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Chapter XVIII

Contents

CHAPTER XVIII

Return to a Peacetime Basis

With the war's end, first in Europe and then in the Pacific, pressure to return to a peacetime basis was so great that hospital resources built up over a period of more than five years were liquidated in little over a year. This process was first completed in overseas theaters.

Redeployment and Demobilization of Numbered Hospital Units

The peak of hospital beds in overseas theaters was reached in May 1945, when there were in all theaters 343,975 fixed hospital beds and 85,975 mobile hospital beds. Of these, the greatest number were in the European theater, which at that time had 200,350 fixed beds and 58,200 mobile beds.1 With the approach of V-E Day, the War Department placed emphasis upon evacuating as many patients as possible from both the European and Mediterranean theaters, in order to make full use of shipping space that would later be diverted to the Pacific and to free as many hospital units as possible for redeployment after the defeat of Germany.2 In April 1945 the 60-day evacuation policy which Europe had been following on a de facto basis for several months was made official for both the European and Mediterranean theaters.3 After V-E Day, as both troops and patients were moved out of these theaters, plans were made to ship some of their hospital units direct to the Pacific, some to the United States for later shipment to the Pacific, and some to the United States for inactivation.4 As a result, by August 1945 the number of fixed beds in the European theater decreased to 141,850 and of mobile beds to 50,775.5 In that month it was possible to place both the European and Mediterranean theaters on an inactive basis-that is, to reduce their establishments to the requirements of occupation forces. Their evacuation policies were therefore set at 120 days and their fixed-bed ratios at 4 percent.6

1Statistics Branch, Control Division, Hq. ASF, Statistical Review, World War II: A Summary of ASF Activities (n d), App R, p. 243 (cited hereafter as Statistical Review, World War II).
2(1) Ltr WDGDS 10303, Dep ACofS G-4 WDGS to CofSA, 17 Mar 45, sub: Evac of Pnts from ETO, with 3 incls. HRS: G-4 files, "Hosp, vol. III." (2) Cablegram CM-OUT-65962, WD to Hq ComZ ETO, 10 Apr 45. Same file. (3) Memo, SG for ACofS G-4 WDGS, 11 Apr 45, sub: Evac Policy with Spec Ref to ETO. SG: 705.
3
S/S WDGDS 11921, ACofS OPD WDGS to CofSA, 18 Apr 45, sub: Proposed Change in Evac Policy for ETO and MTO. HRS: G-4 files, "Hosp, vol. III."
4(1) ASF Monthly Progress Rpt, Sec 7. Health, 30 Jun 45, p. 34. (2) ASF Monthly Progress Rpt, Sec 7, Health, 31 Jul 45, p. 29.
5Statistical Review, World War II, App R, p. 243.
6(1) Rad CM-IN-19035 (19 Jul 45), TERMINAL to WD, 19 Jul 45. SG: 705. (2) Memo, Lt Col E[dward] C. Spaulding, GSC for ACofS G-4 WDGS, 27 Jul 45, sub: Reduction of Fixed Hosp Bed Basis in ETO. HRS: G-4 files, "Hosp, vol. IV." (3) Memo, SG for ACofS G-4 WDGS, 10 Sep 45, sub: Recommended Reduction in Fixed Beds in ETO and MTO to 4 percent. SG: 632.2. (4) Rad CM-OUT-63182, WAR to CG ETO and MTO, 12 Sep 45. HRS: G-4 files, "Hosp, vol. IV." (5) Memo SPOPP 370.05, Act Dir Plans and Oprs ASF for SG and CofT, 24 Jul 45, sub: Evac Policy ETO. SG: MOOD "ETO." (6) Rad CM-OUT-46451 (Aug 45), COMGENSERV to CG USAF MTO, 8 Aug 45. SG: 705.


