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Chapter XII

Contents

CHAPTER XII

Estimating and Meeting Requirements of Theaters for Hospital Beds

Although estimates of beds required for theaters were generally made separately from those for the zone of interior, developments attending the estimation of requirements for both areas were in some respects similar. Such similarities occurred despite the fact that co-ordination between interested divisions of the Surgeon General's Office was incomplete.

Until the late summer of 1943 the Plans Division of the Surgeon General's Office continued to plan hospitalization for active overseas theaters on the basis of a 10-to 15-percent ratio of fixed beds to troop strength.1 One reason for this high ratio was that the director of the Division, aware of public criticism which the Medical Department would incur if it ever failed to have enough beds, desired to have a sufficient number to meet promptly a greatly accelerated build-up of troops overseas and still have enough left to constitute a safety factor.2 Another reason of equal cogency was that sufficient information about various factors that affected bed requirements during World War II was not yet available to justify the establishment of lower ratios than those derived from World War I experience.

Factors Influencing Bed Requirements

Among the factors that influenced bed requirements were: (1) overseas troop strengths, both actual and projected; (2) disease and nonbattle-injury hospital-admission rates; (3) battle-casualty hospital-admission rates; (4) the average length of time patients stayed in hospitals; and (5) evacuation policies. While troop strengths and admission rates for disease and nonbattle-injury cases could be determined with reasonable accuracy, admission rates for battle casualties could be estimated only roughly and were therefore uncertain at best. The average length of time that patients stayed in hospitals depended upon some factors that were uncontrollable, such as the severity of wounds and the seriousness of illnesses, and upon others, such as evacuation poli-

1For example, see Ltr, SG to CG ASF, 13 Jul 43, sub: Trp Basis for Pacific Area. SG: 320.2.
2Interv, MD Historian with Col Arthur B. Welsh, MC, 27 Dec 50. HD: 000.71. According to Colonel Welsh the safety factor was an undeployed reserve within the United States for use in case the enemy employed atomic, chemical, or biological weapons effectively.


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cies, that could be determined by the War Department.

Evacuation policies governed the numbers and types of patients to be transferred from theaters to the zone of interior and were expressed in terms of days. For example, a theater which evacuated all patients requiring 120 or more days of hospitalization was said to have a "120-day policy." Under such a policy a theater would retain for treatment in its own hospitals all patients who, it was expected, could be returned to duty within 120 days and would evacuate the balance, not at the end of the 120-day period, but as soon as they were able to travel and conveyances were available. Under a 120-day policy the average length of stay of patients in theater hospitals was shorter than under a 180-day policy and more patients were evacuated to the zone of interior. It was estimated, for example, that 30 percent of all battle-casualty patients were returned to the United States under the former, while only 20 percent were returned under the latter. Thus the evacuation policy affected the number of hospital beds required in theaters. It also affected the number needed in the United States to hospitalize evacuees, the amount of transportation required for patients, and the number of replacements needed by theaters. From a theater commander's viewpoint, the ideal arrangement was to hospitalize in theaters those patients who could be returned to duty within a "reasonable" period of time, thus reducing the number of replacements needed, and to evacuate the rest as soon as possible, thus reducing the number of hospital units and the amount of equipment shipped into and used in the theater. The Surgeon General believed that a 120-day policy more nearly approached the ideal than did any other.3

Establishment of Official Evacuation Policies

Although the Surgeon General's Office and ASF headquarters had tried to get official evacuation policies established in the spring of 1943, final action was delayed until August. Being of vital concern to theaters, evacuation policies were normally established by the War Department only after consultation with theater headquarters, and several months were required to get comments on a proposal of The Surgeon General in May 1943 that a 120-day policy be officially adopted.4 These replies revealed that all theaters except the European and Asiatic (China-Burma-India) agreed upon the desirability of that policy. Having enough beds to operate under a 180-day policy, both the European and Asiatic theaters preferred the latter. It permitted them to return to duty a greater proportion of experienced personnel. It also enabled them to save shipping required both to evacuate patients to the United States and to return replacements to theaters. In addition, the European theater favored a 180-day policy because it lacked hospital ships for evacuation and its chief surgeon opposed returning patients to the United States in transports. Although the South Pacific, Southwest Pacific, and North African theaters preferred a 120-day policy, they requested permission to continue operations under a 90-day policy because of short-

3(1) ASF Monthly Progress Rpt, Sec 7, Health, 31 Dec 44, pp. 29-34. HD. (2) Memo SPOPP 370.05, Dir Planning Div ASF for Dir Plans and Oprs ASF, 24 Jan 45, sub: Review of "Elements of an Evac Policy." HRS: ASF Hq Planning Div File, 370.05 "Hosp and Evac."
4WD Memo W40-12-43, Evac Policy for Overseas Comds, 8 May 43. HD: Wilson files, 008 "Policy re Evac for Overseas." See p. 165.


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ages of beds. After analysis of these replies, the War Department announced on 28 August 1943 that it was establishing a 180-day policy for the European and Asiatic theaters and a 120-day policy for all others to become effective as soon as required hospital and transportation facilities were available.5

Establishment of Bed Ratios for Theaters of Operations

A few days before theater evacuation policies were announced, official bed ratios had been authorized for theaters for the first time in World War II. Early in August 1943, when the Surgeon General's Office and the General Staff were concerned about means of meeting the needs of the Army with the number of physicians authorized, The Inspector General reported that members of his staff, including General Snyder, had found in a survey of North African operations that battle-casualty rates had been lower than anticipated and that hospitalization requirements had been met during the first two campaigns with less than half the number of beds originally considered essential.6 In view of this report the Deputy Chief of Staff of the Army directed OPD to survey bed requirements of all theaters "in the light of experience to date." Meanwhile, OPD was to limit the total number of beds shipped overseas, whether in fixed or mobile hospitals, to 8 percent of theater troop strengths.7

In the study that followed, both OPD and the Surgeon General's Office agreed that fixed and mobile beds should be estimated and authorized separately because they served different purposes. Designed to support divisions in combat, mobile hospitals cared for patients requiring only short-duration treatment before return to duty and prepared others for evacuation to the rear. Thus sufficient numbers of fixed hospital beds were needed in the rear to take over patients whom mobile hospitals could not return to duty. Both offices agreed also that theaters should be supplied with "50-percent expansion equipment"-that is, with enough equipment to permit each fixed hospital to expand its bed capacity for short periods of time by 50 percent, without any increase in its authorized personnel. This would provide a safety factor for emergencies. Both offices further agreed that combat operations up to that time furnished an insufficient basis for estimating future rates of battle-casualty admissions, but they differed as to how this should affect the establishment of fixed-bed ratios. A computation by the Surgeon General's Office of beds needed in each theater for disease and nonbattle-injury cases, based on experience between the last of 1941 and the early part of 1943, did not alter its opinion that the 10- to 15-percent ratio should still be adhered to. It therefore recommended that this ratio be officially authorized. Believing that fewer beds would suffice, OPD used The Surgeon General's rates for disease and nonbattle injuries along with limited information available about World War II battle-casualty rates to develop

5WD Memo W40-19-43, Policy on Evac of S&W from Overseas Comds, 28 Aug 43. HD: Wilson files, 008 "Policy re Evac from Overseas Comds." Replies of theaters to the War Department memorandum of 8 May 43 are found in SG: 705-1.
6(1) Memo, IG for DepCofSA, 10 Aug 43, sub: Ests of Battle Casualties as Affecting Repls and Plans for Evac and Hosp. HRS: OPD, 700 "ETO." (2) Memo, IG for DepCofSA, 10 Aug 43, sub: Surv of the Orgn and Opr of the MD Fac in NATOUSA and Sicily. Same file.
7Memo WDCSA 333 (10 Aug 43), DepCofSA for ACofS OPD WDGS, 13 Aug 43, sub: Surv of the Orgn and Opr of the MD. HRS: OPD, 700 "ETO."


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other ratios of fixed beds that ranged from a low of 4 percent for one theater to a high of 10 percent for others. Abandoning its former position because of the limited number of physicians now available, the Surgeon General's Office concurred in recommending these ratios.

As a result, on 24 August 1943, the Deputy Chief of Staff approved the proposal to authorize fixed and mobile beds separately, agreed to supply all theaters with 50-percent expansion equipment, and authorized ratios of fixed beds as follows: 8 percent for the European and Asiatic (China-Burma-India) theaters, 10 percent for the South and Southwest Pacific theaters, 6.6 percent for the North African theater, 6 percent for the Middle East-Central-African theater, and 4 percent for the American (the Western Hemisphere, exclusive of the United States) theater.8 A short time later a ratio of 7 percent was established for the Central Pacific,9 and the 8 percent ratio for the Asiatic theater, which at first applied only to American troop strength, was revised in February 1944 to provide 8 percent each for the American forces and the Chinese Army in India.10 In establishing such ratios the Deputy Chief of Staff announced that he was not thereby authorizing additions to the troop basis. It remained to be seen whether quotas of beds authorized for various theaters could be met with units already included in the troop basis.

