposition to evacuating patients in troop transports and North Africa's lack of adequate shipping.¹⁷ The bed surplus, in short, was only temporary and earlier estimates would prove correct. These arguments failed to change the opinion of the ASF Director of Plans and Operations, but on 25 September 1944 his proposal to require The Surgeon General to make the desired reductions was quashed by General Somervell, who considered it unwise to order such cuts in the face of The Surgeon General's opposition.¹⁸

Two days before, on 23 September 1944, G-4 directed both AAF and ASF headquarters to reduce the beds in station and regional hospitals to the number authorized by the new ratios (3.5 and 0.5 percent of troop strength respectively) and to plan a further reduction of 25 percent in each-the same cut proposed earlier by ASF headquarters.¹⁹ Later G-4 apparently directed ASF headquarters to plan reductions in the number of general hospital beds also.²⁰ The Air Surgeon and The Surgeon General readily agreed to reduce beds to current authorizations, but they objected to a further lowering of the bed ratio. Such action, they said, would allow no vacant beds for dispersion or epidemics. It would limit beds in station hospitals to 2.6 percent and in regional hospitals to

¹⁵Memo SPOPP 632 (23 Aug 44), CG ASF (Dir Plans and Oprs) for SG, 4 Sep 44, sub: ZI Hosp Program. HRS: ASF Planning Div file, 700 "ZI Hosp."
¹⁶(1) Remarks by Col Schwichtenberg, MC, in Notes on Conf of AAF Comd Surgs, Off of Air Surg, 16-20 Apr 45. SG: 337. (2) Transcription of written answers by Maj Gen Norman T. Kirk, USA, Ret, to questions in Ltr of 10 Nov 50, from Editor, Hist Med Dept in World War II. HD: 314 (Correspondence on MS)I.
¹⁷Memo, SG (init E. G[inzberg]) for CG ASF, 15 Sep 44, sub: ZI Hosp Program. HRS: Hq ASF Planning Div file, 700 "ZI Hosp."
¹⁸(1) Memo, Dir Plans and Oprs ASF for CG ASF, 23 Sep 44, sub: ZI Hosp Program, with ind. HRS: ASF Planning Div file, 700 "ZI Hosp." (2) MRS, [Gen] Somervell to [Maj Gen Wilhelm D.] Styer, 25 Sep 44, atchd to Memo just cited. Same file.
¹⁹Memo WDGDS 3221, ACofS G-4 WDGS for CGs AAF, AGF, ASF, 23 Sep 44, sub: Reduction of ZI Hosp. SG: 322 "Hosp Misc."
²⁰S/S WDGDS 4166, ACofS G-4 WDGS to DepCofSA, 20 Oct 44, sub: ZI Hosp Reqmts. HRS:
G-4 files, "Hosp and Evac Policy."

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0.4 percent of troop strength, while beds actually occupied in station hospitals ranged from 2.5 to 2.7 percent of troop strength.²¹ While this argument was in progress the question of general-hospital bed requirements was being discussed among G-4, The Surgeon General, and the War Department Manpower Board.

In these discussions the Manpower Board raised two new issues: the propriety of lumping together the capacities of all types of hospitals when considering present and future needs and of counting beds in convalescent facilities as part of these resources. The Manpower Board followed both practices. It considered all beds in convalescent facilities as hospital beds and added to them the beds in station, regional, and general hospitals to arrive at a total number of beds already established. Comparing the number of patients in all hospitals with this total, the Board concluded that a surplus of 78,000 beds existed in the United States.²² The Surgeon General contended that beds in convalescent facilities should not be considered as hospital beds, since the Board had until then refused to allocate personnel for them. He insisted, moreover, that beds in hospitals of different types were not interchangeable. For example, under existing policies vacant beds in station and regional hospitals could not be used for overseas evacuees. Nor were all beds in general hospitals available for the treatment of such patients. Some were used for prisoners of war, non-Army patients, and Army patients from surrounding areas who needed only minor care and treatment, while others had to be set aside to receive evacuees in transit from ports to hospitals of definitive treatment. He argued, therefore, that the Manpower Board's conclusion about a surplus of hospital beds was invalid.²³

