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Chapter XIV

Contents

CHAPTER XIV

Changes in Size and Make-Upof Staffs of Zone of nterior Hospitals

Changes in policies and procedures affecting the occupancy of beds resulted in part from limitations upon the amount of personnel available for the hospitals. One such limitation was a definite requirement that hospitals get along on proportionately smaller staffs than accustomed to. Although the Manpower Board and ASF headquarters were chiefly responsible for this development, the Surgeon General's Office participated indirectly. Established in March 1943 to advise the Chief of Staff on personnel matters,1 the Manpower Board analyzed the functions of hospitals in the United States, as it did those of other installations, and developed "yardsticks" by which to measure their personnel requirements.2 Using these yardsticks, the Board estimated the total amount of military and civilian personnel which ASF installations needed, and the General Staff normally accepted the Board's estimates in making personnel authorizations. ASF headquarters then subdivided its quota among service commands. Service commanders in turn authorized personnel for subordinate installations which then took similar action.3 Under this system, despite its nominally advisory capacity the Manpower Board exercised a rigid control over the personnel which the Service Forces received, and subordinate commands might or might not authorize as much for hospitals as the Manpower Board's yardsticks showed they needed.4 To provide a guide for subordinate commands in manning hospitals, and perhaps to influence service commanders in making authorizations, the Surgeon General's Office developed manning tables for general, regional, and station hospitals of various sizes and obtained sanction for them in a War Department circular issued in the spring of 1944.5 They agreed gener-

1(1) Memo W600-27-43, 11 Mar 43, sub: WD Manpower Bd. (2) Ltr, CofSA to CG SOS, 12 Mar 43, same sub. Both in SG: 322.7-1 (Bds, etc.).
2(1) WDMB Yardstick No 7 for Measuring Pers Reqmts of Named Gen Hosps. SG: 323.7-5. (2) Rpt, SGO Bd of Offs on the Util of MC Offs, 19 Oct 43. Off file, Gen Bliss' Off SGO, "Util of MCs in ZI" (19) #1.
3(1) History of Control Division, ASF, 1942-45, pp. 31-33. HD. (2) ASF Cir 39, 11 Jun 43. (3) 1st ind, CG ASF to SG, n d, on Memo SPMDC 320.2 (2d SvC)AA, SG for CG ASF, 10 Apr 45, sub: Strength Auth, MD. HRS: ASF SPGA 320.2 "Med."
4For example, see Diary, Hosp Div SGO, 28 Sep 44 and 16 Mar 45. HD: 024.7-5.
5(1) Memo, Gilbert W. Beebe, Control Div SGO for Col Tracy S. Voorhees, Control Div SGO, 31 Oct 43. SG: 632.-2. (2) Memo SPMCH 300.5-5, SG for CofS ASF, 19 Apr 44, sub: Pers Strength Tables for Med Instls in ZI. AG: 320.3 (18 Apr 44)(1). (3) WD Cir 209, 26 May 44.


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ally with the Manpower Board's yardsticks and with recommendations made by the Inspector General's Office. While they were not compulsory they served as guides supplied by the Medical Department for the reduction of hospital staffs.6

General Nature of Changes

The general reduction made in hospital staffs can be illustrated by changes in the ratio of employees to beds. In July 1943 the average number of employees (military and civilian) per 100 beds in general hospitals was 94. At that time 58.6 percent of all beds in general hospitals were occupied. Therefore the number of employees per 100 occupied beds was 160. By July 1944 the average number of employees per 100 beds in all general hospitals had dropped to 68.6. At that time, however, only 42 percent of the beds were occupied, and therefore the number of employees per 100 occupied beds was 160-the same as a year before. About a year later (June 1945), when 81.4 percent of all general hospital beds were occupied and the number of patients on the rolls of general hospitals (those absent from hospitals on leave or furlough as well as those occupying beds) was 122 percent of their bed capacities, the average number of employees per 100 beds was 71.1, but the average per 100 occupied beds was only 87. Thus, by the middle of 1945 the staffs of Army general hospitals in the United States had been reduced to the point where they had roughly only about half as many people to care for patients as in former years.7

Another general change in hospital staffs during the latter half of the war was the widespread substitution of civilians, Wacs, and limited service personnel for the enlisted men, officers, and nurses who were taken out of zone of interior hospitals for overseas assignments. This change resulted from a War Department policy governing the use of personnel by the Service Forces, reiterated by ASF headquarters in June 1943. In general, men qualified for overseas service were to be released as rapidly as possible from assignment to all zone of interior installations. In replacing them commanders were not to assign men to positions that could be filled by women; they were not to assign military persons, male or female, to those that could be filled by civilians; and they were not to assign officers to duties that could be performed by enlisted persons or civilians.8 Compliance with this policy had two effects upon hospital staffs. In the first place, as officers, nurses, and men were withdrawn from hospitals for overseas service, hospital staffs were subject to a continuous personnel turnover. For example, during 1944 Birmingham General Hospital gained 53 Medical Corps officers, but lost 33; it gained 177 nurses, but lost 89; and it gained 758 enlisted men, but lost 416.9 Redeployment following V-E Day and demobilization following V-J