Mobile bed requirements were agreed upon in a conference which OPD held with representatives of G-3, G-4, ASF headquarters, the Ground Surgeon, and The Surgeon General, and were approved on 23 August 1943 by the Deputy Chief of Staff. For planning purposes, beds were authorized in evacuation hospitals for 3 percent, and in convalescent hospitals for 1 percent, of the troops in combat zones. Although there was misunderstanding about what this meant in terms of units, it was generally considered that one 400-bed evacuation hospital would be supplied for every division (except airborne divisions, which were not authorized evacuation hospitals) and for each group of army or corps troops equivalent in number to a division; that one 3,000-bed convalescent hospital would be supplied for each group of nine divisions; and that three portable surgical hospitals would be supplied, whenever theaters used them, for each division. If 750-bed evacuation hospitals were used, they were to be supplied in numbers sufficient to give a quantity of beds equal to that authorized in 400-bed hospitals. It was expected that portable surgical hospitals would be used only in the Pacific and Asiatic theaters and that convalescent hospitals would be used as mobile units chiefly in the European and North African theaters.11 In addition, spe-

8(1) Memo, SG for ACofS OPD WDGS, 17 Aug 43, sub: Fixed Hosp, Overseas. SG: 701.-1. (2) Memo, Act ACofS OPD for DepCofSA, 20 Aug 43, sub: Surv of Orgn and Opr of the MD, with notation: "Approved as amended," by order of SecWar, by Col W. A. Schulgren, Asst Sec WDGS, 24 Aug 43. HRS: OPD, 700 "ETO."
9This ratio was established before April 1944. See Memo, CG ASF for CofSA thru ACofS G-4 WDGS, 10 Apr 44, sub: Overseas Hosp. HRS: ASF Planning Div Program Br file, "Hosp, Apr 44."
10(1) Memo OPD 632 (19 Sep 43), ACofS OPD WDGS for DepCofSA, 24 Sep 43, sub: Hosp-Asiatic Theater. HRS: WDCSA 632. (2) DF OPD 632 (22 Oct 43), ACofS OPD WDGS to TAG, 1 Feb 44, sub: Hosp in the Asiatic Theater (Beds). HRS: G-4 file, "Hosp and Evac Policy."
11(1) Memo, [Col] R[obert] B. S[kinnerl for Record, 26 Aug 43. Ground Med files: Chronological file (Col Skinner). (2) Memo, Act ACofS OPD WDGS for DepCofSA, 28 Aug 43, sub: Surv of the Orgn and Opr of the MD. HRS: OPD, 700 "ETO." (3) Memo, Col A[rthur] B. Welsh for Record, 7 Sep 43. SG: 632.-2.


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cial provision had to be made for the hospitalization of Chinese troops in the Asiatic theater. For the Chinese Army in India (which had an authorized strength of 57,000) beds were authorized in evacuation hospitals on a 2-percent ratio; and for the Chinese Army in China, beds were authorized in portable surgical hospitals at the rate of one such unit for each of twenty-seven divisions.12

Ratios of mobile beds authorized at this time remained unchanged during the war;13 but some theaters never received full quotas and therefore had to improvise mobile hospitals, while others found it desirable to use, in addition to authorized mobile hospital units, some fixed hospital units (field hospitals) as mobile hospitals.14

Efforts to Provide Theaters With Authorized Quotas of Beds

After bed ratios and evacuation policies were established, adjustments had to be made in hospital facilities in each theater. Some, notably the South Pacific, Central Pacific, and European theaters, had less than their authorized quotas of mobile beds. Others, the Southwest Pacific, Asiatic, and North African, had more.15 A few areas, for example Alaska and the Middle East, had more fixed beds than authorized, while others-the European, North African, Pacific and Asiatic theaters-had fewer.16 Theaters that had too many mobile and too few fixed beds were permitted either to convert excess mobile hospital units into fixed hospital units, as was done in the Southwest Pacific area,17 or to use mobile units as fixed units, without conversion or reorganization, as was done in the Asiatic and North African theaters.18

When these changes did not erase deficits of fixed beds, other methods of increasing capacities were employed. The most obvious was to send additional hospital units to theaters. Between September and December 1943, 24 general hospital units, 10 field hospital units, and 39 station hospital units were shipped from the United States,19 but they were insufficient to supply all theaters with authorized bed capacities.

Another method was to enlarge hospitals already in theaters by increasing capacities authorized various units by tables of organization and equipment. This was economical of personnel. In the fall of 1943 a 750-bed station hospital, for example, required 40 officers (of whom 24 were Medical Corps officers), 75 nurses, and 392 enlisted men, while three 250-bed

12(1) Memo OPD 632 (19 Sep 43), ACofS OPD WDGS for DepCofSA, 24 Sep 43, sub: Hosp-Asiatic Theater. HRS: WDGSA 632. (2) DF OPD 632 (22 Oct 43), ACofS OPD WDGS to TAG, 1 Feb 44, sub: Hosp in the Asiatic Theater (Beds). HRS: G-4 file, "Hosp and Evac Policy."
13Memo SPMDA 322.05, SG for SecWar, 10 Jan 45, sub: The Med Mission Reappraised. HRS: G-4 file, "Hosp and Evac, vol. II."
14These developments will be discussed fully in a volume planned for this series on hospitalization and evacuation in theaters of operations.
15Table Showing Mobile Hosp Units in Theaters, Tab X to Memo, Act ACofS OPD WDGS for DepCofSA, 28 Aug 43, sub: Surv of Orgn and Opr of the MD. HRS: OPD, 700 "ETO."
16See Chart 11.
17(1) Memo OPD 320.2 (5 Oct 43), ACofS OPD WDGS for CG ASF, 9 Oct 43, sub: Evac Policy for Overseas Comds (Hosp Units). SG: 320.2. (2) Ltr AG 322 (14 Oct 43) OB-I-SPMOU-M, TAG to Comdr-In-Chief SWPA, 18 Oct 43, sub: Reorgn and Redesignation of Certain Hosp Units, SWPA. SG: 320.3-1.
18(1) DF OPD 632 (22 Oct 43), ACofS OPD WDGS to TAG, 1 Feb 44, sub: Hosp-Asiatic Theater (Beds). HRS: G-4 file, "Hosp and Evac Policy." (2) Rpt, Asst Comdt MFSS, Carlisle Bks to SG, 29 Nov 43, sub: Visit to ETO and NATO, 1 Sep-24 Oct 43. SG: 333.1.
19An Rpt, MOOD SGO, FY 1944. HD.


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station hospitals required 63 officers (of whom 39 were Medical Corps officers), 90 nurses, and 450 enlisted men.20 For this reason the Surgeon General's Office had proposed as early as the summer of 1943 that from 662/3 to 80 percent of all fixed beds should be in general hospitals (1,000-bed capacity) and the remainder in smaller units.21 In the fall of 1943 the Central Pacific theater enlarged the table-of-organization capacities of some of its hospitals in order to provide additional fixed beds with a minimum of additional personnel,22 and in December 1943 The Surgeon General asked other theaters to do likewise.23

A third method of increasing numbers of fixed beds was to expand hospitals beyond table-of-organization capacities-that is, to have a 1,000-bed general hospital, for example, set up beds and temporarily care for more than 1,000 patients without any increase in personnel. Anticipated in the provision that theaters be authorized 50-percent expansion equipment, this method was used in many instances, particularly in the Southwest Pacific and North African theaters, in the fall and winter of 1943.24

If bed capacities were not increased sufficiently by these means, theaters were permitted temporary "reductions" in official evacuation policies to enable them to transfer more patients to the United States. The South Pacific theater, for example, operated under a 60-day evacuation policy until January 1944 and changed to a 90-day policy in February, while the North African theater followed a 90-day policy until May 1944.25

Although some theaters objected to using the expedients discussed above,26 all succeeded in meeting hospitalization needs during the winter of 1943-44. While none having a deficit of fixed beds in the fall of 1943 reached its authorized quota by the end of the year, only one-the North African theater-had more patients than it did table-of-organization beds.27

While efforts were being made to supply theaters with authorized quotas of fixed beds, the Surgeon General's Plans Division was looking toward the future. As theaters built up troop strengths and planned combat operations, they called upon the War Department for specific types and numbers of units to meet anticipated needs. The OPD and G-3 Divisions of the General Staff, attempting to meet theater requests if possible, periodically issued a "Six Months Forecast"-a document showing units needed and the time