The final decision which the General Staff made in the face of conflicting arguments proved to be a compromise. After further study by G-4 of the beds required in all types of hospitals, the Staff agreed in November 1944 to authorize 40,000 convalescent beds-10,500 of them in AAF hospitals. This was substantially the number recommended by The Surgeon General and the Air Surgeon and already set up in convalescent hospitals. The Manpower Board now reluctantly agreed to provide staffs for them. Moreover, the Staff required no cut in the existing number of beds in general hospitals or in the ratio authorized for regional hospitals. On the other hand it directed a cut in the ratio of station hospital beds, but only from 3.5 to 3 percent of troop strength instead of to the 2.6 percent first suggested.²⁴ The Air Surgeon apparently considered this

²¹(1) Memo, CG AAF for CofSA attn G-4, 30 Sep 44, sub: Reduction of ZI Hosp. HRS: G-4 files, "Hosp and Evac Policy." (2) Memo, CG AAF (Air Surg) for CofSA attn G-4 Div, 7 Oct 44, same sub. Same file. (3) T/S SPMC 322 Hosp, SG to Dir Plans and Oprs ASF, 30 Sep 44, same sub. HRS: Hq ASF Planning Div file, 700 "ZI Hosp." (4) Memo, SG (init E. G[inzberg]) for Dir Plans and Oprs ASF, 25 Oct 44, same sub. SG: 632.2. (5) Memo SPOPP 700, CG ASF for ACofS G-4 WDGS, 30 Oct 44, same sub. AG: 323.3 (4 Sep 44)(1).
²²Memo WDSMB 323.3 (Hosp), Pres WDMB for CofSA, 16 Oct 44, sub: ZI Hosp Reqmts. HRS: G-4 files, "Hosp and Evac Policy."
²³(1) Memo, Eli Ginzberg, Spec Asst, Dir Hosp Div SGO for Pres WDMB, 23 Aug 44. (2) Memo, SG for CG ASF, 15 Sep 44, sub: ZI Hosp Program. (3) Inf Memo, Dir Resources Anal Div SGO for Lt Col Huncilman (ASF), 26 Dec 44, sub: Background for Staffing Conv Hosps. All in HRS: Hq ASF Planning Div file, 700 "ZI Hosp."
²⁴(1) S/S WDGDS 4166, ACofS G-4 WDGS to Dep CofSA, 20 Oct 44, sub: ZI Hosp Reqmts. (2) S/S WDGDS 4956, same to same, 8 Nov 44, same sub. (3) Memo, CG AAF (Air Surg) for ACofS G-4 WDGS, 31 Oct 44, sub: AAF Conv Hosps. (4) Memo, Dep SG (init A. H. S[chwichtenberg] and E. G[inzberg]) for ACofS G-4 WDGS, 2 Nov 44, sub: Reqmts for ASF Conv Fac. (5) S/S WDSMB 323.3 (Hosp), Pres WDMB to CofSA, 13 Nov 44, sub: ZI Hosps. All in HRS: G-4 files, "Hosp and Evac Policy."

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compromise satisfactory, but The Surgeon General's representatives insisted that no reduction at all should be made.²⁵ In announcing the Staff's decision on 17 November 1944, G-4 directed both AAF and ASF headquarters to study the hospital situation further in the light of actual experience and to submit by 15 January 1945 any recommendations which they might have on changes in requirements.²⁶

Changes in the Manner of Reporting Beds

The movement to reduce the number of hospital beds caused a change in the method of reporting them. ASF headquarters decided that "unrefined data" on hospitalization, published by the Surgeon General's Office in Weekly Health Reports and in ASF Monthly Progress Reports, gave erroneous impressions and made it difficult to arrive at sound conclusions about the adequacy of hospital facilities.²⁷ Earlier the Surgeon General's Office had warned that a distinction needed to be made between the total number of beds in general hospitals and the smaller number available for "true general-hospital cases." To obtain the latter figure one must subtract from the total the number of beds necessarily vacant because of the practice of distributing patients into wards according to disease, sex, and rank, as well as those set aside for other purposes-such as the care of station-hospital-type patients, civilians, veterans, and Navy personnel, and the debarkation processing of patients arriving from theaters of operations.²⁸ This implied that to get a true picture of hospitalization not only the capacity of hospitals by type but their capacity to handle particular types of patients should be known, and that the number of beds set aside for special purposes and lost through dispersion should be taken into account.