6(1) Memo, SG for DepCofSA thru CG ASF, 10 May 44, sub: Pers Strength Tables. . . . (2) Memo, WDMB for ACofS G-4 WDGS, 25 Apr 44, sub: Anal of Proposed Strength Tables. . . . Both in AG: 320.2 (18 Apr 44)(1).
7(1) Tables on basic data and ratios of gen hosps. Off file, Resources Anal Div, SGO. (2) Statistical Health Rpts. Off file, Med Statistics Div, SGO. In 1939 civilian hospitals in the United States had an average of 83 employees per 100 beds and 121 employees per 100 patients. See Warren P. Morrill, "Ratio of Personnel to Patients," Hospitals (The Journal of the American Hospital Association), XIV (1940), pp. 47-49.
8ASF Cir 39, 11 Jun 43.
9An Rpt, 1944, Birmingham Gen Hosp. See also An Rpts, 1944 and 45, Ashford, Wakeman, Baker, and Lovell Gen Hosps and Waltham, Ft Geo. G. Meade, Cps Bowie, Crowder, and Shelby Regional Hosps. HD.


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Day gave impetus to this turnover. Secondly, as hospitals replaced persons qualified for overseas service with those in other categories, their staffs gradually became heterogeneous mixtures of doctors, administrative officers, Army nurses, civilian nurses, paid nurses' aides, voluntary nurses' aides, general and limited service men, Wacs, skilled and unskilled civilians, and prisoners of war. Some of the problems involved in the reduction, turnover, and replacement of personnel in particular categories will now be considered.

Wider Use of Administrative Officers

Medical Corps officers available for assignment to zone of interior hospitals were limited in number. According to manning tables, the proper ratio of physicians to beds ranged from 2.5 per 100 in a 1,000-bed general hospital to 2 per 100 in a 4,000-bed installation. During 1944 the actual average ratio for all general hospitals was approximately 2.6 per 100 beds. The next year, with the expansion of the hospital system, that ratio dropped to about 2.3 per 100 and remained there until November 1945.10 Hospital commanders apparently accepted the fact that additional doctors were not available, for they complained about shortages during this period less than earlier. In a few instances hospital commanders and service command surgeons reported that the quality of professional care declined. In others they called attention to the need for more specialists, such as neuropsychiatrists, orthopedic surgeons, and neurosurgeons.11 More frequently, they complained about constant changes in professional staffs and about the inferior quality of replacements received.12 Despite these complaints, there seem to have been enough Medical Corps officers to care adequately for all patients provided they were relieved of administrative work and permitted to devote full time and attention to professional activities.13

The chief method of relieving physicians of administrative work was the more extensive use of Medical Administrative Corps officers. It will be recalled that substitution of these for Medical Corps officers in strictly administrative positions had begun during the early war years, but had not reached widespread proportions. In the fall of 1943 a strict limitation upon the number of Army physicians combined with an increasing supply of Medical Administrative Corps officers to suggest to both the Surgeon General's Office and the medical officer on The Inspector General's staff a wider use of administrative officers, not only in administrative work unconnected with medical practice but also in jobs having semiprofessional aspects.14 In November 1943, therefore, The Surgeon General proposed that Medical Administrative Corps officers be used throughout the Army in many positions

10Tables on basic data and ratios in gen hosps. Off file. Resources Anal Div SGO.
11An Rpts, 1944, 2d, 4th, 7th, and 9th SvC Surgs; An Rpts, 1945, 5th and 7th SvC Surgs; An Rpt, 1944, Ashburn Gen Hosp. HD.
12(1) An Rpts, 1944, 4th and 5th SvC Surgs; An Rpt, 1944, Ft Benning Regional Hosp; An Rpts, 1945, 1st, 4th, 5th, and 9th SvC Surgs; An Rpts, 1945, Beaumont Gen Hosp, Ft Bragg and Cp Lee Regional Hosps. HD. (2) Mins, Conf of Hosp Comdrs, 7th SvC, 22 Aug 45. HD: 337.
13(1) Memo, Act IG for CG ASF, 7 Feb and 15 Mar 45, sub: Med Pers and Hosp Fac in ZI. IG: 333.9-Med Pers (2). (2) Memo WDSIG 333.9-Hosp Fac (2), Act IG for DepCofSA, 14 May 45, sub: Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (3) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45. HD: 337.
14(1) Mins, Mtg of Bd of Offs to Study Util of MC Offs, 17 Sep 43. (2) Ltr IG 333.0-Med Pers, IG to DepCofSA, 13 Jan 44, sub: Util of Med Off Pers in ZI Instls. Both in Off file, Gen Bliss' Off SGO, "Util of MCs in ZI" (19) #1 and (20) #2.


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previously held by doctors, such as battalion surgeons' assistants in the field and registrars in hospitals.15 The General Staff approved this proposal.16 In May 1944 this policy was reflected in hospital manning tables prepared by the Surgeon General's Office.17

The demand for Medical Administrative Corps officers to fill positions assigned to them under the new policy created a temporary shortage in the latter part of 1944. Gradually, as the supply of such officers increased they took over all customary administrative positions in hospitals in the zone of interior, except those of executive officer and commanding officer, as well as new positions established to handle such additional wartime functions as legal assistance, personal affairs, vocational counseling, and reconditioning. In addition, during 1944 and 1945 some hospital commanders appointed Medical Administrative Corps officers as assistants to doctors to relieve them of duties not directly connected with the treatment of patients. In such positions, Medical Administrative Corps officers assumed responsibility for all property in hospital wards, for the cleanliness of wards, and for the discipline of patients; granted passes, leaves, and furloughs to patients; and in some instances assigned and supervised the work of enlisted and civilian ward employees. Thus, by the end of the war Medical Administrative Corps officers, whose use had been almost negligible in 1942, had become an important part of Army hospital staffs.18