20See T/O 8-560, Sta Hosp, 22 Jul 42 with C 1, 5 Sep 42, and C 2, 18 Sep 42.
21(1) Draft Rad, CG ASF to CGs NATO, SWPA, USAF CBI, SPA, and ETO, 21 Jun 43. HD: Wilson files, "Day File, Jun 43." (2) Memo for Record on Draft Memo, Asst to CofS ASF for ACofS OPD WDGS, 23 Jun 43, sub: Proposed Rad for Certain Overseas Theaters Concerning Fixed Hosp Policy. Same file. It is not readily apparent how such a percentage could be applied generally, unless the essential difference between functions of general and station hospitals were to be ignored.
22Ltr AG 322 (24 Sep 43)OB-I-SPMOU-M, TAG to CG USAFCPA, SG, and Chiefs of Tec Servs, 28 Sep 43, sub: Reorgn of Sta and Gen Hosps in CPA. SG: 320.3-1.
23(1) Diary, MOOB SGO, 4-10 Dec 43. HD: 024.7-5, "MOOB Diary." (2) Rad CM-OUT-8738 (23 Dec 43), CG ASF to theater commanders. SG: 322.15-1.
24(1) Notes atchd to Memo, Col William L. Wilson, MC for Chief Control Div [SGO], 1 Nov 43, sub: Visit to SWPA. SG: 333.1-1 (Aust)F. (2) Rad CM-IN-9494 (15 Jan 44), Algiers to AGWAR, 14 Jan 44. SG: 322.15-1.
25(1) Rad CM-IN-18720 (25 May 44), CG NATO to WD, 24 May 44. HRS: G-4 file, "Hosp and Evac Policy." (2) Rad CM-OUT-42858 (28 May 44), WD to CG NATO, 27 May 44. Same file.
26Theater objections will be discussed in a volume planned for this series on hospitalization and evacuation in theaters of operations.
27See Chart 11.


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CHART 11-FIXED HOSPITAL BED CAPACITY, AND OCCUPANCY IN OVERSEAS THEATERS: MARCH 1943-DECEMBER 1945


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of their shipment.28 Hospital units listed in the "Forecast" did not always exist in this country, and it was sometimes necessary to make adjustments among units already activated. The Surgeon General's Plans Division proposed such action. For example, in November 1943 the Mobilization and Overseas Operations Branch made a study of units required by the eighth revision of the "Forecast" and found that more station hospital units of 750-, 250-, 200-, 150-, 100-, and 25-bed capacities had been activated than were needed but that fewer general and field hospital units had been activated than were required. The Surgeon General's Office then recommended the inactivation and reorganization of certain station hospital units in order to supply personnel for the required number of general and field hospitals.29 ASF headquarters approved this recommendation and orders were issued to make it effective. At successive times later, as for example in September 1944, the Surgeon General's Office suggested similar action to insure the availability of units in the types and sizes desired by theaters.30

In addition to recommending adjustments among types of hospital units being prepared for overseas service, the Surgeon General's Office took other actions in the fall of 1943 to meet future needs. After the Deputy Chief of Staff authorized 50-percent expansion equipment for fixed hospitals in theaters, the Mobilization and Overseas Operations Branch co-operated with the Supply Service of the Surgeon General's Office in securing authority to procure the equipment thus authorized.31 In addition, the troop basis of 1944 was reviewed and G-3 agreed to increase the number of fixed hospital units included in it to provide 20,000 additional beds. Even so, the troop basis did not list enough units to supply all theaters with quotas authorized by the Deputy Chief of Staff in August 1943.32 Finally, and not of least importance, under a system of telegraphic reporting initiated in July 1943, the Surgeon General's Office began to receive from theaters fuller, more accurate, and more current data on which to base studies of admission rates.33

Problems encountered in the fall and winter of 1943 in providing theaters with authorized quotas of fixed beds were merely a preview of 1944. The increasing scope and intensity of combat operations created more pressing needs for hospitalization and at the same time, by using up more personnel in the form of replacements, accentuated the shortage of men for assignment to hospital units. From the early part of 1944 this shortage was so great that it became one of the controlling factors in planning overseas hospitalization. Early in February 1944 the Surgeon General's Office warned ASF headquar-

28An example of this document, Twentieth Revision of the Six Months Forecast, Units and Availability, Data as of 20 Oct 44, Based on OPD Reqmts 5 Oct 44, G-3 Div WDGS is on file HD: 370.5.
29(1) An Rpt, MOOD SGO, FY 1944. HD. (2) Diary, MOOB, 27 Nov-3 Dec 43. HD: 024.7-5, "MOOB Diary." (3) Ltr, SG to CG ASF, 5 Nov 43, sub: Activations, Reorgns and Inactivations of Non-Div Med Units. SG: 322.3-1.
30Ltr, SG to CG ASF, 8 Sep 44, sub: Reorgn of Med Units. SG: 320.3-1.
31(1) Memo, SG for ACofS OPD WDGS, thru CG ASF, 9 Dec 43, sub: Recommended Changes in Victory Program Trp Basis, Revision of 22 Nov 43, with ind. SG: 322.15-1. (2) Memo, Act Chief Sup Serv SGO for SG, 28 Dec 43, sub: Fixed Beds Overseas in Army Sup Program. SG: 632.-2. (3) Memo, Dep Chief Oprs Serv SGO for SG, 30 Dec 43. SG: 632.-2.
32Memo for Record on DF, ACofS G-3 WDGS to ACofS OPD WDGS, 26 Jan 44. HRS: G-3 file, 700-800.
33Memo WDGDS 6442, Act ACofS G-4 WDGS for CG ASF, 7 Sep 43, sub: Hosp in Overseas Theaters, with 1st ind, SG to ACofS G-4 WDGS, 17 Sep 43. SG: 701.-1.


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ters that it would be impossible to meet theater requirements unless enlisted men were supplied in sufficient numbers to activate and train the units authorized.34 Soon afterward ASF headquarters informed G-3 that the Service Forces had 72,813 fewer men than were needed to activate units according to schedule and that 27,160 men were needed for Medical Department units alone.35 Urgent requests from ASF headquarters for more men were of little avail, and during the first four months of 1944 only 12 general, 1 station, and 11 field hospital units were activated. In May the Medical Department received its first substantial allotment of personnel for numbered hospitals during 1944 and activated that month 11 general and 3 field hospital units. Then, during subsequent months, as a result of the policy of releasing from zone of interior installations men who were qualified for overseas service, additional men became available, and during the five months beginning with June and ending with October 98 general, 8 station, and 43 field hospital units were activated.36 Thus few hospital units were activated during 1944 until the latter half of the year.

The Medical Department also had difficulty in procuring enough Medical Corps officers to man the units activated. As early as February 1944 the director of the Surgeon General's Military Personnel Division stated that there would not be enough Medical Corps specialists to staff hospitals being sent overseas and that some units would have to be shipped without specialists.37 A month later the Surgeon General's Office reported to ASF headquarters that physicians to staff forty general hospital units then in training could not be procured until June and that full officer strength for nine of the general hospitals activated in March would not be available until August.38

Use of Negro Hospital Units

The use of Negro personnel-doctors, nurses, and enlisted men-to help relieve the general personnel shortage and meet theater needs for hospital units was complicated by existing policies and practices and by the attitude of theater commanders and surgeons.39 Following a practice adopted early in the war-the organization of all-Negro units to provide opportunities for the use of Negro doctors and nurses-the War Department activated a third Negro hospital unit-the 335th Station Hospital-in August 1943. Meanwhile the 268th Station Hospital unit, which had been activated five months earlier, completed its training and in October 1943 embarked for the Southwest Pacific.40

34(1) Ltr, SG to CG ASF, 15 Feb 44, sub: Projection of Non-Div Med Units. SG: 322.3-1. (2) An Rpt, MOOD SGO, FY 1944. HD.
35(1) Memo, CG ASF for ACofS G-3 WDGS thru ACofS OPD WDGS, 18 Mar 44, sub: Projection of Non-Div Med Units, with incls. HRS: Hq ASF, Lt Gen LeR. Lutes' file, "Hosp and Evac, Jun 43 thru Dec 46." (2) Memo, CG ASF for ACofS G-3 WDGS, 26 Mar 44, sub: Med Units. Same file.
36An Rpt, MOOD SGO, FY 1944. HD.
37Memo, Dir Mil Pers SGO for Chief Oprs Serv SGO, 12 Feb 44, sub: Staffing of Gen Hosp Destined for Shipment to ETO. SG: 320.3-1.
38Memo, Dir Mob Div ASF for Dir Plans and Oprs ASF, 25 Mar 44, sub: Status of Med Units. HRS: Hq ASF, Lt Gen LeR. Lutes' file, "Hosp and Evac, Jun 43 thru Dec 46."
39These questions will be discussed fully in John H. McMinn and Max Levin, Personnel (MS for companion vol. in Medical Dept. series), HD. Also see Ulysses Lee, The Employment of Negro Troops, forthcoming volume in UNITED STATES ARMY IN WORLD WAR II.
40(1) An Rpt, 335th Sta Hosp, 1944. HD. (2) Quarterly Rpt, 268th Sta Hosp, Jul 44. HD.


