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Chapter XVI

Contents

CHAPTER XVI

Changes in the Organization and Equipment of Hospital Units Prepared for Overseas Service

Since hospitals operating in overseas theaters were less subject to The Surgeon General's authority than those in the zone of interior, they were largely unaffected by the movement, discussed in the foregoing chapter, to standardize organization and simplify administrative procedures. Nevertheless, certain changes in their organization and equipment were made before they left the United States. Changes in organization were primarily of two types: the creation of units that would supply larger numbers of beds without corresponding increases in personnel and the reduction of personnel authorized for hospitals of different types.

Trend Toward Use of Larger Units

One method of supplying greater numbers of beds to theaters without proportionately increasing the number of personnel was to emphasize the use of larger hospital units.1 Tables of organization for various sizes of station hospitals, ranging in capacity to 900 beds, had been developed during the early war years; but until the middle of 1944 a general hospital of only one size (l,000-bed capacity) was authorized. During the winter of 1943-44 the Technical Division of the Surgeon General's Office developed tables of organization, published in July 1944, for 1,500- and 2,000-bed general hospitals.2 Another method of supplying more beds with limited amounts of personnel-the use of convalescent facilities to receive the convalescent patients of general hospitals-was employed successfully in the United States and needed to be extended, in the opinion of the Surgeon General's Office, to theaters of operations. Tables of organization for l,000-bed convalescent camps and 3,000-bed convalescent centers were developed, but the General Staff would not include such units in the troop basis without requests from theaters. The latter were reluctant to requisition them because their capacities counted against fixed-bed quotas while their staffs were meager as compared to those of general

1See above, pp. 218-19.
2(1) T/O&E 8-550, Gen Hosp, 3 Jul 44. (2) An Rpt, Tec Div Oprs Serv SGO, FY 1945. HD.


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hospitals with equal numbers of beds.3 As a result, such units were not used widely, only four of each being activated in theaters and none in the United States. Instead, theaters requisitioned station and general hospital units to meet authorized quotas of beds and established convalescent facilities with personnel available from other sources.4

Cuts in Personnel of Hospital Units

As in zone of interior hospitals, reductions were made in the staffs of numbered hospitals. In compliance with a G-1 directive, the Surgeon General's Office in March 1944 reduced the ratio of nurses in station and general hospital units from 1 for every 9 or 10 beds to 1 for every 12. Thus the number authorized for a 1,000-bed general hospital was lowered from 105 to 83 and for a 750-bed station hospital from 75 to 63.5 Also in March, in consonance with the general policy of replacing physicians with administrative officers wherever possible, a War Department circular directed that both the executive officers and registrars of station and general hospitals should be Medical Administrative Corps officers. The Surgeon General protested that executive officers, who served as commanding officers in the absence of their superiors, needed professional training in medicine, and subsequently the General Staff amended the announced policy to permit Medical Corps officers to continue serving as executive officers of general hospitals.6 Meanwhile, the Surgeon General's Office was revising the tables of organization of both station and general hospitals, in order to reduce the number of Medical Corps officers and to increase the number of Medical Administrative Corps officers authorized for such units.7 In July 1944 the number of physicians in a 1,000-bed general hospital was reduced from 37 to 32. Three months later the number of Medical Corps officers in station hospitals was also reduced, that for a 250-bed station hospital, for example, dropping from 13 to 10 and for a 750-bed station hospital from 23 to 20. At the same time, the number of Medical Administrative Corps officers assigned to these units was increased, the number in a 1,000-bed general hospital rising from 7 to 10 and in a 750-bed station hospital from 10 to 12.8 No significant