The Surgeon General's regular reports began to take notice of this latter factor in statistics for the end of September 1944. Previously he had reported the number of beds authorized (which was reasonably close to the number normally available) and the number occupied. Now he added a figure for "effective beds" in general hospitals. It was obtained by subtracting an allowance for dispersion and for "debarkation beds" from the number of authorized beds. The following month he presented similar figures for regional and station hospitals, and at the same time gave the percentage of effective beds occupied in each class of hospital. This percentage, for all general hospitals, was 76.5; the percentage of authorized beds that were occupied (a figure previously given but now dropped) would have been 58.1. The next month, instead of reporting simply beds occupied, The Surgeon General showed "patients remaining," a figure which included not only the number of patients occupying beds but also the number temporarily absent on sick leave, on furlough, and without leave. The ratio of "patients remaining" to "effective beds" was given. In the case of general hospitals, taken collectively, this ratio amounted to

²⁵(1) Memo, CG AAF (Air Surg) for CofSA attn G-4, 7 Oct 44, sub: Reduction of ZI Hosps. HRS: G-4 files, "Hosp and Evac Policy." (2) Diary, Plans and Policy Sec, ASF Planning Div, 31 Oct 44. HRS: Hq ASF Planning Div file, 700 "ZI Hosp." (3) Memo, Dir Hosp Div (init E. G[inzberg]) for Col [William B.] Higgins, G-4, 31 Oct 44, sub: Sta and Reg Hosp Bed Reqmts. SG: 632.2.
²⁶Memo WDGDS 5391, ACofS G-4 WDGS for CGs AAF and ASF, 17 Nov 44, sub: ZI Hosps. SG: 322 "Hosp Misc."
²⁷(1) Memo SPOPP 705, CG ASF for SG, 20 Nov 44, sub: Data on Status of Hosp Beds and Pers, ZI. AG: 323.3 (4 Sep 44) (1). (2) Memo, Maj Gen W. D. Styer for Gen Lutes, 9 Nov 44. HRS: Hq ASF Planning Div file, 700 "ZI Hosp."
²⁸Memo, Eli Ginzberg, Spec Asst, Dir Hosp Div SGO for Pres WDMB, 23 Aug 44. HRS: Hq ASF Planning Div file, 700 "ZI Hosp."

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91.3 percent. The ratio of beds occupied to "effective beds" would have been 73.9 percent; of beds occupied to beds authorized, 56.4 percent.²⁹ Thus, although there was little change in actual occupancy, the new system of reporting makes it appear that hospitals were being more fully utilized than formerly.

By this time (November 1944) a series of conferences on bed reporting had already started under the auspices of ASF headquarters,³⁰ and in February 1945 conclusions were reached regarding the other factor considered necessary to a true presentation of the hospital situation. In that month the Surgeon General's Office and the ASF Planning Division agreed upon a system of reporting beds, patients, and operating personnel in terms of types of care or types of beds, regardless of their location in particular types of hospitals.³¹ Four months later the ASF Monthly Progress Report carried such information. It showed that although there were 213,373 beds in general and convalescent hospitals, only 180,760 were used as general and convalescent hospital beds.³²

Meeting Increased Requirements for the Peak Patient Load

Meanwhile the tide had long since turned in the drive to reduce hospital bed capacity. Not long after G-4's compromise decision of 17 November 1944, The Surgeon General's Resources Analysis Division made a new study of bed requirements that showed a need for more beds in general and convalescent hospitals than G-4 had authorized. There were several reasons for this study: completion by the Medical Regulating Officer of new estimates of patients to be evacuated from theaters during 1945, the prospect that redeployment would interfere with the use of station hospital buildings for any possible overflow from general hospitals, and G-4's directive that further recommendations about bed requirements be submitted by 15 January 1945.³³

In this study the Resources Analysis Division concentrated upon general and convalescent hospitals rather than upon station and regional hospitals, for there was little possibility either that G-4 would raise the bed ratio for the last two or that the Surgeon General's Office would recommend reducing it. In estimating requirements for beds in general and convalescent hospitals, the Division calculated the numbers of beds that would be needed for three groups of patients: debarkees, zone of interior and non-Army patients, and overseas patients. The minimum number of debarkation beds needed, it was assumed, was one half the anticipated monthly evacuee load, or approximately 17,500. Experience showed that 33,000 beds in general hospitals were used by zone of interior and non-Army patients