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With the need to use Negro personnel increasing as difficulties in meeting theater requirements mounted, the War Department in January 1944 requested all theaters to state whether or not they would use all-Negro hospital units. Most replied negatively. Fearing loss of the services of the 335th Station Hospital unit, The Surgeon General in May 1944 appealed to ASF headquarters for "efforts [to] be made to obtain an appropriate assignment" for it.41 The same month he appealed personally to the chief surgeon of the European theater to use Negro nurses in at least one hospital.42 The chief surgeon agreed, and in July 1944 sixty-three Negro nurses, among whom were some who had formerly served with the 25th Station Hospital in Africa and had been returned to the United States at the end of 1943, arrived in the European theater. After a period of training they were assigned in September to replace white nurses in the 168th Station Hospital.43

Meanwhile an assignment for the 335th Station Hospital had been found. In June 1944 the chief surgeon of the China-Burma-India theater made a trip to Washington to explain in person his desperate need for additional hospital units. Among the means of meeting the need, in view of the general shortage of units for shipment overseas, the low priority of the China-Burma-India theater, and the demands of other theaters, the use of the 335th Station Hospital was proposed. The theater surgeon agreed to accept this unit with an overstrength of sufficient size to permit the organization of an additional hospital in the theater.44 As a result the 335th Station Hospital embarked in August 1944 and was stationed on the Stillwell Road after its arrival in Asia. According to plan, it was reorganized in December 1944 and its capacity was reduced from 150 to 100 beds. The personnel thus made surplus, along with that carried as overstrength, was used to form another 100-bed all-Negro hospital unit-the 383d Station Hospital. Both units continued to serve together as one hospital until the 383d was sent to the Philippines in August 1945.45

Thus, although Negroes served in the Medical Department overseas in organic medical units of divisions and in such other units as sanitary companies, the use of Negro professional personnel in hospital units was limited to the 25th Station Hospital (a Negro unit with four white officers in command and supervisory positions), the 268th, 335th, and 383d Station Hospitals (all-Negro units), and the 168th Station Hospital (a white unit with Negro nurses).

Estimating Requirements for Major Combat Operations

Before the full impact of personnel shortages was felt, the Surgeon General's Office began early in 1944 to estimate hospitalization and evacuation requirements for full-scale combat operations. In November and December 1943 the Com-

41Memo, SG for Dir Planning Div ASF, 17 May 44, sub: Overseas Employment of 335th Sta Hosp (Colored). AG: 370.05 (335th Sta Hosp)1944-I.
42Ltr, SG to Chief Surg, ETOUSA, 16 May 44. HD: ETO file, "Kirk-Hawley Corresp."
43An Rpt, 168th Sta Hosp, 1944. HD.
44(1) Memo for Record, 30 Jun 44, sub: Hosp in CBI, by Chief Theater Br MOOD SGO. HD: 024 "MOOD (CBI)." (2) Ltr, Col Robert P. Williams, Theater Surg USAF in CBI to Col George E. Armstrong, Dep Theater Surg USAF in CBI, 30 Jun 44. Same file. (3) Interv, MD Historian with Brig Gen Robert P. Williams, 13 and 15 Feb 50. HD: 000.71.
45(1) An Rpt, 335th Sta Hosp, 1944. HD. (2) Final Rpt, 383d Sta Hosp, Jul 45. HD. (3) AG Unit Card, 383d Sta Hosp. Orgn and Directory Sec, Oprs Br, Admin Servs Div, AGO.


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bined Chiefs of Staff met with President Roosevelt and Prime Minister Churchill at the SEXTANT conference in Cairo and then with the President, the Prime Minister, and Marshal Stalin at Teheran.46 The decision of these conferences to mount both OVERLORD (the invasion of Europe from England) and ANVIL (the invasion of Southern France from bases in the Mediterranean) during May 1944 focused attention on the European and North African theaters,47 and twice during the winter of 1943-44 the Surgeon General's Office made studies of their need for hospital beds. On the basis of the first, made by the Mobilization and Overseas Operations Branch,48 The Surgeon General recommended to ASF headquarters that North Africa be supplied with additional hospital units and with additional personnel for existing units to raise its bed capacity to its authorized quota, and to G-4 that the current bed ratios of both the European and North African theaters be raised.49 Both recommendations were disapproved. OPD was handling requests from North Africa for additional personnel and hospital units. Because of the shortage of personnel in the United States, it proposed that the North African theater increase is fixed-bed capacity by using personnel already in the theater to expand existing hospitals.50 G-4 disapproved raising current bed ratios because it believed hospital units supplied under them would provide sufficient beds for the early phases of operations on the European continent. If additional beds should then be needed, they could be sent later. Meanwhile, both theaters could use expansion equipment to increase capacities of existing hospitals for emergencies, and the European theater, if it should have a shortage of beds, could reduce its evacuation policy from 180 to 120 days and thus send a larger proportion of patients to the United States.51

The Surgeon General "strongly urged" that the decision not to send additional personnel and units to North Africa be reconsidered. He concurred in the decision not to raise bed ratios, but recommended that it be considered temporary, pending accumulation of more definite information about needs. Furthermore, he warned that evacuation facilities (ships and planes) would have to be adequate to remove patients from theaters if they were not given additional beds.52 Meanwhile, his office had begun another study of the needs of overseas theaters.

The second study, made by the Facilities Utilization Branch of the Hospital Administration Division in connection with its attempt to estimate the number of beds that would be needed in the United States, covered estimated requirements of

46Biennial Report . . . Chief of Staff, 1943-45, p. 27.
47Memo SPOPP 337, Dir Plans and Oprs ASF for Dir Sup and Mat ASF; Chiefs of TC et al., 15 Dec 43, sub: Sextant Decisions. HRS: Hq ASF Planning Div Program Br file, "Gen, vol. 2, 17 Jul 44." The invasions actually occurred later than planned.
48(1) Diary, MOOB SGO, 11-17 Dec 43. HD: 024.7-5, "MOOB Diary." (2) DF WDGDS 9381, ACofS G-4 WDGS to ACofS OPD WDGS and CG ASF, 11 Jan 44, sub: Fixed Bed Hosps, NATO and ETO. HRS: G-4 file, "Hosp and Evac Policy."
49Memo, SG for Dir Planning Div ASF, 17 Jan 44, sub: Serv Units for NA Forces. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3."
50Rad CM-OUT-8230 (21 Jan 44), ACofS OPD WDGS to CG NATO, 20 Jan 44. SG: 322.15-1.
51DF WDGDS 9381, ACofS G-4 WDGS to ACofS OPD WDGS and CG ASF, 11 Jan 44, sub: Fixed Bed Hosps, NATO and ETO. HRS: G-4 file, "Hosp and Evac Policy."
52(1) Memo, SG for CG ASF, 17 Feb 44, sub: Serv Units for NA forces. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3." (2) T/S, SG to ACofS G-4 WDGS thru CG ASF Planning Div, 9 Feb 44, sub: Fixed Bed Hosps, NATO and ETO. SG: 632.2.


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all theaters as well as of the United States for hospitalization and evacuation facilities. Among the general conclusions drawn from this study were the following: under existing plans there would be a shortage of beds in both the European and North African theaters after the mounting of OVERLORD and ANVIL; the number of patients that would be brought back to the United States each month would rise to 40,000, of whom 60 to 70 percent would be in the "helpless" category; there would be a shortage of space on transports and hospital ships for evacuation from the European and North African theaters; using only the evacuation facilities planned, not more than 20 percent of all patients would be returned on hospital ships; and air evacuation offered little promise of supplementing ships in view of past accomplishments.53 Ultimately action was taken upon each of these problems, but only those pertaining to theater hospitalization will be discussed at this point.