Alleviation of the "Shortage" of Army Nurses

During 1944 and the early part of 1945 hospital commanders and service command surgeons complained loudly of an "acute shortage" of Army nurses; but by the middle of 1945, they reported, the shortage had been eliminated and there were plenty of nurses for the rest of the year.19 During the first four months of 1944 (for which figures are available) the average number of beds per Army nurse in general hospitals ranged from 21.2 to 23.8, but the average number of patients per Army nurse was between 10.1 and 13.7. In June 1945, when the peak patient load was reached, the average number of beds per nurse in general hospitals was 13.7, but the average number of occupied beds per nurse (11.2) remained about the same as the year before.20 If one considers the general situation, and that only in terms of the ratio of occupied beds to nurses, there seems to have been no more reason for complaint in 1944 than later when hospitals reported that the shortage had been eliminated. At any rate, the validity of complaints made in 1944 was openly questioned by the commander of the Fifth Service Command.21

15Memo SPMCT 353.-1, SG for CG ASF, 25 Nov 43, sub: Conservation of MC Offs. AG: 320.2(10-30-41)(2) T/Os.
16DF WDGCT 322 (25 Nov 43), ACofS G-3 WDGS to TAG, 1 Mar 44, sub: Conservation of MC Offs. AG: 320.3(10-30-41)(2) T/Os.
17WD Cir 209, 26 May 44.
18An Rpts, 1944, 5th and 9th SvC Surgs; An Rpts, 1944, Baker, Beaumont, Birmingham, O'Reilly, and Wakeman Gen Hosps and Cps Barkeley, Shelby and Ft McClellan Regional Hosps; An Rpt, 1945, 5th SvC Surg; An Rpts, 1945, Birmingham, Crile, and Lovell Gen Hosps. HD.
19An Rpts, 1944, 2d, 3d, 4th, 5th, and 9th SvC Surgs; An Rpts, 1945, 2d, 5th, 7th, and 9th SvC Surgs; An Rpts, 1944 and 45, Ashford, Fitzsimons, Baker, Halloran, O'Reilly, Baxter, Beaumont, Lovell, Birmingham, and Wakeman Gen Hosps and Waltham, Cps Barkeley, Crowder, and Shelby, and Ft McClellan Regional Hosps. HD.
20Tables on basic data and ratios of gen hosps. Off file, Resources Anal Div SGO. See Charts 8, 9, and 10, and Table 13.
21Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, pp. 202-03. HD: 337.


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Hospital commanders may have been complaining about a potential rather than an actual shortage of nurses, but whether potential or actual there were reasons for their belief that it was serious. In the first place, the authorized ratio of nurses to beds during 1944 was lower than that to which hospitals had been accustomed. Early that year the Deputy Chief of Staff of the Army ordered it reduced from one for every ten beds to one for every fifteen.22 Next, the number of nurses actually assigned to hospitals during 1944 was often lower than the number authorized23 and there was thus a shortage of nurses to fill authorized quotas. If hospitals had been called upon to operate at full capacity at that time, they might have encountered serious difficulties. Furthermore, at the time when hospitals were required to adjust to lower ratios of nurses, their enlisted staffs were reduced also and some of their trained technicians were withdrawn for overseas service.24 This situation perhaps contributed to a feeling on the part of nurses themselves that they were shorthanded and overworked, a feeling possibly heightened by the fact that nurses had to devote attention to new activities, such as the educational and physical reconditioning programs, that were being introduced during 1944.25 Finally, the continuous turnover of personnel interfered with the achievement of stable, well-organized staffs to operate hospital wards. Whatever the reason, there was a widespread belief in Army hospitals during 1944 and the early part of 1945 that there was an "acute shortage" of nurses; and the Medical Department, from the Surgeon General's Office down, tried to alleviate that condition.26

A number of measures were adopted to insure an adequate nursing service for the Army's patients. Some, such as the elimination of inessential nursing records and the concentration of patients requiring continuous nursing care in as few wards as possible, were administrative.27 Others, such as the employment of civilian registered nurses and senior student nurses, were designed to supplement the professional nursing service.28 By April 1945 there were in general hospitals more than 2,000 cadet nurses and more than 1,000 civilian nurses.29 A measure that was pro-

22(1) DF WDGAP 320.21, ACofS G-1 WDGS to CG ASF and SG, 8 Jan 44, sub: Nurse Pers Reqmts. HD: 211. (2) Memo, SG for DepCofSA thru CG ASF, 10 May 44, sub: Pers Strength Tables for Med Instls in ZI. AG: 320.2(18 Apr 44) (1). (3) WD Cir 209, 26 May 44.
23For example, see Conf, Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44. HD: 337.
24See below, pp. 253-56.
25An Rpts, 1944 and 45, Birmingham, Lovell, Wakeman, and Baker Gen Hosps. HD.
26Florence A. Blanchfield and Mary W. Standlee, Organized Nursing and the Army in Three Wars (1950) (cited hereafter as Blanchfield and Standlee, Organized Nursing) gives a full discussion of the nursing "shortage" in the winter of 1944-45. In general, the authors indicate that the Medical Department's estimate of nurse requirements was unrealistically high. In an interview on 20 November 1951 General Kirk stated that the Medical Department was "always short" of nurses until a draft was proposed in the winter of 1944-45. (HD: 314 Correspondence on MS) V. The question of whether or not there was a shortage of nurses in zone of interior hospitals was only part of a larger question of a shortage of nurses for use in theaters of operations as well as in the zone of interior. This question will be discussed more fully in John H. McMinn and Max Levin, Personnel (MS for companion vol. in Medical Dept. series), HD.
27(1) Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, p. 128. HD: 337. (2) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, pp. 191-93. Same file. (3) An Rpt, 1944, O'Reilly Gen Hosp. HD.
28An Rpts, 1944, 2d, 3d, 4th, 5th, and 9th SvC Surgs; An Rpts, 1944, Fitzsimons, Halloran, O'Reilly, Birmingham, and Baxter Gen Hosps, and Waltham, Cps Shelby and Crowder Regional Hosps. HD.
29Tables on basic data and ratios of gen hosps. Off file, Resources Anal Div SGO.