²⁹ASF Monthly Progress Rpts, Sec 7, Health, 30 Sep, 31 Oct, and 30 Nov 44.
³⁰(1) Memo SPOPP 720 (9 Nov 44), Dir Plans and Oprs ASF for CofS ASF, 30 Nov 44, sub: Status of Hosp Beds and Med Pers, ZI. AG: 323.3 (4 Sep 44)(1). (2) Diary, ASF Planning Div (Lt Col H. A. Huncilman), 28 Nov 44. HRS: Hq ASF Planning Div file, 700 "ZI Hosp." (3) Memo SPOPP 700, Dir Planning Div for Gen Wood, 26 Dec 44, sub: ZI Hosps. HRS: Hq ASF Planning Div file, "Hosp and Evac." (4) Memo, Maj W. H. Hastings (ASF) for Lt Col H. A. Huncilman, 25 Jan 45, sub: Hosp Occupancy Data for Monthly Progress Rpt. HRS: Hq ASF Planning Div file, 700 "ZI Hosp."
³¹ASF Cir 68, 26 Feb 45.
³²ASF Monthly Progress Rpt, Sec 7, Health, 30 Jun 45.
³³(1) Interv, MD Historian with Col John C. Fitzpatrick, MC, formerly MRO, SGO, 18 Apr 50. HD: 000.71. (2) Memo, Eli Ginzberg for the Record, 28 Nov 44. HD: 560.-2 (Hosp Ships). (3) Memo for Record on Memo, CG ASF for SG, 13 Dec 44, sub: Gen Hosp Program, ZI. HRS: Hq ASF Planning Div file, "Hosp and Evac." Documents dealing with conflicting claims to the use of station hospitals are in HRS: G-4 file, 602.3. (4) Memo SPOPP 322, CG ASF for SG, 7 Dec 44, sub: ZI Hosps. SG: 322 "Hosp Misc."

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despite the policy of transferring complicated cases from station to regional, instead of general, hospitals. Beds for overseas evacuees receiving definitive treatment were computed on the basis of the number to be brought in each month, as forecast in the study made by the Medical Regulating Officer, and on the average length of time they were expected to stay in hospitals. From these calculations, it appeared that patients in general and convalescent hospitals would reach a peak number of 198,000 in August 1945. If 17,500 beds were set aside for debarkation processing, a total of about 215,000 beds would then be needed. Additional beds for dispersion were not included in this number because it was anticipated that the patient load would ordinarily be lower than the estimated peak and that many patients would leave beds vacant when they went on leaves and furloughs.³⁴

This study led The Surgeon General on 8 January 1945 to ask for 70,000 additional general and convalescent hospital beds. He proposed that 49,500 of them should be in general hospitals and that they should be provided as follows: 10,000 by converting the convalescent annexes of general hospitals into wards; 17,500 by using hospital barracks for patients instead of enlisted men of the medical detachment, for whom other housing would be provided; 8,000 by placing ambulatory patients of general hospitals in post barracks; 9,000 by converting four station hospitals into temporary general hospitals; and 5,000 by using beds in staging area hospitals for debarkation purposes, thus freeing an equal number of beds in general hospitals for patients needing prolonged care. The Surgeon General suggested that about 20,500 additional beds in convalescent hospitals could be provided by using vacant barracks located near by. In this connection it should be noted that he followed a policy of expanding existing hospitals rather than establishing new ones because smaller ratios of personnel to patients were required for large than for small installations and scarce specialists were used more advantageously by concentrating rather than dispersing them.³⁵

A combination of circumstances intervened in December 1944 and January 1945 to cause the General Staff to consider favorably this request. In mid-December the Battle of the Bulge put to flight all thoughts of an early end to the war in Europe. About the same time, approval by the Joint Chiefs of Staff of the Medical Regulating Officer's estimates of evacuees to be received during 1945 made it appear that the number of patients in zone of interior hospitals would increase. In addition, a directive from the Chief of Staff on 3 December 1944 requiring the European theater to use transports for evacuation assured the early return to the United States of many patients from that area.³⁶ Of perhaps more importance, the Secretary of War wrote to the Chief of Staff early in January: "If we later prove to

³⁴(1) Memo SPMCH 322 (Hosp-Cp Edwards)C, SG for CG ASF, 21 Nov 44, sub: Use of Cp Edwards as a Debarkation Hosp. HRS: G-4 file, 602.3. (2) Memo, Asst SG for Act Dir Plans and Oprs ASF, 8 Jan 45, sub: Gen Hosp Program, ZI with tabs and incls. HRS: Hq ASF Planning Div file, "Hosp and Evac." (3) Diary, Resources Anal Div, SGO, 19, 20, 22, and 23 Dec 44. HD: 024.7-3.
³⁵(1) Memo, Asst SG for Act Dir Plans and Oprs ASF, 8 Jan 45, sub: Gen Hosp Program, ZI, with Tabs A-J. HRS: Hq ASF Planning Div file, "Hosp and Evac." (2) Memo, SG for CG ASF, 4 Jan 45, sub: Gen and Conv Hosps. Same file. (3) Memo, SG for Col Prichard, 22 Feb 45, sub: Background Info Covering the Gen Hosp Expansion Program. SG: 632.
³⁶(1) Interv, MD Historian with Lt Col J[ames] T. McGibony, MC, 20 Feb 50. HD: 000.71. (2) JCS Document 1199, 16 Dec 44. SG: 560.2. (3) Rad CM-OUT-72113 (3 Dec 44), CofSA to CG Hq ComZ ETO and CG UK Base Sec, 3 Dec 44. SG: 560.2.