Decisions concerning overseas hospitalization were made at a conference on 28 March 1944. At that time General Somervell directed (1) that the number of beds supplied to Europe and North Africa under existing ratios should be increased, (2) that the General Staff should be requested to raise the authorized ratio for North Africa from 6.6 to 8.5 percent, and (3) that bed requirements for all theaters should be reviewed.54 Plans to supply additional beds to Europe and North Africa were colored by the shortage of personnel and of trained hospital units in the United States. To furnish the European theater with a total of ninety-one general hospitals by the end of July, some had to be shipped before completion of training.55 The shortage of fixed beds in North Africa was alleviated, as OPD had suggested earlier, by expanding table-of-organization capacities of existing hospitals with personnel available in the theater. With War Department approval, that theater inactivated six 250-bed station hospitals and with personnel formerly assigned to them expanded twelve 1,000-bed general hospitals to 1,500-bed capacities and five to 2,000-bed capacities. This increased the fixed-bed capacity by 9,500 beds and brought the ratio of available beds to troops up to 6.4 percent.56

The question of raising the ratio for North Africa became involved in a general review of bed requirements for all theaters because the General Staff refused to consider the former before completion of the latter.57 Prepared by the ASF Planning Division and the Strategic Logistics Planning Unit of the Surgeon General's

53(1) Hosp and Evac: A Re-estimate of the Pnt Load and Facilities, Feb 44. HD: 705.-1. (2) Memo, SG for CG ASF, 22 Feb 44, sub: Hosp and Evac. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3."
54(1) Memo, CG ASF for Dir Planning Div ASF, 28 Mar 44, sub: Hosp. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3." (2) Memo, CG ASF for Dir Plans and Oprs ASF, 28 Mar 44, sub: Conf on Hosp and Evac. Same file.
55Memo, Chief Program Br Planning Div ASF for Col Bogart, ASF, 4 Apr 44, sub: ETO Hosp. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3."
56(1) Rad CM-IN-16542 (23 Mar 44), CG USAF NATO to WD, 23 Mar 44, sub: Expansion of Hosp. SG: 322.15-1. (2) Rad CM-OUT-20160 (7 Apr 44), War (OPD) to CG USAF NATO, 7 Apr 44. Same file. (3) Memo SPOPI 632, Dir Plans and Oprs ASF for ACofS G-3 WDGS, 29 Mar 44, sub: Expansion of Gen Hosps in NATO. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3."
57(1) Memo, CG ASF for CofSA, 30 Mar 44, sub: Deficiency of Fixed Hosp Units in NATO. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, Apr 44." (2) Memo WDGSA/371 NATO (31 Mar 44), CofSA for CG ASF thru ACofS OPD WDGS, 4 Apr 44, sub: Deficiency of Fixed Hosp Units in NATO. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3."


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Office, the general review was presented to the General Staff on 10 April 1944.58 It was based upon recommendations of theaters, the average occupancy of beds in theaters during the previous six months, and the number of hospital units included in the troop basis. It represented an attempt to balance bed requirements against the number of hospital units already authorized.

Most of its proposals were accepted by G-4: that the bed ratio of the Southwest Pacific should be reduced from 10 to 8 percent, and of the Central Pacific from 7 to 5 percent, and that ratios for the European, Middle East, and American theaters should remain unchanged. G-4 rejected the proposal to raise the North African bed ratio above 6.6 percent, stating that the theater had gotten along satisfactorily on it and that the invasion of Southern France was uncertain. North Africa's later request (in May 1944) to change its evacuation policy from 90 to 120 days indicates that this decision was justified. G-4 also believed that the South Pacific ratio should be reduced from 10 to 6 percent (since the theater itself had recommended only 5 percent) instead of to 7 percent as ASF headquarters and the Surgeon General's Office proposed. While the two latter authorities recommended that the China-Burma-India ratio be reduced from 8 to 7 percent, G-4 thought that beds for the Chinese Army in India should remain at 8 percent and that the ratio for American troops only should be reduced to 7 percent.

The Deputy Chief of Staff approved G-4's findings. This meant that 351,528 of the 370,500 beds in units in the troop basis would be distributed among theaters, but that the remainder (18,972 beds) would be held in the United States as an undeployed reserve to meet unforeseen contingencies.59

Movement To Reduce Authorized Bed Ratios

Continuing Difficulty in Providing Authorized Quotas of Beds

Although beds authorized for theaters in the spring of 1944 did not exceed the number in hospital units in the troop basis, personnel shortages made it difficult to supply theaters with authorized quotas. A method formerly used-expansion of the table-of-organization capacities of the hospitals already in theaters-was applied again, particularly in the Southwest Pacific, where the closure of small hospitals released enough officers to expand capacities of larger hospitals by 7,250 beds and to permit the assignment elsewhere of 259 Medical Corps officers.60 Occasionally, reductions in bed ratios and in troop

58(1) Memo, Dep Dir Plans and Oprs ASF for CG ASF, 4 Apr 44, sub: Overseas Hosp. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3." (2) Memo, Dir Strategic Logistics Planning Unit SGO for Chief Oprs Serv SGO, 6 Jun 44, sub: Rpt of Accomplishments of SGO. HD: 319.1-2 (MOOD Oprs Serv SGO).
59(1) Memo, CG ASF for CofSA thru ACofS G-4 WDGS, 10 Apr 44, sub: Overseas Hosp, with Tabs A-F. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, Apr 44." (2) Memo WDGS 13077, ACofS G-4 WDGS for CG ASF, 27 Apr 44, sub: Overseas Hosp. HRS: Hq ASF Planning Div Program Br file, "Staybacks, 14 Apr-8 Aug 44." (3) Memo, Dep Dir Plans and Oprs ASF for SG, 29 Apr 44, sub: Overseas Hosp. Same file. (4) Rad CM-OUT-42858 (28 Mar 44), Marshall to CG USAF NATO, 27 May 44. HRS: G-4 file, "Hosp and Evac Policy."
60(1) Memo for Record, by Lt Col Lamar C. Bevil, SGO, 4 Jul 44, sub: Conf with Surg SOS SWPA. SG: MOOD "Pacific." (2) Memo, Dep Chief Oprs Serv SGO for SG, 5 Sep 44, sub: Anal of CM-IN-2287 (3 Sep 44) for SWPA. Same file. (3) An Rpt, MOOD SGO, FY 1945. HD.


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strengths of one theater released hospital units for transfer elsewhere. In the summer of 1944, for example, units no longer needed in the South Pacific area were transferred to the China-Burma-India, Central Pacific, and Southwest Pacific theaters.61 Moreover, changes in the zone of interior hospital system were expected not only to use personnel more efficiently at home but also to release some physicians for assignment to units earmarked for theaters. In addition, ratios of doctors, nurses, and enlisted men to beds were decreased in numbered hospital units as well as in zone of interior hospitals.62 Furthermore, hospitals were "short-shipped" to the European theater-that is, before completion of training and without balanced or full staffs of physicians. In such cases, the theater was expected to complete the training of units and to supply missing specialists and other Medical Corps officers. Such personnel was believed to be available from several sources: from affiliated hospital units overstaffed with specialists and already in the theater, from hospital units in the theater that were being reorganized under revised tables of organization; and from infantry regiments where Medical Administrative Corps officers were replacing Medical Corps officers as battalion surgeons' assistants.63 Finally, it was recognized that authorized bed quotas of theaters in some instances could not be met even by expedients just discussed, and that a theater would then have "to take care of its own requirements."64

Review of Requirements of European Theater

As difficulties were encountered in the summer and early fall of 1944 in meeting authorized fixed-bed quotas, The Surgeon General's Mobilization and Overseas Operations Division began to review the needs of theaters to see if estimates had been too high and if authorized bed ratios might therefore be lowered. As early as July 1944 there were "preliminary indications" that ratios authorized for both the European and the Southwest Pacific theaters could be lowered,65 but a directive of the Deputy Chief of Staff that requirements of the European theater be reviewed 30 days after the initial landing in France (or the mounting of OVERLORD)

61(1) Rad WARX 62981, Marshall to Comdr-in-Chief SWPA; CG USAF CPA; CG USAF SPA; CG USAF CBI, 10 Jul 44, sub: Movement of Ptbl Surg Hosp in Pacific. (2) Rad WARX 72125, Marshall to CG USAF CBI, 26 Jul 44, sub: Departure of 18th and 142d Gen Hosps from SPA. (3) Rad CM-IN-25976, CG USAF SPA to WD and CG USAF CPA, 31 Jul 44. All in SG: 322 "Hosp Misc 1944."
62See below, pp. 181-99, 248-50.
63(1) Mins, Mtg of Staff Conf ASF, 13 Jul 44, incl 4 to Memo SPOPP 320.2, Act Dir Plans and Oprs ASF for Act CofS ASF, 21 Jul 44, sub: Status of Hosp units. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3." (2) Rad CM-OUT-34789 (10 May 44), Marshall (OPD) to Eisenhower, 10 May 44. SG: 320.3. (3) Rad CM-IN-11147(15 May 44), CG USF ETO to WD, 15 May 44. Same file. (4) Memo, Dep SG for CG ASF, 27 Jul 44. HD: MOOD "ETO." (5) Rad CM-OUT-77546 (8 Aug 44), Marshall to Eisenhower, 8 Aug 44. Same file. (6) Rad CM-IN-2778 (30 Aug 44), Eisenhower to WD, 29 Aug 44. Same file. (7) Memo, SG for ACofS OPD WDGS thru CG ASF, 31 Aug 44, sub: Hosp in ETO. Same file. (8) Memo, SG for CG ASF, 5 Oct 44. SG: 322 "Hosp Misc 1944."
64(1) Memo with Memo for Record, Dir Plans and Oprs ASF for Joint Logistics Plans Cmtee, 6 May 44, sub: Med Reqmts-Twentieth AF. HRS: Hq ASF Planning Div file, "Hosp and Evac." (2) Memo, Lt Col Lamar C. Bevil for Col Arthur B. Welsh, 18 Aug 44, sub: Est of Med Situation in CBI. HD: MOOD "CBI." (3) Draft rad, ACofS OPD WDGS to CG USAF NATO, 12 Jul 44, with Memo for Record. HRS: OPD, 632 "Security Sec I."
65Memo, Act Dir Plans and Oprs ASF for Act CofS ASF, 25 Jul 44, sub: Hosp Reqmts, ETO. HRS: Hq ASF Planning Div Program Br file, "Staybacks, 15 Apr 44-8 Aug 44."