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posed, but not adopted, was a draft of nurses.30 Still another measure was the increased employment of ancillary personnel to relieve nurses of nonprofessional duties in the care of patients. During 1944 and 1945 hospitals hired civilian nurses' aides and ward orderlies, sought the services of volunteer Red Cross nurses' aides, and used both enlisted men and Wacs, as they were available, to assist nurses in the care of patients.31

Greater Use of Limited Service Men

Along with measures affecting the allotment of officers and nurses to hospitals, there were changes in the type of enlisted men employed during 1944 and 1945.32 The existing policy of reassigning general service men from zone of interior installations to overseas units was made stricter and applied more widely during 1944 than before. In January ASF headquarters began a drive to have all general service men, except those who were more than thirty-five years old, those who had already served overseas, those who had had less than one year of Army service, and those who were considered to be in certain "key" categories, released from its installations by June; later, October.33 This drive threatened to strip hospitals of even their trained technicians. In order to prevent this, the Surgeon General's Office got the Military Personnel Division of ASF headquarters to consider such men as dental laboratory technicians, meat and dairy inspectors, pharmacists, X-ray technicians, reconditioning instructors, medical technicians, surgical technicians, and laboratory technicians as being in "key" categories.34 In July 1944 ASF headquarters announced that even "key" technicians, if physically qualified for overseas service, would be taken out of zone of interior installations as soon as replacements were available.35 Service commands interpreted these directives differently, and some pulled "key" men out of hospitals without thought of the availability of properly trained replacements.36 To recover for the Medical Department some of the technicians improperly transferred as well as those misassigned initially to the Ground Forces, the Surgeon General's Office succeeded in getting orders published during 1944 and 1945 requiring their retransfer to Medical Department units and installations. These actions saved enough technicians, so the Enlisted Personnel Branch of the Surgeon General's Office reported at the end of 1944, to man all hospitals properly,37 but not all

30Blanchfield and Standlee, Organized Nursing, pp. 551-95.
31An Rpts, 1944 and 45, 2d, 3d, and 9th SvC Surgs; An Rpts, 1944, Deshon, Halloran, O'Reilly, Baker, Fitzsimons, Baxter, Wakeman, Birmingham, and Lovell Gen Hosps. HD.
32For example, see An Rpts, 1944 and 45, Fts Bragg and Knox, Cps Barkeley and Lee Regional Hosps, and Baxter, Beaumont, Halloran, Schick, and Wakeman Gen Hosps. HD. See also McMinn and Levin, op. cit.
33(1) ASF Cir 26, 24 Jan 44. (2) Quarterly Rpt, 3d Qtr 1944, Enl Pers Br, Mil Pers Div SGO. HD.
34(1) ASF Cir 193, 26 Jun 44. (2) WD Memo W615-44, 29 May 44, sub: Critically Needed Specialists. HD. (3) Quarterly Rpt, 3d Qtr 1944, Enl Pers Br Mil Pers Div SGO. HD. (4) Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, p. 194. HD: 337.
35ASF Cir 239, 29 Jul 44.
36(1) Ltr, Capt Luther F. Dunlop, QMC, Hosp Div SGO to HD SGO, 4 Jul 44, sub: Summary of Civ Situation in Sta and Gen Hosps during the Past Few Months. HD: 230.-1 "Civ Pers (Gen)." (2) Quarterly Rpt, 4th Qtr 1944, Enl Pers Br Mil Pers Div SGO. HD. (3) An Rpts, Ft Bragg Regional Hosp and Beaumont Gen Hosp. HD.
37Quarterly Rpt, 3d and 4th Qtr 1944 and 2d Qtr 1945, Enl Pers Br Mil Pers Div SGO, and An Rpts, 1944, Baxter and Schick Gen Hosps. HD.


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commanders were satisfied with saving technicians. Some complained loudly about the loss of certain clerical employees, such as those occupying the position of sergeant major, whom they considered also as "key" persons.38

One reason that hospital commanders complained about the loss of general service men was that they encountered personnel-management problems in using civilians, Wacs, and limited service men to replace them.39 As a rule, limited service men assigned to hospitals came either from nonmedical units in the United States or from organizations overseas. Many were not trained for work in hospitals and had to be oriented and trained on the job, even in clerical positions. Some felt that they had already contributed their share toward winning the war and wished to be discharged from the Army. Others were psychoneurotic and their job-assignments had to be made with caution. Still others had mental limitations which made it difficult for them to absorb job-training. Many were physically handicapped and could not do heavy work. These restrictions on the use of limited service men complicated the problem of staffing hospitals.40 Furthermore, the assignment of such men to hospitals often created morale problems. Under the ASF personnel-control system, each hospital was authorized a specific number of noncommissioned officers. So long as it had that number it could make no promotions.41 Many limited service men assigned to hospitals held noncommissioned-officer grades which they had earned in nonmedical units. They were usually not qualified, either by experience or by training, to hold such grades in hospitals. When required to do work which they considered beneath the dignity of their grades, they became resentful. Moreover, their mere presence prevented the promotion of other men who, by reason of qualifications and jobs held, deserved to be noncommissioned officers. Lack of opportunities for promotion lowered the morale of these men.42