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have erred [in forecasting requirements] I want to make sure that we have erred on the side of too much."³⁷ Finally, The Surgeon General's Resources Analysis Division seems to have established better relations than formerly with the War Department Manpower Board and a new Deputy Chief of Staff of the Army, perhaps inclined to be more favorable to The Surgeon General's position than his predecessor, had taken office in October 1944.³⁸ During the early part of January 1945, Surgeon General Kirk vigorously pushed his program for additional beds in personal conferences with the commanding general of the Service Forces, members of the General Staff, the Deputy Chief of Staff, the Chief of Staff, and perhaps also the Secretary of War. On 20 January 1945 it was approved.³⁹

In succeeding months G-4 and The Surgeon General differed about the number of additional beds actually required. G-4 suggested, it will be recalled, that the number might be reduced by placing overseas patients in vacant beds in AAF regional hospitals. The Air Forces offered beds for that purpose and emphasized, along with G-4, the desirability of using them to reduce the number of additional beds required in other hospitals. When The Surgeon General and ASF headquarters argued that no emergency existed to require such use of regional hospitals, G-4 asked ASF headquarters on 3 April 1945 for a justification of the number of beds authorized in January.⁴⁰

Meanwhile the Surgeon General's Office had reappraised its former estimate of requirements. Beginning in December 1944 the number of evacuees arriving in the United States from all theaters increased each month until in March 1945 it surpassed by about 12,000 the monthly average on which planning at the end of December had been based.⁴¹ This trend indicated that the peak load in general and convalescent hospitals would occur in June, two months earlier than previously expected, and that it would be higher by 46,000 patients than the 198,000 estimated in December 1944. Accordingly, in the latter part of March 1945 the Surgeon General's Office asked ASF

³⁷Memo, SecWar for CofS, n d, included as Tab B to Memo, WDCSA 700 (13 Jan 45), Asst DepCofSA for ACofS G-1, G-2, G-3, G-4, and OPD WDGS and for CGs ASF, AGF, and AAF, 13 Jan 45, sub: Med Mission Reappraised. HRS: G-4 file, "Hosp, vol. II."
³⁸Weekly Diary, Resources Anal Div SGO, 13 Jan 45. HD: 024.7-3. Lt. Gen. Joseph T. McNarney was succeeded by Lt. Gen. Thomas T. Handy as Deputy Chief of Staff, United States Army, in October 1944. Info supplied by OCS files.
³⁹General Kirk had a conference with the Chief of Staff on 26 December 1944, with the commanding general, ASF, on 5 and 8 January 1945, and with members of the General Staff and the Deputy Chief of Staff on 18 January 1945. (1) Memo WDCSA 632 (26 Dec 44), Gen George C. Marshall for Gen Thomas T. Handy, 26 Dec 44. HRS: OCS 632. (2) Notes for Gen Kirk on Conf with Gen Marshall, Summary, 25 Dec 44. HD: Resources Anal Div file, "Hosp." (3) MRS SPGAA 705 (4 Jan 45), MPD ASF for Dir Plans and Oprs ASF, 11 Jan 45, sub: Gen and Conv Hosps. HRS: Hq ASF Planning Div files, "Hosp and Evac." (4) Weekly Diary, Resources Anal Div, SGO, 13 Jan 45. HD: 024.7-3. (5) Memo, Lt Col Huncilman, ASF for the Record, 19 Jan 45. HRS: Hq ASF Planning Div files, "Hosp and Evac." (6) DF WDGDS 7623, SecWar (G-4) to CG ASF, 20 Jan 45, sub: Gen Hosp Program, ZI. HD: Resources Anal Div file, "Hosp."
⁴⁰(1) See above, pp. 185-86. (2) DF WDGDS 11208, ACofS G-4 WDGS to CG ASF, 3 Apr 45, sub: Gen Hosp Program for ZI. HRS: Hq ASF Planning Div file, 700 "Hosp."
⁴¹The increase by month from November 1944 through March 1945 was as follows:

These figures are from statistics compiled by the Medical Regulating Officer on the basis of monthly reports by port surgeons and the Air Transport Division. History . . . Medical Regulating Service. . .