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focused attention upon that theater.66

During July 1944 the Surgeon General's Office analyzed reports of hospital admissions for the first 32 days of operations in France and computed actual hospital admission rates for that period. This analysis showed that the average battle-casualty rate had been lower than anticipated-51 per 1,000 per month instead of 60-although during one week it had been as high as 89 per 1,000. Other studies showed that the average length of time that patients stayed in hospitals in the North African theater between the fall of 1942 and the middle of 1944 was 23.7 days. This was shorter than the average in Europe during World War I-27.29 days. If admission rates in the future should approximate those of the 32-day period of operations in France and if the average number of days patients stayed in hospitals should be as low as in the North African theater, the European theater would need fewer beds than at first anticipated. The Surgeon General's Office computed the number that would be required under a variety of combinations of admission rates, lengths of stay, and evacuation policies, and then calculated bed ratios that might be required under different sets of circumstances. It appeared that, under a 180-day evacuation policy, the highest ratio that would be needed under the most unfavorable circumstances was 12.05 percent and the lowest, under more favorable circumstances, was 5.46. Under a 120-day policy, the highest would be 8.06 and the lowest, 3.90 percent. It was thought that such ratios would provide sufficient beds not only for all patients hospitalized by the Army, including civilians and prisoners of war, but also for their dispersion in wards. The Surgeon General therefore considered it safe to reduce the bed ratio of the European theater from 8 to 7 percent if at the same time the evacuation policy should be reduced from 180 to 120 days.67

ASF headquarters arrived at the same conclusion after taking into consideration certain additional facts. General and convalescent hospitals in the United States had about half of their beds empty during the first half of 1944.68 At the same time, the European theater was not sending to the United States as many patients as it could on returning troop transports.69 Presumably a reduction in the evacuation policy would require the theater to return a great number of patients to the zone of interior and would therefore result in fuller use of available evacuation space on transports and of hospital beds in the United States. It would also make possible a reduction in the bed ratio of the European theater and, consequently, in the number of hospital units that would have to be sent there. In view of these considerations, ASF headquarters recommended on 11 August 1944 that the authorized bed ratio for the European theater be reduced from 8 to 7 percent and that its evacuation policy be lowered from 180 to 120 days.70 The Deputy Chief of Staff ap-

66Memo with Memo for Record SPOPP 337, Plans and Oprs ASF for ACofS OPD WDGS, 1 Jul 44, sub: Fixed Hosp Data, with incls. HRS: Hq ASF Planning Div, "Hosp and Evac."
67(1) Ltr, SG to CG ASF, 1 Aug 44, sub: Overseas Hosp, with 2 incls. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac." (2) An Rpt, MOOD SGO, FY 1945. HD.
68See above, pp. 202-07.
69Memo, SG for ACofS OPD WDGS thru CG ASF, 31 Aug 44, sub: Hosp in ETO. HD: 705 (MRO Fitzpatrick Staybacks, 1 May 44-29 Oct 44).
703d ind SPOPP 370.05 (8 Aug 44), Plans and Oprs ASF to ACofS G-4 WDGS, 11 Aug 44, with Memo for Record, on Ltr, SG to CG ASF, 1 Aug 44, sub: Overseas Hosp. HRS: Hq ASF Planning Div, "Hosp and Evac."


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proved this recommendation and the War Department informed the theater of the changes on 5 October 1944.71

Shift of Attention to the Pacific

The review of fixed-bed requirements of the European theater had hardly been completed when the Chief of Staff of the Army Service Forces, returning from a visit to the Pacific, turned attention in that direction.72 He reported that increased operations against islands nearer the Japanese homeland and the necessity of caring for civilians on such islands might require more hospitals than those already planned for the Pacific. ASF headquarters then directed The Surgeon General on 8 September 1944 to re-examine plans for hospitalization and evacuation in that area.73

In complying with this directive The Surgeon General's Mobilization and Overseas Operations Division computed bed ratios by a different method from that used for the European theater. From statistical reports it determined the actual ratio of occupied beds to troop strength during 1943 and 1944 and to this ratio it added estimated ratios of beds to troop strength to provide for casualties from increased combat operations, for dispersion within hospitals, for dispersion of hospitals within theaters (that is, to permit some beds to be vacant or unused either because hospitals were situated in places with little or no combat or because they were being moved from one place to another), for soldiers of Allied armies, for prisoners of war, and for patients evacuated from mobile hospitals to permit such units to move. For example, in the Southwest Pacific area the ratio of occupied beds had been 3.75 percent; to this ratio were added the following: 1.00 percent for increased operational requirements, .90 percent for hospital dispersion, .45 percent for theater dispersion, .45 percent for Allied soldiers and prisoners of war, and .45 percent for patients from mobile hospitals.74 The sum of these ratios was 7.00 percent and was considered the ratio of fixed beds to troop strength that would be required for the Southwest Pacific area. Ratios for other areas of the Pacific were also computed according to this method and on 14 September 1944 The Surgeon General recommended a reduction in the ratio for the Southwest Pacific from 8 to 7 percent and an increase in that for the Pacific Ocean areas (a theater formed in August 1944 by the combination of the Central and South Pacific areas) from 6 percent in the South Pacific and 5 percent in the Central Pacific to 7 percent for the entire area. At the same time he recommended that the 120-day evacuation policy should remain in effect and that the Army Medical Department should continue free of responsibility for the care of civilians in occupied islands.75

71Memo AG 704 (30 Sep 44) OB-S-SPOPP, TAG for CG ETO, 5 Oct 44, sub: Hosp and Evac Policy for the ETO. HD: MOOD "ETO."
72Memo, CofS ASF for SG, 27 Aug 44. HRS: Hq ASF Planning Div, "Hosp and Evac."
73Memo SPOPP 632.2, CG ASF for SG, 8 Sep 44, sub: Hosp and Evac, POA and SWPA. HRS: Hq ASF Planning Div, "Hosp and Evac."
74The reason for adding in the ratio of beds to troop strength to provide beds for patients evacuated from mobile hospital units to permit them to move is not clear. Actually, one of the chief functions of fixed hospitals was to receive patients evacuated from mobile hospitals to insure mobility. This had been pointed out by the Surgeon General's Office in August 1943, and as a result the General Staff had agreed that fixed- and mobile-bed requirements would be computed separately.
751st ind, SG to Dir Plans and Oprs ASF, 14 Sep 44, on Memo SPOPP 632.2, Dir Plans and Oprs ASF for SG, 8 Sep 44, sub: Hosp and Evac, POA and SWPA. HRS: Hq ASF Planning Div, "Hosp and Evac."


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ASF headquarters approved these recommendations, with minor modifications, but the General Staff took no final action upon them because a new study of hospital bed requirements for all theaters soon superseded the study of requirements for the Pacific.76

The Manpower Board Estimates Requirements

The drive of the War Department Manpower Board to save personnel by reducing the number of hospitals in the Army-a drive which threatened the closure of some hospitals in the United States in the fall of 1944-extended to overseas areas also.77 The method which the Board used to compute theater bed requirements differed from The Surgeon General's. The Board proposed that the average noneffective rate (that is, the number of persons per 1,000 per day unfit for duty because of sickness or other disability) be converted into a ratio for authorizing fixed beds. Thus the number of authorized fixed beds would equal but not exceed the number of noneffectives. The Board contended that this method would provide sufficient hospitalization for all theaters, since beds were not actually needed for all noneffectives (some being treated in quarters) and since all hospitals could expand authorized capacities by 50 percent. If any theater should by chance accumulate more patients than beds, the Board stated, it could transfer greater numbers of patients to the United States, because in the Board's opinion evacuation facilities and zone of interior hospital capacities already exceeded requirements. Arriving on the basis of statistics published by the Surgeon General's Office at an average noneffective rate of 50, the Board concluded that not more than 250,000 beds were needed for the 5,000,000 troops in all theaters of operations. It therefore advocated deleting from the troop basis fixed hospital units containing 120,000 beds in excess of this number.78