3(1) Memo, SG for Dir Mil Pers Div ASF, 4 Aug 43, sub: Conv Cps. SG: 322.15-1. (2) T/O&E 8-595, Conv Cps (1,000-bed), 12 Jun 44. (3) T/O&E 8-591T, Conv Ctr (3,000-bed), 12 Jun 44. (4) Interv MD Historian with Col Arthur B. Welsh, 27 Dec 50. HD: 000.71. (5) Telewriter conv between Surg ETO and SG, 22 Oct 43. SG: 337.-1.
4An Rpt, MOOD SGO, FY 1945. HD.
5(1) DF WDGAP 320.21, ACofS G-1 WDGS to MPD ASF and SG, 8 Jan 44, sub: Nurse Pers Reqmts. HD: 211 (Nurse Reqmts). (2) T/O 8-550, Gen Hosp, C 3, 4 Mar 44. (3) T/O 8-560, Sta Hosp, C 3, 4 Mar 44.
6(1) WD Cirs 99, 9 Mar; 122, 28 Mar; and 152, 17 Apr 44. (2) Memo WDGCT 320.3 (11 Mar 44), ACofS G-3 WDGS for CG ASF, 25 Mar 44, sub: T/O&E 8-500 and T/O&E 8-550, with 4 inds. SG: 320.3-1.
7Ltr, SG to CG ASF, 17 Mar 44, sub: Revision of T/O&E 8-560, Sta Hosp, and Revision of T/O&E 8-550, Gen Hosp. SG: 320.3-1.
8(1) T/O 8-550, Gen Hosp, 1 Apr 42; C-2, 5 Oct 42; and T/O&E 8-550, Gen Hosp, 3 Jul 44. (2) T/O 8-560, Sta Hosp, 22 Jul 42, and T/O&E 8-560, Sta Hosp, 28 Oct 44. In 1948 the wartime chief of the Surgeon General's Mobilization and Overseas Operations Division stated that these cuts of Medical Corps officers had been too great. (Ltr, Col Arthur B. Welsh, MC, USA, 19 Apr 48, quoted in Rpt, Subcmtee on Employment of Med Resources, "Use of Med Resources," Cmtee on Med and Hosp Serv of Armed Forces, Off SecDef, 25 May 48. HD.) Several years later the number of Medical Corps officers in a 1,000-bed general hospital unit was further reduced to 28. (T/O&E 8-551, Gen Hosp, 3 Jul 50.) This final cut in physicians in general hospital units after the war represented a reduction of over 50 percent in the number of doctors authorized for a 1,000-bed general hospital in 1940.


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reductions were made in the latter half of the war in the number of Medical Corps officers or nurses authorized for evacuation hospitals.9 

In the spring of 1944 the General Staff directed reductions in the number of enlisted men in hospital units, as well as in those of units of other technical services.10 The Technical Division of the Surgeon General's Office complied with this directive by reducing in the table of organization of general hospitals the number of men who performed housekeeping functions. It overcompensated for that reduction by providing for the attachment to hospitals of personnel from other technical services.11 This meant that the number of enlisted men authorized for assignment to a 1,000-bed general hospital was reduced from 500 to 450, but that additional men could be supplied by attaching teams from nonmedical services, such as a Signal Corps team to operate communications systems and a Military Police team to supply interior and exterior guards.12 Subsequently, in the fall of 1944 cuts were made also in the number of enlisted men authorized for station hospital units but, as in the case of general hospitals, provision was made for the attachment of teams of men from other technical services.13While this change did not necessarily mean that the total number of men working in and around a hospital plant was always reduced, it actually had that effect in many instances because some theater commanders did not approve the use of the teams authorized by the War Department and desired by theater surgeons. As a result, the change was unpopular with many Medical Department officers, especially those in theaters who wished the personnel needed to perform station services for hospitals to be organic elements of hospital units and not dependent upon decisions and actions of theater staff officers. In this connection, it is significant that the chief complaint which theater Medical Department officers made about cuts in both enlisted and commissioned personnel in hospital units was not that they would endanger the care of patients but that they would reduce the ability of hospitals to expand beyond table-of-organization capacities.14

Another change designed to save personnel was made in the organization of the hospital-center unit. This unit, intended to operate a 1,000-bed convalescent camp and to perform certain administrative services common to all hospitals in a center, was authorized 29 officers, 4 warrant officers, 1 nurse, and 255 enlisted