Hospital commanders were powerless to correct this situation, and the Surgeon General's Office tackled it. Hoping to solve the dual problem of having men with proper job qualifications assigned as replacements and of promoting men who deserved noncommissioned-officer grades, that Office in 1944 prepared tables of organization for zone of interior hospitals, showing job specifications and corresponding grades.43 These tables were not published in 1944. In January 1945, after the problem of grades for enlisted men was made more acute by the proposal to assign WAC companies to hospitals,44 Surgeon General Kirk appealed to the Secre-

38For example, see remarks of hospital commanders in the following: (1) Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, pp. 204 and 209. HD: 337. (2) An Rpt, 1944, Ashford Gen Hosp. HD.
39In the middle of 1943 the Army abolished the term "limited service" but continued to classify men as qualified or not qualified for overseas service. Unofficially men not qualified for overseas service continued to be called limited service men.
40An Rpts, 1944, 2d, 4th, 5th, 7th, and 9th SvC Surgs; An Rpts, 1944, Halloran, Beaumont, Wakeman, Baxter, Baker, Ashford, and Birmingham Gen Hosps and Cps Barkeley, Lee, and Ft Knox Regional Hosps. HD.
41ASF Cir 39, 11 Jun 43.
42(1) An Rpt, 1943, 2d SvC Surg; and An Rpts, 1944, Wakeman and Birmingham Gen Hosps. HD. (2) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, p. 190. HD: 337.
43An Rpt, FY 1944, Enl Pers Br Mil Pers Div SGO. HD.
44See below, pp. 256-59.


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tary of War to approve the table-of-organization method of manning hospitals in the zone of interior.45 The Secretary approved this proposal in principle, and the Surgeon General's Office revised the tables it had prepared in 1944.46 During the following six months, the latter attempted to have them published. For some reason, perhaps simply red tape, this was not done and the problem of job qualifications and grades remained unsolved in ASF hospitals.47

Replacement of Military by Civilian Employees

Although limited service men were authorized as replacements for men physically qualified for overseas service, chief emphasis of War Department policy regarding nonprofessional personnel was on the use of civilians to replace military employees, whether general service men, limited service men, or enlisted women. Beginning in 1943 civilians were used actually to replace enlisted men, rather than to supplement them. Under the ASF personnel-control system established in June of that year, hospitals had personnel ceilings which they could not exceed, and as they employed additional civilians they had to release proportionate numbers of enlisted men.48 The War Department's goal during 1944 and 1945 was to replace military personnel with civilians up to about half the total force.49 This goal-one to which Surgeon General Magee had objected vigorously in the fall of 194050-was approached, though not reached, during the later war years. In June 1944 ASF station and regional hospitals employed 33,023 enlisted men and women, but only 19,469 civilians, exclusive of registered nurses-a ratio of approximately 17 military to 10 civilian employees. During the following year civilians replaced enlisted persons at such a rate that in June 1945 such hospitals had 17,673 enlisted men and women and 11,703 civilians-approximately 10 civilians for every 15 enlisted men and women.51 General hospitals used civilian employees in greater proportion. In March 1944 the ratio of enlisted to civilian workers in all general hospitals was about 10 to 10.5, for there were 28,060 enlisted men and women and 29,546 civilians employed in those installations. About a year later, when general hospitals employed 40,659 enlisted and 45,793 civilian workers, the ratio had changed to about 10 enlisted persons to 11 civilians.52

In replacing military with civilian employees, hospitals encountered difficulties,

45Memo SPMDA 322.05, SG for SecWar, 10 Jan 45, sub: Med Mission Reappraised. HRS: G-4 file, "Hosp, vol. II." It should be noted that this was a reversal of The Surgeon General's traditional opposition to staffing zone of interior hospitals according to tables of organization.
46(1) DF WDGAP 321 Med, ACofS G-1 WDGS for ACofS G-4 WDGS, 29 Jan 45, sub: Med Mission Reappraised. HRS: G-4 file, "Hosp, vol. II." (2) Diary, Hosp Div SGO, 31 Jan 45. HD: 024.7-3. (3) Quarterly Rpt, 1st Qtr 1945, Enl Pers Br Mil Pers Div SGO. HD. (4) Unsigned Memo for Record, 22 Feb 45. SG: 320.3 "(T/O) Jan-Mar 45."
47(1) Memo, Dir Resources Anal Div SGO for Gen Bliss, 20 Jun 45, sub: Pers Guides. HD: Resources Anal Div file, "Hosp." (2) 2d ind, Dep SG to CG ASF, 14 Jul 45, on basic not located. Same file.
48ASF Cir 39, 11 Jun 43.
49Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, pp. 197, 207, and 208; and Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, pp. 193-94. HD: 337.
50See above, pp. 31-32.
51Tables on basic data and ratios for sta, regional, POW, and conv hosps. Off file, Resources Anal Div SGO.
52Tables on basic data and ratios for gen hosps. Off file, Resources Anal Div SGO.