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TABLE 13-HOSPITALIZATION DATA AS OF 29 JUNE 1945

^aGeneral hospitals-only general hospitals proper.
^bConvalescent hospitals-included both separate convalescent hospitals and those operated in connection with general hospitals.

Source: Weekly Hospitalization Report, vol. II, No. 26. AML.

headquarters for 9,000 additional debarkation beds and for 25,000 additional convalescent beds.⁴²Perhaps in recognition of the inconsistency of requesting additional beds at a time when they were arguing that no emergency existed to require the use of vacant beds in regional hospitals for overseas patients, representatives of the Surgeon General's Office and ASF headquarters agreed in conference on 5 April 1945 not to pass this request on to G-4. Instead, they would care for the higher number of patients in beds already authorized by placing more patients on leave and furlough, by speeding the disposition of cases being treated, and by limiting general and convalescent hospitals more strictly to overseas patients. ASF headquarters agreed to some additional construction to increase the capacity of existing debarkation facilities and justified the beds authorized in January by explaining to G-4 the upward trend in patient evacuation.⁴³

The peak patient load in the zone of interior occurred at the end of June 1945, approximately two months after V-E Day.⁴⁴An analysis of hospital-occupancy figures at that time shows that all beds in general, convalescent, and regional hospitals were needed and that even more might have been required if many patients had not been placed on leave or furlough. For example, the patient census of general, convalescent, and regional hos-

⁴²(1) Memo, SG for Dir Plans and Oprs ASF, 19 Mar 45, sub: Temp Debarkation Reqmts. SG: 632.2. (2) Memo, SG for CG ASF, 23 Mar 45, sub: Gen Hosp Program, ZI. SG: 322 "Hosp."
⁴³(1) Memo, SG for CG ASF, 6 Apr 45, sub: Gen Hosp Program, ZI, with 1st ind. SG: 322 "Hosp." (2) 1st ind, CG ASF to ACofS G-4 WDGS, 9 Apr 45, on DF WDGDS 11208, ACofS G-4 WDGS to CG ASF, 3 Apr 45, same sub. HRS: Hq ASF Planning Div file, 700 "ZI Hosp."
⁴⁴This statement is based upon figures in Weekly Hospitalization Reports that include both Army and non-Army patients as of midnight of Friday of each week. Statistical Review, World War II: A Summary of ASF Activities, prepared by the Statistics Branch, Control Division, ASF, lists the average number of Army patients each month and shows the peak load occurring during July.

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CHART 9-HOSPITAL BEDS AUTHORIZED AND OCCUPIED, AND PATIENTS REPORTED IN ALL HOSPITALS IN THE CONTINENTAL UNITED STATES: JUNE 1944-DECEMBER 1946

pitals was 283,306, while the number of beds in those hospitals was only 263,027. Of these beds, 203,070 were occupied. The rest of the patients-80,236-were absent from hospitals on leave or furlough. Not all hospitals were equally used, and the patient load was unevenly distributed. General hospitals were filled beyond the saturation point, normally considered to be 80 percent of their total bed capacities, and had more than 62,000 patients on leave. Regional hospitals, on the other hand, were only 73.4-percent occupied, and had few patients on leave. This suggests either that beds in these hospitals might have been reduced in number or that some might have been used for overseas patients to relieve general hospitals of part of their heavy load. In general, ASF hospitals showed higher occupancy ratios than did those of the Air Forces. This raises the question of whether the number of beds in the latter might have been reduced or vacant beds in them used for more non-AAF personnel. The low occupancy of both AAF and ASF station hospital beds indicates that the Staff had been justified in reducing their ratio to 3 percent and in suggesting even further reductions.

A more even distribution of patients and a fuller utilization of all hospitals would have been achieved, perhaps, by modifications of existing hospitalization policies but this was precluded chiefly by the separation of zone of interior hospitals into AAF and ASF hospitals and by the struggle for power between The Surgeon General and the Air Surgeon. (Table 13, Charts 9, 10)

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CHART 10-HOSPITAL BEDS AUTHORIZED AND OCCUPIED, AND PATIENTS REPORTED BY CONVALESCENT, REGIONAL, GENERAL, AND STATION HOSPITALS IN CONTINENTAL UNITED STATES: JUNE 1944-DECEMBER 1946

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