9Compare T/O&E 8-581, Evac Hosp, Semimobile, dated 26 Jul 43 with that dated 25 Mar 44, and T/O 8-580, Evac Hosp, 23 Apr 43, with T/O&E 8-580, Evac Hosp, 31 Jan 45.
10Memo, Dir Tec Div SGO for Chief Oprs Serv SGO, 17 Apr 44, sub: T/O&E 8-550, Gen Hosp. SG: 320.3-1.
11Memo, Dir Tec Div SGO for SG thru Chief Oprs Serv, 20 Apr 44, with incl. SG: 320.3-1.
12(1) T/O 8-550, Gen Hosp, C 4, 16 May 44. (2) WD Cir 256, 16 Oct 43.
13Ltr, SG to CG ASF, 21 Jul 44, sub: Revision to T/O&E 8-550, Sta Hosp. SG: 320.3-1. Compare T/O&E 8-560, Sta Hosp, 28 Oct 44, with T/O 8-560, Sta Hosp, 22 Jul 42.
14(1) Memo, Off Chief Surg Hq ETO for SG, 14 Jul 44, sub: Difficulties Presently Being Encountered in the Med Serv, ETO. HD: MOOD "ETO." (2) Memo, Dep Chief Plans and Oprs SGO for Dir Tec Div SGO, 21 Sep 44, with routing slip. SG: 320.3-1. (3) Ltr AG 320.3(14 Aug 44) OP-I-WDGCT-M, TAG to COs and CGs in TofOpns, 28 Nov 44, sub: Revised T/O&E 8-560, Sta Hosp. SG: 320.3-1. (4) Memo, Plans and Oprs MTO for Maj Gen [Morrison C.] Stayer, 25 Dec 44, sub: Memo for Dir Hosp Div SGO, 31 Oct 44, with incl. SG: 320.3 "T/Os Apr-Jun 45." (5) Memo, Dep Dir MOOD SGO for Insp Br SGO, 14 Aug 45, sub: Comments on Rpt by Col [Floyd L.] Wergeland and Lt Col Moorhead ref their visit to SWPA and POA. HD: MOOD "Pacific." (6) Rpt, Gen Bd USFET, "Orgn and Equip of Med Units," Study No 89. HD: 334 (ETO).


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men until the early part of 1944.15 During that year the belief developed that no saving in personnel was gained by concentrating hospitals and then providing them with increased overhead personnel.16 Furthermore, separate tables of organization had been developed for convalescent camps and convalescent centers. The old table of organization for hospital centers, in consequence, was superseded in April 1944 and a hospital center headquarters, consisting of 7 officers, 1 warrant officer, 1 nurse, and 23 enlisted men, was authorized.17 This headquarters was not expected to operate a convalescent camp and it was to borrow any additional personnel it needed for the performance of its functions from general hospitals located in the center. Only two of the hospital centers activated under the old table of organization were sent overseas. The other eight were inactivated and their personnel used in units of other types.18 Toward the end of the war, six hospital center headquarters were activated under the new table of organization in the Southwest Pacific and sixteen in the European theater.19

New Hospital Units

Although emphasis in the latter half of the war was less upon the development of new hospital units than upon the use-through improvisation, if necessary-of Medical Department units already available, two new hospital units were developed and a third was proposed. In response to a request from the chief surgeon of the European theater for a hospital that would specialize in the treatment of neuropsychiatric cases, the Surgeon General's Office developed a table of organization in the latter half of 1943 for a neuropsychiatric general hospital. It was published in October.20 The second hospital developed was for use in forward areas. In the absence of small surgical hospitals that were highly mobile, the need to treat and hold near the front lines nontransportable casualties (those who could not be moved immediately without danger to their lives) was met throughout most of the war by improvisation. During 1945 the Ground Surgeon and surgeons of some forces in combat zones proposed publication of a table of organization for a unit to meet this need. The Surgeon General opposed this development, believing that the reinforcement of available units-such as platoons of field hospitals -with surgical teams met the need adequately and at the same time promoted flexibility in the use of scarce categories of officers. The former view finally prevailed and on 23 August 1945 a table of organization for a 60-bed mobile army surgical hospital was published.21 The third hospital, proposed but not developed, was also intended for use