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With redeployment, the number of fixed and mobile beds in the Southwest Pacific increased from 67,250 in May 1945 to 82,700 in August 1945. Meanwhile, the number of beds in other areas of the Pacific declined from 37,600 to 32,700.7 The surrender of Japan in August heralded a cancellation of the shipment of further hospital units to the Pacific8 and a repetition of the process that had been followed in Europe of clearing hospitals of patients by evacuating them to the United States. Early in August, the War Department directed the Pacific-which in April had been placed under a single command-to use all evacuation facilities available, reducing the evacuation policy to 60 days if necessary.9 The next month it was possible to plan to place that area on an inactive basis. The War Department therefore directed it to return to a 120-day policy effective 1 December 1945 and to comment on a proposed reduction of its bed ratios to 4.8 percent.10 Before this reduction was actually made, the Surgeon General's Office and the General Staff turned to re-examining the needs of all theaters.

By the end of October 1945 the number of beds in fixed hospitals in theaters of operations had been reduced, through the inactivation of some units in theaters and the return of others to the United States, from a peak of 343,975 in May 1945 to 236,050.11 This reduction was not great enough to return physicians, dentists, and nurses to civilian life as rapidly as the public and the Congress desired, and in November 1945 both the Secretary of War and the Chief of Staff of the Army took personal interest in speeding that process. Consequently, G-1 called a conference of representatives of other General Staff divisions, of AAF, AGF, and ASF headquarters, and of the Surgeon General's Office. At this conference it was agreed that the Surgeon General's Office would make studies of the requirements of various theaters for beds during demobilization and would submit recommendations for changes in authorized ratios.12 During November and December 1945 such studies were completed and the General Staff requested theaters to comment on the proposals of The Surgeon General. Aside from a recommendation that the authorized bed ratio of each theater be reduced, his most important proposal was the application of that ratio to beds not only in fixed hospitals but also in mobile hospital units that retained professional staffs of physicians, dentists, and nurses. The reason that The Surgeon General now proposed what he had protested against in August 1943-that is, the use of a single ratio for authorizing beds in both fixed and mobile hospitals-was that the need for mobile hospitals to support troops in combat had vanished with the cessation of hostilities. The only possible excuse for a theater's keeping professional staffs in the mobile units left there was to use these units as fixed hospitals. The Surgeon General's proposals were approved and as a result of studies by his Office and

7Statistical Review, World War II, App R, p. 243.
8ASF Monthly Progress Rpt, Sec 7, Health, 31 Aug 45, p. 13. HD.
9Memo, C. M. Ankcorn for ACofS G-4 WDGS, 10 Aug 45, sub: Evac from Pacific Theater. HRS: G-4 files, "Hosp, vol. IV."
10(1) Memo, Dir MOOD SGO for Record, 24 Sep 45. SG: MOOD "Pacific." (2) Rad CM-OUT-70899 (Sep 45), WARGFOUR to CINCAFPAC, 27 Sep 45. SG: 705. (3) Rad CM-IN-2145, CINCAFPAC to WD, 4 Oct 45. HRS: G-4 files, "Hosp, vol. IV."
11Statistical Health Rpts. Off file, Health Rpts Br Med Statistics Div, SGO.
12Memo, Lt Col Johnnie R. Dyer, GSC for ACofS G-4 WDGS, 26 Nov 45, sub: Delays in Discharge of Doctors and Dentists. HRS: G-4 files, "Hosp, vol. IV."


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of comments by theaters, the General Staff in December 1945 authorized a bed ratio of 4 percent for all theaters except the American, which was to continue on a 3 percent basis.13 In consequence, the number of beds in fixed hospitals and professionally staffed mobile hospitals decreased rapidly until by the end of May 1946 there were only 42,100 such beds in all theaters.14

Contraction of the Zone of Interior Hospital System

Soon after V-E Day G-4 began to put considerable pressure upon ASF, and that headquarters in turn upon the Surgeon General's Office, to estimate general and convalescent hospital requirements in the United States through the first quarter of 1946 and to make plans to reduce the number of beds accordingly.15 Emphasis was placed upon planning for the contraction of the general-convalescent hospital system because the reduction and closure of station and regional hospitals, dependent primarily upon the reduction and closure of posts where they were located, had already begun and would continue under established procedures. After V-E Day, G-4 called for revised estimates of requirements and The Surgeon General projected forward to the end of 1946 his plans for shrinking the general-convalescent hospital system.16