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as they had earlier.53 They still had trouble recruiting civilians in sufficient numbers, maintaining stable civilian-personnel forces, and using women and elderly or partially disabled men. They had to hire civilians who were not qualified for jobs they were to hold, and train them afterward. For example, hospitals in the Fourth Service Command trained civilians as apprentice dietitians, dental assistants, dental mechanics, laboratory helpers, X-ray technicians, guards, firefighters, telephone operators, steamfitters, refrigeration and air-conditioning mechanics, laundry operators, ward attendants, mess attendants, orthopedic shoe mechanics, cooks, and meatcutters. Furthermore, particularly in wards, hospital commanders confronted the difficulty of replacing enlisted men who worked twelve hours a day with civilians who worked only eight. Hoping to solve this problem, The Surgeon General asked for replacements on a basis of three civilians for two enlisted men. Some service commands followed this practice, but the War Department Manpower Board disapproved it and recommended allotments of civilian replacements for enlisted men on a one-for-one basis.54 Hospitals then used split shifts for civilian employees and made other changes in work schedules, in order to have sufficient numbers on duty during the hours when work was heavy. Other difficulties for hospital commanders resulted from their lack of control over civilians, who often failed to show up for work, refused to work on night shifts, and, because of civil service regulations, could not be moved from one job to another to meet emergency needs. In such instances it was necessary to assign enlisted personnel to fill the vacancies. Finally, hospitals began to employ a different type of civilian during the later war years-paid nurses' aides-who, although not numerous, often created morale problems among enlisted Wacs by their mere presence.55

Use of Wacs in Army Hospitals

Although the Medical Department had begun to use Wacs56 in hospitals earlier, by the middle of 1943 their number was small in proportion to that of enlisted men and civilians. Apparently WAC headquarters could not supply more, for in January

53See above, pp. 33, 135. This paragraph is based in general upon the following: An Rpts, 1944, Surgs 4th, 5th, 7th, and 9th SvCs, and 1945, 2d and 5th SvCs; and An Rpts, 1944 and 45, Brooke, Halloran, O'Reilly, Ashford, Baker, Birmingham, Wakeman, Baxter, Beaumont, Ashburn, and Battey Gen Hosps and Regional Hosps, Cps Shelby, Polk, Lee and Crowder, Scott and Keesler Flds, and Fts Bragg, Knox, and Meade, all in HD; and Ltr, Capt Luther F. Dunlop, QMC, Hosp Div SGO to HD SGO, 4 Jul 44, sub: Summary of Civ Situation in Sta and Gen Hosps during Past Few Months, in HD: 230.-1 "Civ Pers (Gen)."
54(1) Memo, WDMB for ACofS G-3 WDGS, 25 Apr 44, sub: Anal of Proposed Strength Tables for Med Instls in ZI. (2) Memo, SG for DepCofSA thru CG ASF, 3 May 44, same sub. (3) Memo WDSMB 323.3 (Hosp), WDMB for CofSA, n d, sub: WD Cir 209, 1944. (4) Memo SPMDM 300.5, SG for ACofS G-1 WDGS, 17 Feb 45, same sub. (5) Memo WDGSA 200.3 (3 Mar 45), Asst DepCofSA for ACofS G-1 WDGS, 7 Mar 45, same sub. All in AG: 320.2 (18 Apr 44)(1). (6) WD Cir 87, 19 Mar 45. (7) Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, p. 199. HD: 337.
55ASF Cir 226, 20 Jul 44. The best discussion available of the employment of civilian nurses' aides in Army hospitals is in Blanchfield and Standlee, Organized Nursing, pp. 487-89, 492-93, 568.
56The Women's Army Corps (WAC) was authorized by Congress to supersede the WAAC on 1 July 1943. For a general discussion of the use of Wacs by the Medical Department see McMinn and Levin, op. cit., and Mattie E. Treadwell, The Women's Army Corps (Washington, 1954), Chap XIX, in UNITED STATES ARMY IN WORLD WAR II.


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1944 The Surgeon General's Hospital Administration Division reported that many unfilled requisitions were on hand.57 As the withdrawal of general service men from zone of interior hospitals and the lack of sufficient nurses to fill authorized quotas increased the need of hospitals for ancillary personnel, The Surgeon General approved the use of Wacs and of both voluntary and paid nurses' aides. During 1944 and 1945 special recruiting campaigns were conducted both by WAC headquarters for additional Wacs and by the Red Cross for civilian nurses' aides. By the spring of 1945 a surplus of Wacs had been recruited for the Medical Department.58 In order to use all of them, and at the same time to offset the shorter hours which Wacs were by then authorized to work, The Surgeon General requested their allotment to replace enlisted men in a ratio of three Wacs for two men. The Staff refused this request, and some of the Wacs recruited for the Medical Department had to be transferred to other assignments.59

As hospitals began to use more Wacs, a controversy developed over policies governing their employment. Basically, it sprang from the question of whether Wacs were to be considered primarily as women or as enlisted personnel. The director of the Women's Army Corps placed more emphasis on their sex than on their enlisted status. Interested in their welfare and in the success of recruiting programs, she wanted Wacs to work shorter hours than was customary for enlisted men assigned to ward duties, to be used only as technicians and not as ward orderlies or kitchen workers, and to be given grades commensurate with technical duties performed.60 Aware of difficulties which hospital commanders encountered in manning installations in compliance with War Department policies, The Surgeon General wished to give them as much flexibility as possible in the employment of military personnel. Therefore, he emphasized the enlisted status of Wacs and insisted that they should not be given preferential treatment, just because they were women, in jobs, work-hours, or grades.61 This attitude, along with the kind of jobs to which some Wacs in hospitals were assigned, laid the Medical Department open to the accusation in the fall of 1944 that it sidestepped recruiting promises.62