15T/O 8-540, Hosp Ctr, 1 Apr 42.
16Speech, Med Hosp, Evac, and Sanitation, by Maj John S. Poe, MC, SGO, 11 Feb 44. HD: 322 (Hosp).
17T/O&E 8-500, MD Serv Orgn, 23 Apr 44.
18The 12th and 15th Hospital Centers were shipped to the European theater; the 9th, 10th, 11th, 16th, 17th, 18th, 19th, and 24th were inactivated. An Rpts. HD.
19(1) Quarterly Rpts, 1945, 26th, 27th, 28th, 29th, 30th, and 31st Hosp Ctrs. HD. (2) An Rpts, 1945, 801st, 802d, 803d, 804th, 805th, 806th, 807th, 808th, 809th, 812th, 813th, 814th, 815th, 818th, 819th, and 820th Hosp Ctrs. HD.
20(1) Telewriter conv, Surg ETO and SGO, 9 Aug and 22 Oct 43. SG: 337.-1. (2) Memo, CG ASF for AG, 26 Oct 43, sub: T/O&E 8-550S, Gen Hosp (1,000-bed) NP, ComZ, with Memo for Record. AG: 320.2 (13 Jul 43)(4). (3) T/O&E 8-550S, Gen Hosp, NP, 26 Oct 43.
21(1) Memo, Lt Col C[lifton] F. Von Kann for ACofS G-4 WDGS, 11 Aug 45, sub: Conf Rpt, Proposed Mobile Army Surg Hosp, T/O&E 8-571. HRS: G-4 files, "Hosp, vol. IV." (2) T/O&E 8-571, Mobile Army Surg Hosp, 23 Aug 45. Additional documents on this subject are on file in SG: 320.3.


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in forward areas. Both in theaters of operations and in the Surgeon General's Office there was a belief that a small hospital was needed near the front lines to treat neuropsychiatric casualties who could be salvaged for further duty. A table of organization for such a unit was never published and theaters met this need by improvisation.22

Changes in Supplies and Equipment

During the latter part of the war changes occurred in both the medical and nonmedical equipment of hospitals. As a result of changes and improvements in pharmaceuticals and biologicals and of the accumulation of experience in the operation of hospitals under various sets of conditions in different parts of the world, the Surgeon General's Office made three complete revisions and several partial revisions of Medical Department equipment lists between the middle of 1943 and the end of 1945. Revision of these lists involved the selection of types and amounts of pharmaceuticals and biologicals, of surgical instruments and other operating room equipment, of X-ray and laboratory equipment, of ward equipment, and of other Medical Department items needed by hospitals of different types for the performance of their missions. These revisions, made by the Surgeon General's Organization and Equipment Allowance Branch, were based on combat experience as revealed by reports of essential technical medical data (ETMD's), interviews with officers who served overseas, and inspections of theater medical services; on changes in the size and personnel of units; and on the advice and recommendations of the Professional and Preventive Medicine Services of the Surgeon General's Office, the Army Medical Center, and the National Research Council. A significant administrative feature of these revisions was the consolidation and publication during 1944 and 1945 of equipment lists as parts of the medical section of the ASF supply catalog and their distribution by the Adjutant General's Office. Until that time, such lists had been issued in mimeograph form by the Medical Department alone. Items added to them made available to hospitals the newer drugs and biologicals and improved items of equipment developed during the war.23

Changes in the nonmedical equipment of hospital units revolved around the problem of supplying items of equipment necessary for station services, or housekeeping functions. The chief question was whether such equipment would be included in tables of equipment of hospitals, and therefore supplied automatically, or whether it would not be included, and supplied only when and if theater commanders requested it. Types of nonmedical equipment which demanded the attention of the Surgeon General's Office were those needed for such station services as laundries, electric lighting systems, and telephone communications systems.