In estimating bed requirements at this time, there still were uncertainties to contend with. Before V-J Day the number of battle casualties that would occur and the number of patients to be evacuated monthly from the Pacific were of course unknown. In addition, there was uncertainty about the amount and rate of redeployment of troops to the Pacific through the United States and the speed with which German prisoners of war would be repatriated.17 After V-J Day some of these difficulties vanished but additional factors appeared. Among them were the rate at which the Army would be demobilized; the time required to treat patients for secondary diagnoses; the number of soldiers that would be found at separation centers to need hospitalization, especially for tuberculosis and deafness, before their discharge from the Army; and delays that the shortage of specialists might occasion in the disposition of patients already under treatment, particularly plastic surgery and amputation cases.18

In view of these uncertainties and difficulties, the Resources Analysis Division of the Surgeon General's Office presented to G-4 "conservative" estimates of the number of beds that could be eliminated each quarter, in order to protect the Medical Department against the possibility of having too few beds for any reason. For example, the number of patients who would

13ASF Monthly Progress Rpt, Sec 7, Health, 31 Dec 45, p. 17, HD. The studies made by the Surgeon General's Office, the comments of theaters, and the documents in which the Staff authorized new bed ratios are filed in HRS: G-4 files, "Hosp, vol. V."
14ASF Monthly Progress Rpt, Sec 7, Health, 31 May 46, p. 22. HD.
15(1) Diary, Resources Anal Div SGO, 16 Jun 45. HD: 024.7-3. (2) DF WDGDS 15204, ACofS G-4 WDGS to CG ASF, 23 Jun 45, sub: ZI Hosps. HRS: Hq ASF Planning Div file, 700 "ZI Hosp." (3) T/S SPOPP 702 (25 Jun 45), CG ASF to SG, 27 Jun 45, sub: ZI Hosps. Same file.
16(1) DF WDGDS 2399, ACofS G-4 WDGS to CG ASF attn SG, 18 Aug 45, sub: ZI Hosps. SG: 322 "Hosp." (2) Memo, SG for ACofS G-4 WDGS thru CG ASF, 14 Sep 45, sub: Cut-back in Gen and Conv Hosp Fac. Same file.
17Memo, SG for ACofS G-4 WDGS, 8 Jun 45, sub: Hosp Fac. SG: 322 "Hosp."
181st ind, SG to CG ASF, 28 Nov 45, on Memo SPOPP 705, CG ASF for SG, 9 Nov 45, sub: Cut-back in Gen and Conv Hosp Fac, ZI. SG: 323.3 (Gen Hosp).


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need beds in November was used as the number who would need them in December, and to this number were added additional beds that would be vacant either because of dispersion or because some patients were absent from hospitals on leave and furlough.19 On 14 September 1945 The Surgeon General informed G-4 that the capacities of general hospitals could be reduced by 40,000, 38,000, and 39,000 beds and of convalescent hospitals by 21,000, 14,000, and 8,000 beds during the last quarter of 1945 and the first two quarters of 1946, and that 16,000 additional general hospital beds could be eliminated during the last half of 1946. In December this program was revised, chiefly to speed the liquidation of the convalescent hospital system.20

Soon after V-E Day the Resources Analysis Division had established a procedure for reducing the number of beds in general and convalescent hospitals. It involved closing entire hospitals rather than parts of all of them, in order to free more physicians for return to civilian life-a matter that was to assume increasing importance as the press, the public, and the Congress continued to clamor for their release. For example, a reduction of the capacities of five 2,500-bed hospitals by 500 beds each would release only 25 physicians while the closure of one 2,500-bed hospital would release 60.21 This decision having been made, the Division established certain broad principles to govern the selection of particular hospitals for closure during successive quarters. They were as follows: leased buildings should be returned to their owners, and hospitals needed by other government agencies, such as the Veterans Administration, should be transferred to these agencies as soon as possible; hospitals in heavily populated areas should be retained to permit the hospitalization of patients near their homes; hospitals that were less desirable because of climate and construction should be closed before others; hospitals needed for the postwar Army and for station hospital purposes should be retained; and hospitals designated as specialized centers for long-term cases, such as amputation and neurosurgery cases, should be retained as long as possible in order to keep to a minimum the transfer of those patients to other hospitals.