In the winter of 1944-45 The Surgeon General almost lost out in the controversy over policies on Wac employment. In December 1944 G-1 ruled that Wacs should work the same hours as nurses

57(1) Tables on basic data and ratios of gen, regional, sta, and conv hosps. Off file, Resources Anal Div SGO. (2) Diary, Hosp Admin Div, 25 Jan 44. HD: 024.7-3.
58(1) Treadwell, op. cit., Ch. XIX, gives from the WAC viewpoint a full discussion of both the recruiting of Wacs for, and their use by, the Medical Department. (2) Blanchfield and Standlee, Organized Nursing, pp. 489-93, have a discussion of the nurses' aide recruiting campaign.
59(1) Ltr, SG to CG ASF attn Dir Mil Pers Div, 23 May 45, sub: Asgmt of MD Enl Pers (WAC). SG: 322.5-1(WAC) 1945. (2) Ltr, SG to CG ASF attn Dir Mil Pers Div, 23 Jun 45, sub: Tng of Enl Pers (WAC). Same file. (3) Quarterly Rpts, 2d and 3d Qtrs (1 Jun and 1 Oct) 1945, Enl Pers Br Mil Pers Div SGO. HD.
60Ltr WDWAC 720 (29 Jun 44), Dir WAC to CG ASF, 29 Jun 44, sub: WAC Duties on KP Detail and Hosp Orderly Asgmt. AG: 220.3 "WAC(29 Jun 44) (2)."
61(1) T/S, SG to ACofS G-l WDGS, 31 Oct 44, sub: WAC Pers Asgd to Hosp Duties. AG: 220.3 "WAC(29 Jun 44)(2)." (2) Memo, Dir Tng Div SGO for Chief Prof Admin Serv SGO, 22 Nov 44. HD: 353 "WAC Gen."
62(1) T/S SPGAM/322.5 WAC(6 Sep 44)-97, CG ASF to ACofS G-1 WDGS, 12 Sep 44, sub: WAC Duties on KP Detail and Hosp Orderly Asgmts. AG: 220.3 "WAC(29 Jun 44)(2)." (2) Blanchfield and Standlee, Organized Nursing, p. 494.


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(normally less than those of enlisted men employed in wards).63 The following month the Chief of Staff, in approving a recruiting program for Wacs for the Medical Department, directed that WAC table-of-organization or table-of-distribution companies should be organized for general hospitals. The table of distribution that was adopted listed only technical jobs, except for company administrative work, and contained no grades lower than that of technician fifth grade (the equivalent of corporal).64 If the wishes of the WAC director had been followed, all of the Wacs already serving in hospitals under the bulk-allotment system would have been either assigned to these companies or transferred from hospitals. Either action would have deprived hospitals of the use of Wacs as ward orderlies, drivers, clerks, cooks, and bakers. The Surgeon General objected to such an arrangement and the General Staff then agreed that general hospitals might retain some Wacs, without assigning them to table-of-distribution companies, for use in nontechnical jobs.65 After V-J Day WAC companies were disbanded and the Medical Department returned to the former system of employing enlisted women, along with enlisted men, as part of its bulk allotment of military personnel.

As hospital commanders employed greater numbers of Wacs, some reported that they could be used in all departments on almost every type of job, but others believed that Wacs could not replace enlisted men on a one-for-one basis in the wards and kitchens of hospitals, where the work was heavy and the hours long.66 To keep enough men in such places for heavy work, the General Staff approved The Surgeon General's proposal that the number of enlisted women assigned to wards and diet kitchens should not exceed 40 percent of the total enlisted staff.67

While some hospital commanders resented limitations upon their authority to select the jobs and set the duty-hours of Wacs, the most common problem in employing them was one of morale. Nurses rarely thought of enlisted women in terms of the nursing service and objected to their assumption of many professional nursing duties.68 Because of misleading recruiting publicity, Wacs came to expect more opportunities in the nursing care of patients than was warranted, and many were disillusioned and disappointed when they found their actual jobs less glamorous than had been depicted.69 Enlisted men resented the preferential treatment which Wacs received in the matters of rank and working conditions. Wacs in turn resented