Inspections of theater medical services by Surgeon General Kirk and his chief of Professional Services in the middle of 1943 revealed what they considered to be inadequate laundry service for hospitals in both the North African and Southwest

22(1) Ltr, Surg Fifth Army to SG thru Surg MTOUSA, 22 Jun 45, sub: Mobile Med Hosp. SG: 320.3. (2) An Rpt, NP Consultants Div SGO, FY 1945. HD.
23(1) History of Organization and Equipment Allowance Branch [SGO], 1939-44. HD. (2) An Rpt, Sup Serv SGO, FY 1944. HD. (3) An Rpt, Orgn and Equip Allowance Br Oprs Serv SGO, FY 1944. (4) An Rpt, Tec Div Oprs Serv SGO, FY 1945. Copies of the Equip Lists are on file, HD.


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Pacific theaters. In their opinion this resulted from lack of sufficient numbers of laundries and from the use of improper types of laundry equipment. On 5 June 1943 The Surgeon General informed ASF headquarters of the improvements he considered necessary.24 As a result, the offices of The Quartermaster General and The Surgeon General collaborated in changing washing formulae and laundry equipment to improve the quality of service which laundries afforded hospitals.25

The provision of adequate amounts of laundry equipment and of sufficient numbers of laundry operators was more complicated. On 1 July 1943 The Quartermaster General informed ASF headquarters that there was sufficient laundry equipment in this country to meet the needs of theaters, provided the latter requested its shipment.26 Theater opinions of what constituted an adequate laundry service differed from The Surgeon General's, for theaters accepted lower standards of service than he considered desirable.27 He wished, therefore, to find some way to assure that sufficient laundry equipment and personnel would be shipped with each hospital unit. The director of the ASF Planning Division, on the other hand, felt that theater commanders, with the advice and help of their surgeons, should determine the laundry services needed and request the War Department to supply the necessary equipment and personnel.28 The ASF view prevailed and in August 1943 theater commanders were reminded of the necessity of planning in advance for the laundry service of hospitals but were informed that the War Department would not supply them with laundry equipment and personnel unless such were requested.29 During the following year, after the General Staff authorized the attachment of technical-service teams to units of other technical services, revised tables of organization and equipment of hospital units carried a statement that Quartermaster Corps laundry teams were authorized for attachment to hospitals when theater commanders requested them.30 Although this served as a reminder to theater staffs that they had to make specific provisions for hospital laundry services, it left to theaters considerable discretion in the matter and the Surgeon General's Office continued its unsuccessful attempt to have laundry equipment and personnel made integral parts of numbered hospitals.31

24(1) Ltr, SG to CG ASF, 5 Jun 43, sub: Laundry Fac in TofOpns. SG: 486.3. (2) Memo, Col R[obert] B. Skinner for the Record, 8 Jul 43, sub: Gen [Charles C.] Hillman's Trip to SWPA. Ground Med files, Chronological file (Col Skinner). (3) Memo, SG for CG ASF, 10 Aug 43, sub: Interim Progress Rpt: Steps Taken During First Sixty Days Since Apmt as SG. SG: 024.-1.
25Ltr, SG to CG ASF, 5 Jun 43, sub: Laundry Fac in TofOpns, with 1st, 2d, and 4th inds. SG: 486.3.
26Memo SPAOG 331.5, Dir Oprs ASF for Dir Planning Div ASF, 23 Jun 43, sub: Laundries and Laundry Equip, with 1st ind. HD: Wilson files, "Day File, Jul 43."
27(1) Memo, Col Arthur B. Welsh, MC for Dep SG, 13 Aug 43, sub: Data for Gen Somervell. SG: 486.3. (2) Memo, Dep SG for CG ASF, 16 Aug 43, sub: Interim Progress Rpt. HRS: ASF Control Div, 319.1 "SGs Interim Rpt, G-56."
28(1) Memo, Col Arthur B. Welsh, MC for Dep SG, 1 Jul 43, sub: Laundry for Overseas Hosps. SG: 331.5. (2) Memo, Maj John S. Poe for Col [Howard T.] Wickert, 16 Jul 43. SG: 414.4-5. (3) Historical Record, Laundry Section, Hospital Division [SGO], 1 July 1944, p. 18. HD: 024.
29Memo SPOPP 008, CG ASF for TAG, 3 Aug 43, sub: Aux Fac for Fixed Hosps. SG: 632.-1.
30(1) T/O&E 8-581, Evac Hosp (400-bed), 25 Mar 44. (2) T/O&E 8-550, Gen Hosp, 3 Jul 44. (3) T/O&E 8-560, Sta Hosp, 28 Oct 44. (4) T/O&E 8-580, Evac Hosp (750-bed), 31 Jan 45.
31Ltr, SG to CG ASF attn Dir Mob Div, 10 May 45, sub: Tables of Orgn and Equip. SG: 320.3. Success came after the war. For example, see T/O&E 8-566, Sta Hosp, 500-bed, ComZ, and T/O&E 8-551, Gen Hosp, 1,000-bed, ComZ. Reviewing the experiences of World War II several years after its end, the former chief of the Surgeon General's Mobilization and Overseas Operations Division pointed out the failure to solve this problem. (Extract from Ltr, Col Arthur B. Welsh, MC, 19 Apr 48, quoted in "Use of Med Resources," Rpt by Subcmtee on Employment of Mil Med Resources to Hawley Bd, 25 May 48, p. 346. HD: 334.)


