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Chapter XXII

Contents

CHAPTER XXII

Providing the Means for Evacuation by Land

Supplying enough ambulances and rail cars of suitable types for the transportation of patients in the United States and in overseas areas was a continuing problem. Plans for improved types were being made before the war started, and when it ended new ones were still being developed and ordered. Numerous difficulties were encountered in this process, as well as in manning and equipping hospital trains.

Motor Ambulances

Of all conveyances the motor ambulance was the most widely used and transported the largest number of patients. The type in greatest use was the general-service ambulance. Capable of serving in training camps in the United States as well as in communications and combat zones of theaters of operations, it was called at different times the field ambulance, the station ambulance, and the cross-country ambulance. Others of more specialized-and therefore more limited-use were the metropolitan and multipatient ambulances.

General-Service Ambulances

Because general-service ambulances were basic conveyances for patients in both peace and war, experiments to improve them were made between World Wars I and II. In 1932 a field ambulance on a (4 x 2)1 chassis of 1-ton capacity was developed by the Medical Department Equipment Laboratory and by 1939 it had replaced ambulances of World War I type. Although this ambulance was designed for use at Army posts and camps in the United States as well as for field service with tactical units, it was not entirely satisfactory for either. It rode too roughly and was too poorly heated and ventilated for the comfort of patients in the United States, and it got stuck in the mud too easily for satisfactory service in the field or in forward areas of theaters of operation.2 The Surgeon General's Office concluded that heavier ambulances, perhaps of the metropolitan type normally used by civilian hospitals, should be used not only at Army hospitals in the United States but also in communications zones of theaters, and that a light ambulance, able to oper-

1That is, having four wheels, two of which were attached to the engine drive-shaft.
2(1) Ltr, SG to TAG, 21 Feb 34, sub: Repl of Wartime Ambs. HRS: G-4/29094. (2) Ltr, QMG to TAG, 15 Apr 35, sub: Mil Characteristics for Ambs, Light Fld Type. QMG: 451.8. For letters on motor vehicular requirements and assignment of ambulances see files HRS: G-4/29714 and QMG: 451.8; for changes in specifications and rear spring improvements see files SG: 451.8-1 and 451.8-1 (Carlisle Bks).


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ate over bad terrain, should be developed for use in combat zones.3

Beginning in 1937 the Medical Department and the Quartermaster Corps had experimented with development of such an ambulance. Meanwhile the General Staff reaffirmed its policy of limiting the types of chassis used by the Army in order both to assure the mass production of vehicles and to simplify the procurement and distribution of spare parts as well as the maintenance and repair of vehicles. It announced in August 1939 that all tactical vehicles (that is, those used by table-of-organization units) would be all-wheel-drive types, and that only five chassis would be considered standard for the Army: -ton, 1-ton, 2-ton, 4-ton, and 7-ton.4 The Medical Department Equipment Laboratory and Holabird Quartermaster Depot then concentrated on experiments with a -ton (4 x 4) chassis, and in June 1940 The Surgeon General announced that the ambulance built on it would be "accepted as the new cross-country motor ambulance for use in all divisional and corps units in the combat zone."5 This ambulance, like the one it was to replace, could carry four litter patients. When the first of this type was delivered for testing early in January 1941, the Surgeon General's Office and the Laboratory found that the ambulance which had been developed primarily for use in combat zones rode so comfortably and was so well heated and ventilated that it would serve satisfactorily for hospitals in the zone of interior as well.6 In short, the new cross-country ambulance was a better general-service ambulance than the 1-ton (4 x 2) field ambulance.

A change in standard chassis required a change in the new ambulance during 1942. In 1941 two new chassis--ton (4 x 4) and -ton (4 x 4)-were introduced, and the -ton (4 x 4) was dropped from the Army's standard list. As early as February 1942 the Quartermaster Corps was anticipating issuing -ton ambulances in place of -ton vehicles.7 About four months later plans for the change had been completed, and -ton ambulances were ordered along with other -ton vehicles. Although similar in appearance to the -ton ambulance, the new -ton ambulance had a shorter wheelbase, larger tires, and more clearance under the axle.8 The Medical Department Equipment Laboratory thought that these differences made it more comfortable for patients and less apt to get stuck in mud and sand.