63 DF WDGAP 220.3 WAC, ACofS G-1 WDGS to SG thru CG ASF, 26 Dec 44, sub: WAC Pers Asgd to Hosp Duties. AG: 220.3 "WAG (29Jun)(2)."
64T/D 8-1037, WAC Hosp Co (ZI), 17 Feb 45. SG: 322.5-1 (WAC) 1945.
65(1) Mins, Mtg Held in Off of Dir WAC, 9 Mar 45. SG: 322.5-1 (WAC) 1945. (2) Memo, Act Chief Pers Serv SGO for SG, 14 Mar 45, sub: WAC Recruiting Program for T/D Co at Named Gen hosps. Same file. (3) Memo, Lt Col E. R. Whitehurst for Dir Tng Div SGO, 18 Jul 45. Same file. (4) Quarterly Rpt, 1st and 2d Qtrs, 1945, Enl Pers Br Mil Pers Div SGO. HD.
66(1) An Rpts, 1944 and 45, Lovell, Wakeman, Baker, Percy Jones, Baxter, Birmingham, Beaumont, Ashford, and Crile Gen Hosps, and Waltham, Ft. Knox, and Cps Polk and Barkeley Regional Hosps; and Quarterly Rpt, 3d Qtr (2 Oct 44) 1944, Enl Pers Br Mil Pers Div SGO. HD. (2) Weekly Summary of Daily Diaries, Hosp and Dom Oprs SGO, 14 Jul 45. HD: 024.7-3.
67(1) Memo SPMCQ 300.5 (WD Cir), SG for Dir Publication Div AGO thru CG ASF and ACofS G-1 WDGS, 31 Jan 45, sub: Proposed WD Cir. . . . AG: 220.3 "WAC (29 Jun 44)(2)." (2) WD Cir 71,6 Mar 45.
68Blanchfield and Standlee, Organized Nursing, pp. 487, 594.
69Treadwell, op. cit., Ch. XIX, and Blanchfield and Standlee, Organized Nursing, p. 487.


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preferential treatment accorded civilian nurses and nurses' aides.70 Despite these difficulties, Wacs became valuable and integral parts of hospital staffs by the end of the war.71

Use of Prisoners of War in Army Hospitals

A final category of personnel which proved advantageous in the operation of hospitals in the United States was prisoners of war. Hospitals began to use them during 1944 and by the end of the year some general hospitals employed as many as two or three hundred each. They continued to be used until their repatriation in 1945. Normally, prisoners of war were not used in wards in the care of patients. The most common place for their employment was in kitchens and messes and on buildings and grounds. In some hospitals they served also in warehouses, motor pools, laundries, post exchanges, and orthopedic shops. Some prisoners had skilled trades and others were skilled technicians. Hospital commanders used them, when desirable, on jobs for which they had been trained. Generally, prisoners of war seem to have been an industrious, easily managed lot, who did their work efficiently and well so long as they were properly supervised.72

The record of the Medical Department's experience in manning hospitals leads to two conclusions. In the first place, during the earliest part of the war Army hospitals had larger staffs than they actually needed to maintain a satisfactory standard of care, for the Surgeon General's Office itself was agreeable to some reductions in 1944 when necessity required them. It is a moot point whether or not the reductions required by policies and practices of the War Department Manpower Board and ASF headquarters were too great. In the second place, experience showed that hospitals could be operated with a lower ratio of doctors and able-bodied enlisted men to total hospital staffs than had been thought possible. The Surgeon General's Office resisted the substitution of Medical Administrative Corps officers for doctors in administrative positions as well as the substitution of civilians, limited service enlisted men, and Wacs for able-bodied enlisted men; but when necessity or directives from higher authority compelled these steps to be taken experience proved that they were not disastrous.

This is not to say that the practice of reducing the staffs of hospitals and of substituting personnel of various kinds for able-bodied enlisted men had no adverse effect upon hospital operations. On the contrary, as shown above, changes in personnel created serious problems for hospital commanders. Furthermore, opinion differed about the effect of those changes upon the quality of professional care. Many hospital commanders reported that

70(1) Draft Ltr, SG to CG ASF, 23 Jul 45, sub: Discipline and Morale of ASF Trps. (2) Memo, Consultant Women's Health and Welfare Unit SGO for Chief Pers Serv SGO, 28 Jul 45, sub: Use of WAC in Army Med Instls. Both in SG: 322.5-1 (WAC).
71(1) Rpt, Subcmtee on Employment of Mil Med Resources to the Exec Sec, Cmtee on Med and Hosp Serv of the Armed Forces, 25 May 48, p. 542. HD. (2) Memo, Dep Dir Educ and Tng Div SGO for Spec Planning Div SGO, 17 Apr 46, sub: Wacs in Postwar Mil Estab. HD: 353 "WAC Gen."
72(1) An Rpts, 1944, Percy Jones, Ashford, Baker, Letterman, and Halloran Gen Hosps, and Cp Barkeley and Ft McClellan Regional Hosps; and An Rpts, 1945, Birmingham, Lovell, Baker, Baxter, and Ashford Gen Hosps and Waltham and Cp Shelby Regional Hosps. HD. (2) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, p. 192. HD: 337.


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they continued to maintain high standards; but some, as well as certain service command surgeons and indeed the chief of the Surgeon General's Hospital Division, believed that medical care suffered as a result of changes in both the quality and quantity of personnel assigned to hospital staffs.73

On the other hand, a group of nonmedical officers who investigated complaints of the hospital commander at Fort Jackson (South Carolina) during the spring of 1944 believed that many hospital commanders became "panicky" when faced with changes in their staffs and that most of their problems were capable of solution through "determined and efficient personnel management."74 Certainly the problems of hospital commanders would have been fewer and the possibility of adverse effects upon professional care less if changes eventually made in hospital staffs, as well as measures to improve personnel management in hospitals, had been initiated early in the war by the Medical Department itself.

73(1) See above, pp. 249-59. (2) Interv, MD Historians with Brig Gen Albert H. Schwichtenberg, 29 Apr 52. HD: 000.71.
74Proceedings, Bd of Offs Held at Ft Jackson, SC, 1-4 May 44, Pursuant to Verbal Orders CG [ASF]. HRS: SPGA/320.2 Med.

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