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A similar problem arose in connection with electric lighting equipment. The Surgeon General's Office recommended that such equipment, including electric generators, should be specifically listed in tables of equipment of hospital units to insure its being provided for each.32 During 1944 and 1945 this action was taken for field and evacuation hospital units; but electric lighting equipment was not included during the war in tables of equipment for general and station hospitals, convalescent hospitals, and convalescent camps and centers. Instead, a War Department memorandum placed upon the Chief of Engineers responsibility for furnishing electric lighting equipment, including generators, to such units when they received orders to move to theaters.33 

At the beginning of the war the table of basic allowances for the Medical Department authorized telephone and switchboard equipment for the 750-bed evacuation hospital only. During the early part of the war, the tables for general and convalescent hospitals were revised to include that equipment. Similar action was taken for station and 400-bed evacuation hospitals during the latter part of the war.34

Other significant changes in the equipment of hospital units were additions of tool chests of various sorts. Experience showed that hospital personnel in many instances had to perform much maintenance work and that the number of tool chests previously provided was insufficient. Consequently, in successive revisions of tables of equipment of hospital units there were added tool chests for carpenters, refrigeration mechanics, electricians, plumbers, automobile mechanics, and the like.35

32An Rpt, Tec Div Oprs Serv SGO, FY 1945. HD.
33(1) T/O&E 8-510, Fld Hosp, C 3, 24 Mar 44. (2) T/O&E 8-581, Evac Hosp (400-bed), 25 Mar 44. (3) T/O&E 8-580, Evac Hosp (750-bed), 31 Jan 45. (4) WD Memo W 100-44, 9 May 44. HD: 412.-1. (5) WD Memo 100-45, 31 Mar 45. AG: 412 (5 May 44) (1).
34(1) T/BA 8, MD, 1 Oct 41. (2) T/BA 8, MD, 15 Jul 42; C 1, 29 Aug 42. (3) T/O&E 8-560, Sta Hosp, 28 Oct 44. (4) An Rpt, Strategic and Logistic Planning Sec MOOD SGO, 5 Jun 45 (HD), stated that switchboards and communications equipment had been provided for 400-bed evacuation hospitals. However, a search of the T/O&E for this hospital does not disclose such authorization until publication of T/O&E 8-581 on 11 January 1949.
35For example, see (1) T/E 8-560, Sta Hosp, 28 Dec 43. (2) T/O&E 8-581, Evac Hosp (400-bed), 25 Mar 44. (3) T/O&E 8-510, Fld Hosp, 31 Mar 44. (4) T/O&E 8-550, Gen Hosp, 3 Jul 44. (5) T/O&E 8-560, Sta Hosp, 28 Oct 44. (6) T/O&E 8-580, Evac Hosp (750-bed), 31 Jan 45.

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