On the basis of this study, G-3 recommended on 29 September 1944 that all inactive general, station, and field hospital units (having authorized capacities totaling 44,000 beds) should be deleted from the troop basis; that no further fixed hospital units be sent to theaters of operations; that the active units in training in the United States, with a total authorized capacity of 20,000 beds, be kept in this country in the strategic reserve; and that the bed requirements of all theaters be restudied by 1 November 1944.79

Although OPD believed that these recommendations were "premature,"80 G-4 directed ASF headquarters on 11 October 1944 to make an immediate review of fixed-bed requirements of all theaters on the basis of "the latest and most complete current experience data available to The Surgeon General" and warned that it was "particularly desired that no attempt be made in this study to arbitrarily justify

76(1) Memo with Memo for Record SPOPP 370.05, CG ASF for ACofS OPD WDGS, 16 Sep 44, sub: Hosp and Evac, POA and SWPA. HRS: Hq ASF Planning Div, "Hosp and Evac." (2) Memo WDGDS 3710, ACofS G-4 WDGS for DepCofSA, 5 Oct 44, sub: Hosps for SWPA and POA. HRS: OPD, 632 "Security Sec I."
77See above, pp. 203-05.
78Memo WDSMB 323.3 (Hosp) (25 Sep 44), WDMB for ACofS G-3 WDGS, 25 Sep 44, sub: Fixed Hosp Reqmts for Overseas Theaters. HRS: G-4 file, "Hosp and Evac Policy."
79Memo WDGCT 705.1 (29 Sep 44), ACofS G-3 WDGS for CofSA, 29 Sep 44, sub: Fixed Bed Reqmts. HRS: G-4 file, "Hosp and Evac Policy."
80DF, Act ACofS OPD WDGS to ACofS G-4 WDGS, 7 Oct 44, sub: Fixed Bed Reqmts, with Memo for Record. HRS: OPD, 632 "Security Sec I."


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present figures on fixed bed hospitalization for theaters."81

General Review of Bed Requirements

The study which the Surgeon General's Office prepared in compliance with the G-4 directive was impressive. It included estimates of requirements of all theaters arrived at by two methods-the "admission rate" method used earlier for the European theater and the "beds occupied" method used earlier for the Pacific. Each was supposed to serve as a check on the other. All estimates were based upon certain principles or assumptions which the Mobilization and Overseas Operations Division considered important. First, hospitals could operate with 50 percent more patients than authorized beds for only short emergency periods and hence expansion capacities could not be considered available for normal needs. Second, beds for dispersion would be needed within hospitals and within theaters. Vacant beds in contagious wards could not be used for surgical patients, for example, and some hospitals would always be only partially filled because the shifting fortunes of war temporarily left them on quiet fronts. Finally, though evacuation policies might be changed in emergencies to permit theaters to transfer larger proportions of patients to the United States, the maintenance of policies already established was desirable.

As much as possible this study was based upon World War II statistics, but in some instances rates and ratios still had to be estimated without the benefit of such data. For estimates by the "admission rate" method the Mobilization and Overseas Operations Division used actual admission rates for disease and nonbattle injury patients for the period from July 1943 to June 1944 for most theaters. In some instances, these rates had to be adjusted. For example, the daily admission rate (the number of patients admitted to hospitals per 1,000 men per day) for disease and nonbattle injuries for the Pacific Ocean area had been 1.7, but in anticipation of higher disease incidence in future operations nearer Japan an admission rate of 2 was used. While the length of stay in hospitals-also used in this method-differed from one theater and from one time to another, ranging from 18 to 21 days, the actual average length of stay in hospitals in all theaters during World War II was used. In estimates of requirements by the "beds occupied" method the ratio of occupied beds to theater troop strength during 1943 and 1944 was considered as a base to which were added ratios of beds for patients resulting from increased operations; those needed for transient, Navy, Allied, and prisoner-of-war patients; and those required for dispersion. The ratio of occupied beds was actual, based on statistical reports, but the other ratios were estimated.

Different ratios of beds for the same theater resulted from the use of the two methods of estimating requirements. For the European theater under a 120-day evacuation policy, for example, a ratio of 7.73 percent was needed according to estimates made by the "admission rate" method and of 7 percent according to the "beds occupied" method. Lower ratios of beds would be needed with 90-, 60-, or 30-day evacuation policies. Because zone of interior hospitalization and evacuation

81DF WDGDS 3918, ACofS G-4 WDGS to CG ASF, 11 Oct 44, sub: Fixed Bed Reqmts for Overseas Theaters, with 1 incl. HRS: Hq ASF Planning Div, "Hosp and Evac." Also, SG: 632.2 "Bed Reqmts."


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facilities had been planned on the basis of a 120-day evacuation policy and because such a policy seemed more economical of personnel and shipping than lower ones, The Surgeon General recommended that the 120-day policy be continued and that estimated ratios of beds required under it be approved. Those ratios were the same as the ones already authorized for all theaters except the American, China-Burma-India, Southwest Pacific, and Central Pacific. For the first three of these, The Surgeon General proposed reductions in ratios from 4, 7, and 8 percent to 3, 6, and 7 percent respectively. For the last, he proposed an increase from 5 to 6 percent. In addition, he recommended that beds be provided in hospital units in the strategic reserve for 4 percent of the troops in that reserve. He proposed further that theaters be asked what evacuation policies and bed ratios they wanted and that, until their answers were received, no reduction should be made in the number of units in the troop basis, no personnel should be diverted from training for those units, and hospital units should continue to be shipped overseas as planned. ASF headquarters approved this study and its recommendations.82

Faced with varying estimates of bed requirements made by the War Department Manpower Board and G-3 on the one hand and by the Surgeon General's Office and ASF headquarters on the other, G-4 had the problem of considering both and of arriving at recommendations that could be presented to the Deputy Chief of Staff for approval. As a result of conferences with representatives of The Surgeon General and G-3,83 and of analyses of the different studies, G-4 arrived at a compromise which favored The Surgeon General and on 2 November 1944 sent the following recommendations to the Deputy Chief of Staff: (1) that the bed ratios recommended by The Surgeon General be approved, with minor exceptions; (2) that the evacuation policies already authorized remain in effect; (3) that the shipment of hospital units to the European theater be slowed down in order to permit them to be better staffed and trained and to see if they were actually needed; and (4) that the four general hospital units and the four field hospital units that were in the troop basis but were not scheduled by OPD for shipment to any theater be deleted. On 22 November 1944, the Deputy Chief of Staff approved G-4's recommendations. The bed ratios thus authorized were as follows: for the European and Southwest Pacific theaters, 7 percent; for the Mediterranean theater (formerly North African), 6.6 percent; for the Pacific Ocean areas (formerly the Central and South Pacific), 6 percent; for the Middle Eastern theater, 6 percent; for the China and India-Burma theaters, 6 percent for all American troops and for 102,000 Chinese troops in India; and for the American theater, 3 percent.84

82(1) 1st ind, SG to CG ASF, 18 Oct 44, with Tabs A through D, on Memo SPOPP 370.05, CG ASF for SG, 13 Oct 44, sub: Fixed Bed Reqmts for Overseas Theaters, with 1 incl. (2) 1st ind SPOPP 705, CG ASF to ACofS G-4 WDGS, 24 Oct 44, with Memo for Record, on DF WDGDS 3918, ACofS G-4 WDGS to CG ASF, 11 Oct 44, sub: Fixed Bed Reqmts for Overseas Theaters. Both in HRS: Hq ASF Planning div file, "Hosp and Evac."
83DF WDGDS 4602, Act ACofS G-4 WDGS to ACofS G-3 WDGS, 1 Nov 44, sub: Fixed Bed Reqmts, with Memo for Record. HRS: G-4 file, "Hosp and Evac Policy."
84(1) Memo WDGDS 4434, Act ACofS G-4 WDGS for DepCofSA, 2 Nov 44, sub: Fixed Hosp Bed Allowances for Overseas Theaters, with Tab A. HRS: Hq ASF Planning Div, "Hosp and Evac." (2) Memo WDGDS 4477, ACofS G-4 WDGS for CG ASF, 22 Nov 44, sub as above. Same file.