In some instances, these principles conflicted with one another. For example, Halloran and Mason General Hospitals were located in leased buildings and McGuire and Vaughan were desired by the Veterans Administration, but they were also situated in areas of dense population where many beds were needed. Lovell and Tilton General Hospitals were of poor construction, being among the first of the cantonment-type general hospitals constructed during World War II, but were located on Army posts and might be needed for station hospital use. These con-

19(1) Statement by Eli Ginzberg, Dir Resources Anal Div SGO, in Notes on Morning Sess of SvC Surgs Conf, 27 Sep 45. HD: Resources Anal Div files, "Hosp." (2) Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 7 Jun 45, sub: Criteria for Reduction in Hosp Fac. SG: 323.3 (Hosp).
20(1) Memo, SG for ACofS G-4 WDGS thru CG ASF, 14 Sep 45, sub: Cut-back in Gen and Conv Hosp Fac. SG: 322 "Hosp." (2) Memo, SG for ACofS G-4 WDGS thru CG ASF, 21 Dec 45, same sub. SG: 323.3 (Hosp).
21(1) Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 7 Jun 45, sub: Criteria for Reduction in Hosp Fac. SG: 323.3 (Hosp). (2) Statement by Eli Ginzberg, Dir Resources Anal Div SGO, in Notes on Morning Sess of SvC Surgs Conf, 27 Sep 45. HD: Resources Anal Div file, "Hosp." (3) Ltr, SG to CGs SvCs attn Surg, 20 Dec 45, sub: Comparative Studies of Gen-Conv and Sta-Regional Hosp Systs. SG: 323.3 (Hosp).


304-313

TABLE 15-U.S. ARMY GENERAL HOSPITALS IN THE UNITED STATES DURING WORLD WAR II


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flicts complicated the selection of hospitals to be closed.22

In addition, the needs of both the Veterans Administration and the postwar Army had not been fully determined.23 Finally, local citizens sometimes protested the closure of hospitals, and service command surgeons, because of local conditions, disagreed with some of the decisions made in the Surgeon General's Office.24 Despite these difficulties, the program for closures drawn up in the fall of 1945 was followed with comparatively few changes.

The actual process of closing hospitals was a responsibility of service command officials until April 1946, when general hospitals were placed again, as they had been before the war, under the direct command of The Surgeon General. ASF headquarters informed service commanders of the hospitals that would be closed each quarter; the Surgeon General's Office decided the particular dates on which they would be closed; and several months prior to those dates the Medical Regulating Officer "blocked" those hospitals-that is, permitted no more patients to be sent to them. After hospitals were blocked, service commanders were required to revise authorized bed capacities twice monthly and to reduce personnel in accordance with these revisions. Hospital commanders submitted information which higher authorities needed in order to declare as surplus the property no longer required by the Army. They also disposed of hospital personnel, supplies, and equipment under procedures established by ASF headquarters. After hospital buildings were declared surplus, the Medical Department lost all control over them and they were disposed of by other government agencies.25 In order to assure the reduction and closure of hospitals according to schedule, the Surgeon General's Resources Analysis Division each month analyzed hospitalization reports from service commands and called the attention of local Army authorities to any failures in making reductions.26 Beginning in July 1945, in compliance with instructions from G-4, The Surgeon General reported monthly to that Division the progress made in contracting the hospital system.27

Under these procedures the Medical Department moved from a wartime to a peacetime basis for hospitalization in the United States in approximately a year's time. By July 1946 all of the convalescent hospitals but one, the Old Farms Convalescent Hospital for the blind, had been closed.28 By December of that year all regional hospitals either had been closed or

22Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 4 Sep 45, sub: Plan for Post V-J Day Reduction in Gen Hosp Fac. SG: 323.3 (Gen Hosp).
23(1) Ltr, Dep SG to VA, 29 Dec 45. SG: 323.3 (Gen Hosp). (2) Memo, SG for ACofS G-4 WDGS thru CG ASF, 5 Sep 45, sub: Comd Instls for Retention in Post-War Mil Estabs. SG: 370.01.
24(1) Ltr, SG to Hon Francis J. Meyers, 28 Jan 46. SG: 323.3 (Hosp). (2) Ltr, SG to Mrs Dorothy Finn, Stockton, Calif, 15 Jan 46. Same file. (3) Statements by SvC Surgs in Notes on Morning Sess of SvC Surgs Conf, 27 Sep 45. HD: Resources Anal Div file, "Hosp."
25(1) Memo, SG for Dir Mob Div ASF, 24 Sep 45, sub: Closure of ZI Gen Hosps. SG: 322 "Hosp." (2) Ltr SPMOC 632, CG ASF to Serv Comdrs, 2 Oct 45, sub: Closure of Gen Hosps. Same file. (3) Diary, Resources Anal Div SGO, 13 Dec 45. HD: 024.7-3. (4) Notes on Morning Sess of SvC Surgs Conf, 27 Sep 45. HD: Resources Anal Div file, "Hosp."
26Ltr, SG to CGs SvCs attn Surg, 7 Nov 45, sub: Comparative Studies of Gen-Conv and Sta-Regional Hosp Systs. SG: 323.3 (Hosp). Similar letters for other months are found in the same file.
27Memo, SG for ACofS G-4 WDGS, 15 Jul 45, sub: Hosp Fac. HRS: G-4 files, 334 vol. II. Similar letters for other months are found in this same file and in SG: 322 (Hosp).
28Weekly Hosp Rpt, vol. II, No 27, for week ending 5 Jul 46. Off file, Med Statistics Div SGO.


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had reverted to station hospitals.29 By the beginning of 1947 the Army (including the Air Forces) had only 54 station hospitals with 15,715 beds, only 14 general hospitals with 34,846 beds, and only 1 convalescent hospital (Old Farms) with 100 beds.30 A comparison of bed authorizations for general and convalescent hospitals during successive quarters of 1945 and 1946 with the program for bed reductions prepared by the Surgeon General's Office in the fall of 1945 shows that the program was followed closely. The chief deviation occurred in a more rapid liquidation of convalescent hospitals than had been anticipated. A comparison of "patients remaining" in general and convalescent hospitals with authorized beds shows a close correlation between reductions in the patient-load and in hospital beds. As in earlier months, the number of beds occupied continued to be considerably smaller than either the number of beds authorized or the number of patients remaining.31 (See Table 15; also Chart 10.)

29(1) Weekly Hosp Rpt, vol. III, No 49, for week ending 6 Dec 46. Off file, Med Statistics Div SGO. (2) WD GO 148, 11 Dec 46.
30Information furnished by Resources Analysis Division, SGO, 4 Dec 50. The fourteen general hospitals were Army and Navy, William Beaumont, Fitzsimons, Letterman, Walter Reed, Brooke, Madigan, Oliver, Percy Jones, Tilton, Valley Forge, McCornack, Murphy, and Pratt. The last three had been designated general hospitals in May 1946 by WD GO 45, 15 May 46.
31(1) Memo, SG for ACofS G-4 WDGS thru CG ASF, 14 Sep 45, sub: Cut-Back in Gen and Conv Hosp Fac. SG: 322 "Hosp." (2) Memo, SG for ACofS G-4 WDGS thru CG ASF, 21 Dec 45, same sub. SG: 323.3 "Hosp." (3) Weekly Hosp Rpts, vol. II, No 52, for week ending 28 Dec 45; vol. III, No. 13, for week ending 29 Mar 46; vol. III, No 26, for week ending 28 Jun 46; and vol. III, No 52, for week ending 27 Dec 46. Off file, Med Statistics Div SGO.

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