While the cross-country ambulance was designed mainly for use in theaters of operations, it was used widely in the zone of interior as well. The stoppage of passenger-car production early in the war curtailed the procurement and use of metropolitan ambulances built on pas-

32d ind, SG to TAG, 3 Jan 40, on Ltr, SG to TAG, 25 Nov 39, sub: Fld Ambs, Motor. SG: 451.8-1. Also see the following T/Os: 8-508, Sta Hosp, 25 Jul 40; 8-507, Gen Hosp, 25 Jul 40.
4Ltr AG 451 (6-15-39) Misc-D, TAG to SG, 12 Aug 39, sub: Standardization of Motor Vehs. AG: 451 (8-12-39).
5(1) For letters on these experiments see files QMG: 451.8 and 400.112 T-M, 1937-40, and SG: 451.8-1 and 451.8-1 (Carlisle Bks), 1937-40. (2) Ltr, SG to Dir MD Equip Lab, 1 Jun 40, sub: Critical Measurement Data on Cross-Country Amb. HD: McKinney files, Jun 40.
6Memo, Col G[arfield] L. McKinney (Planning Subdiv) for SG, 14 Jan 41, sub: New Cross-Country Amb; Insp at Carlisle Bks, 13 Jan 41. Off file, Research and Dev Bd SGO, "Cross-Country Amb."
7(1) Ltr QM 451 M-ES, QMG to SG, 14 Feb 42, sub: Reclassification of Amb, Fld, with 3 inds. QMG: 451.8. (2) Memo, TAG for CGs AGF and AAF, C of Arms and Servs, 6 Apr 42, sub: Standardization of Wheeled Motor Veh Chassis and Trailers. AG: 451 (4-4-42).
8(1) TM 9-2800, 1 Sep 43, Standard Military Motor Vehicles.


362

PLACING THE FOURTH LITTER PATIENT IN A FIELD AMBULANCE

senger-car frames.9 The Medical Department therefore used what was available. As ambulances of the cross-country type were delivered to the Army, they were first distributed to table-of-organization units. Those of the older type (1-ton field ambulance) that were no longer needed by such units were divided among posts, camps, and stations in the United States.10 As ambulances of the old type wore out or as requirements exceeded supply, ambulances of the new types were issued to zone of interior installations. In addition, 356 chassis for l-ton (4 x 4) trucks were taken from a civilian pool of motor vehicles in 1943 and were used to build modified field ambulances for service in lieu of unavailable metropolitan ambulances.11

Thus, in addition to the metropolitan ambulances either on hand or procured from available stocks at the beginning of the war, hospitals in the United States used four types of ambulances: the 1-ton (4 x 2) field ambulance; the 1-ton (4 x 4) modified field ambulance; the -ton (4 x

9For letters on efforts to secure additional metropolitan ambulances and their procurement and distribution see file SG: 451.8-1 (1939-43). Also see History of the Automotive Division, War Production Board, 1941-45 (1945). Natl Archives: WPB 020.1.
10SG Cir 81, 8 Aug 41, sub: Admin Motor Veh. For letters on distribution and redistribution of field ambulances from tactical units to zone of interior hospitals see files: SG: 451.8-1, AG: 451.8, and HRS: G-4/29714 for 1940-43.
11Memo, ACofS for Oprs ASF for CofOrd, 6 May 43, sub: Reqmts for Fld Ambs. AG: 451.8 (5-6-43).


363

FIELD AND METROPOLITAN AMBULANCES USED IN 1942

4) cross-country ambulance; and the -ton (4 x 4) ambulance.

By the winter of 1942-43 it appeared that the -ton ambulance was not entirely satisfactory for overseas use. SOS headquarters thought it took up too much shipping space, and some theaters expressed dissatisfaction with its performance. The Southwest Pacific, for instance, stated that lighter vehicles with greater traction were needed for the rough muddy trails over which patients had to be transported, while reports from North Africa indicated that the -ton ambulance was difficult to land from lighters, lacked the traction and drive needed in that theater, and had insufficient angles of approach and departure to allow it to operate easily over ditches and hills of rough terrain.12 The SOS Requirements Division in January 1943 proposed several methods of overcoming these difficulties: shipment of the standard ambulance in a two-unit pack for reassembly in theaters of operations, replacement of its metal body with bows and a tarpaulin top, and provision of "litter kits" for use in adapting stand-

12(1) Diary, SOS Hosp and Evac Br, 13, 16, 22, and 28 Jan 43. HD: Wilson files, "Diary." (2) Ltr, CinC SWPA to CG SOS, 21 Nov 42, sub: Improvement of Equip and Orgn, US Army, with 3 inds. SG: 322.15-1. (3) Memo, Col Robert C. McDonald, Hosp and Evac Br Oprs Div ASF for Gen [Le Roy] Lutes, 21 Apr 43, sub: Gen Kenner's Rpts, with incls. HD: Wilson files, "Book IV, 16 Mar 43-17 Jun 43." (4) Ltr, Joseph A. Keeney, Army Med Serv Tec Cmtee to Col Calvin H. Goddard, 7 Jul 52. HD: 314 (Correspondence on MS) XI.