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This re-examination of the needs of theaters for fixed beds achieved in part the desired end-saving of personnel through a reduction in the number of hospital units the Army would have. While it was being made, the General Staff deleted six general hospital units from the troop basis. Afterward it deleted four more general and four field hospitals.85 These were units which OPD had not scheduled for shipment but which the Surgeon General's Office wished to hold in the United States as an undeployed reserve. The shipment of hospital units to the European theater was also slowed down. With the concurrence of that theater, the General Staff planned to send 11 general hospital units to Europe during the last two months of 1944, instead of 30 that were scheduled, and to send the remaining 19 early in 1945.86 Although these actions may have helped the Medical Department, they did not solve all problems caused by personnel shortages and it was still necessary to ship hospital units with less than full complements of personnel. For example, eleven of the general hospitals sent to Europe during the winter of 1944-45 had no nurses assigned to them upon departure from the United States.87

Experiences of theaters in hospitalization from November 1944 to May 1945 showed that enough fixed beds were supplied to meet actual requirements. During this period only two theaters, the Southwest Pacific and the Asiatic, failed to receive enough beds to fill authorized quotas. The others had numbers that either exceeded quotas consistently or reached them and then wavered slightly above or below. Even during periods when theaters had fewer beds than authorized, they also had fewer patients than the number of fixed beds present, with one exception-the European theater. (See Chart 11.) In the winter of 1944-45, its patient load increased rapidly and by January and February 1945 the number of patients occupying fixed beds was greater than the number of normal beds present in the theater.88 For a short time, then, attention was centered upon this problem. (Table 14.)

The Problem of the European Theater in the Winter of 1944-45

The situation in which there were more patients than normal fixed beds in the European theater arose from a variety of causes. During November and December 1944 hospital admissions increased rapidly. In addition, stoppage by the War Department in the fall of 1944 of the transfer (with few exceptions) of prisoner-of-war patients to the United States resulted in the accumulation of 14,000 German patients in theater hospitals by the end of December. Furthermore, failure of the European theater to follow evacuation policies set by the War Department (because of a shortage of hospital ships and the chief surgeon's opposition to the use of transports for evacuation) created a backlog of Army patients awaiting 

85(1) Memo SPMDA 322.05, SG for SecWar, 10 Jan 45, sub: Med Mission Reappraised. HRS: G-4 file, "Hosp, vol. II." (2) Memo for Record on Memo, CG ASF (SG) for CofSA, 17 Dec 44, sub: Adequacy of Hosp and Evac, ETO. HRS: Hq ASF Planning Div file, "Hosp and Evac."
86(1) Memo WDGDS 4434, Act ACofS G-4 WDGS for DepCofSA, 2 Nov 44, sub: Fixed Hosp Bed Allowances for Overseas Theaters. HRS: Hq ASF Planning Div file, "Hosp and Evac." (2) MRS, Col Durward G. Hall (SGO) to Gen [George F.] Lull then Col A[rthur] B. Welsh then Col Carl [C.] Sox, 14 Nov (1944?). SG: 322 "Hosp Misc."
87Memo, Chief Atlantic Sec Theater Br MOOD SGO for Record, 8 Mar 45, sub: Substitution of Enlisted Technicians for Nurses in ETO Hosps. HD: MOOD "ETO."
88An Rpt, SG, FY 1945, pp. 53-54. HD.


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TABLE 14-EVACUATION POLICIES AND AUTHORIZED BED RATIOS, MAJOR THEATERS OF OPERATIONS


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transfer to the zone of interior. Meanwhile, the theater actually had fewer fixed beds than it was credited with, because many of its field hospitals (normally counted as fixed hospitals) were being used as forward-area surgical hospitals and evacuation holding units.89 Informed of this situation early in December 1944,90 the General Staff, ASF headquarters, and the Surgeon General's Office turned their attention to a solution of some of the theater's problems.

Difficulties of the War Department in meeting authorized quotas of fixed beds for all theaters precluded shipment to Europe of more hospitals than already scheduled. Therefore, G-4 decided that the European theater would have to care for prisoner-of-war patients in hospitals that were manned primarily by captured German medical personnel. On 28 December 1944 the War Department informed the theater of this decision,91 and by February 145 it had in operation or in the process of organization prisoner-of-war hospitals containing 13,000 beds.92

Failure of the theater to use vacant evacuation space on troop transports threatened not only to continue to contribute to a shortage of beds in Europe and insufficient use of those in the United States but also to create a serious evacuation problem. If patients were not evacuated as they accumulated it would be difficult to get them out of the theater after the defeat of Germany, because transports would then be diverted to the Pacific and hospital ships would be unable to move the patient load as rapidly as desirable. On 3 December 1944, therefore, the Chief of Staff of the Army ordered the commanding general of the European theater to use all evacuation space on transports, even if it required the theater to lower its evacuation policy to 90 days or less.93 As a result, the theater evacuated patients under a 120-day policy in January, a 90-day policy in February, and a 60-day policy in March and April.94 By thus transferring a larger proportion of its patient load to the zone of interior, the European theater reduced its requirements for additional beds and contributed at the same time to the more effective use of beds in general hospitals in the United States.

To enable the theater to establish as many fixed beds as it was credited with having, The Surgeon General proposed that it be authorized additional fixed beds to replace those in field hospitals being used as mobile units.95 The General Staff approved this proposal, and on 25 December 1944 the War Department authorized both the European and Mediterranean theaters to subtract from fixed-bed totals the beds in field hospitals being used as mobile units and to replace them by expanding table-of-organization capacities of station and general hospitals already present.96 Later, ASF headquarters pro-

89(1) An Rpt, MOOD SGO, FY 1945. HD. (2) Interv MD Historian with [Maj] Gen [Paul R.] Hawley, 18 Apr 50. HD: 000.71.
90Ltr SHAEF 704-3 Med, SHAEF to CofSA thru ACofS G-4 WDGS, 4 Dec 44. SG: 632.2.
91Rad, ACofS OPD WDGS to CG ComZ ETO and CG USAF MTO, 28 Dec 44. HRS: Hq ASF Planning Div, "Hosp and Evac."
92An Rpt, MOOD SGO, FY 1945. HD.
93(1) Memo, Col William B. Higgins (G-4) for ACofS G-4 WDGS, 4 Dec 44, sub: Evac from ETO. HRS: G-4 file, "Hosp and Evac Policy." (2) Rad CM-OUT-72113 (3 Dec 44), CofSA to CG ComZ ETO and CG UK Base Sec, 3 Dec 44. SG: 560.2.
94Administrative and Logistical History of the Medical Service, Communication Zone-ETO, Ch 13, "Evacuation," pp. 32-34. HD.
95Memo, SG for CG ASF, 13 Dec 44. HRS: Hq ASF Somervell file, "SG 1944."
96Rad OPD 632 (26 Dec 44), ACofS OPD WDGS to CG ComZ ETO and CG USAF MTO, 26 Dec 44, sub: Hosp. HRS: Hq ASF Planning Div, "Hosp and Evac."


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posed that other theaters be given similar authority.97

In addition to the measures just discussed, at the suggestion of the Chief of Staff G-4 sent to Europe one of its representatives, Col. (later Brig. Gen.) Crawford F. Sams, a Medical Corps officer, to discuss with the chief surgeon of the theater and the chief medical officer of SHAEF the most effective use of the beds present.98 The situation in Europe was thereby so alleviated that by March it was possible to divert to the Pacific six of the general hospitals scheduled earlier for shipment to Europe.99

Meeting the needs of theaters for hospitalization in the latter part of the war was characterized by efforts to estimate requirements as realistically as possible and by the necessity of using a variety of expedients to provide quotas of beds actually authorized. Establishment in the second half of 1943 of official evacuation policies and bed ratios for various theaters placed planning on a sounder basis than formerly. The first ratios established were based only partially upon World War II experience; but as statistics of casualty and disease incidence accumulated they were studied repeatedly to determine whether or not ratios could be lowered. Though a reduction was at times possible, shortages of personnel continued to require some theaters to meet their quotas partially by expanding the table-of-organization capacities of some units, using the emergency expansion of others, and employing units shipped from the zone of interior incompletely trained and staffed. Toward the end of 1944 it was necessary to force the European theater to observe War Department policies on evacuation in order to relieve the load on theater hospitals by transferring part of it to the United States. That theater also had to use other expedients, such as the employment of captured enemy personnel in the the treatment of prisoners of war, in order to have sufficient fixed beds for American Army patients.

97Memo SPOPP 705, Act Dir Plans and Oprs ASF for ACofS OPD WDGS, 5 Jan 43, sub: Adequacy of Hosp in TofOpns-Deletion of Fld Hosps from Auth Fixed Beds, with Memo for Record. HRS: Hq ASF Planning Div, "Hosp and Evac."
98(1) Memo, G. C. M[arshall] (CofSA) for [Lt] Gen [Thomas T.] Handy, 26 Dec 44. WDCSA: 632 A 414. (2) Interv, MD Historian with Brig Gen Crawford F. Sams, 18 Jan 50. HD: 000.71.
99(1) Memo, Act CofS ASF for Dir Plans and Oprs ASF, 24 Mar 45, sub: Hosps in ETO. HRS: Hq ASF Control Div files, 323.3 "Hosps." (2) An Rpt, MOOD SGO, FY 1945. (3) Memo, Chief Planning Br G-4 WDGS for ACofS G-4 WDGS, 3 Apr 45, sub: Diversion of Hosps. HRS: G-4 files, "Hosp, vol. III."

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