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MOTOR AMBULANCES Left to right, -ton (4x4), -ton (4x4), and -ton (6x6), the last being an experimental vehicle which was never standardized.

ard vehicles to the transportation of patients.13

The Surgeon General's Office countered with a different proposal. The Medical Department Equipment Laboratory had already begun to evaluate experiments of medical units in replacing litter bearers with motor vehicles-particularly -ton (4 x 4) trucks, or jeeps-to transport patients from battalion aid stations to collecting stations. By the middle of 1942 it had decided that none of the standard vehicles of the Army were satisfactory for this purpose. Some were too rough; some had silhouettes that were too high; and others-notably the unprotected and uncovered jeep-were so small that litters protruded over their sides or ends. Consequently the Medical Department Technical Committee and the Surgeon General's Office had proposed in August 1942 the development of a light forward-area ambulance on a nonstandard chassis-a -ton (4 x 4) chassis to which an extra axle and two wheels were added, making it a -ton (6 x 6) chassis. SOS headquarters had disapproved this proposal because it conflicted with the War Department's policy of using only standard chassis.14 The Surgeon General's Office still believed that this vehicle was a practical solution to the dual problem of saving space on ships and furnishing theaters with ambulances that could be used far forward in rough terrain and in February

13Memo, CG SOS for SG, 30 Jan 43, sub: Ambs. SG: 451.8-1.
14(1) Mins, MD Tec Cmtee, 17 Aug 42. (2) 1st ind, CG SOS to SG, [29 Aug 42], on unknown basic ltr. (3) Memo, Chief Dev Br Research and Dev Div SGO for Chief Fld Equip Br Research and Dev Div SGO, 3 Sep 42, sub: Forward Area Amb. All in Off file, Research and Dev Bd SGO, "Amb, Forward Area."


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1943 recommended again that this type should be developed at once. The SOS Requirements Division referred this recommendation to the Army Ground Forces, principal user of front-line ambulances. Rather than introduce a new type of chassis, AGF headquarters recommended the modification of the -ton (4 x 4) ambulance and the issuance of "litter kits" for use with standard field trucks.15 The Surgeon General's Office consented, and during the early part of 1943 the Ordnance Department and the Medical Department Equipment Laboratory collaborated in the development of an ambulance on a -ton (4 x 4) chassis that incorporated improvements desired for field use and had a body that could be "knocked down" for shipment. By July 1943 two experimental vehicles had been tested, and in August the Surgeon General's Office recommended that one with plywood and steel paneling be adopted as standard.16 As the 1944 ambulance procurement program was nearing completion (April 1944), the new "knock down" ambulance was standardized, and the older -ton vehicle, which had been issued widely to units in all areas, was reclassified as a limited standard item.17

Metropolitan Ambulances

The possibility of procuring metropolitan ambulances in addition to those on hand or acquired at the beginning of the war was raised in the middle of 1944. Early in June the War Production Board called the attention of ASF headquarters to an opinion of the Ambulance Body Manufacturers Industry Advisory Committee that "The Army may not have considered the need for street ambulances to be used in connection with [Army] hospitals in this country."18 Referring the matter to the Surgeon General's Office on 21 June 1944, ASF headquarters routinely called for recommendations as to possible Army requirements for "street" ambulances. When The Surgeon General took this opportunity to insist upon the procurement of 200 metropolitan ambulances, ASF headquarters disapproved, stating that no suitable commercial chassis were in production, that the conversion of passenger cars frozen in the civilian pool would be too expensive, and that requirements for metropolitan ambulances could continue to be met by using field (or general-service) ambulances.19 The Surgeon General's Office then surveyed service command needs and in January 1945 reported its findings. The 149 metropolitan ambulances already in use were so badly worn as to require replacement, and 151 additional vehicles of that type were needed by ASF and AAF hospitals. Accordingly The Surgeon General requested

151st ind, SG to CG SOS, 5 Feb 43, 2d ind, CG SOS (Reqmts Div) to CG AGF, 18 Feb 43, and 3d ind, CG AGF to CG ASF, 10 Apr 43, on Memo, CG SOS for SG, 30 Jan 43, sub: Amb. AG: 451.8 (1-30-43) and Off file, Research and Dev Bd SGO, "Cross-Country Amb."
16(1) Memo, CG ASF for SG, 19 Apr 43, sub: Amb, with ind. SG: 451.8-1. (2) Ord Tec Cmtee, Item 20641, 12 Jun 43. HD: 451.8. (3) Ltrs, MD Equip Lab to SG, 18 Aug, 21 Oct 43, sub: Amb, Cross-Country, Improvements, with inds. SG: 451.8-1.
17(1) Memo, CofOrd for CG ASF (Reqmts Div), 10 Mar 44, sub: Truck, -ton, 4 x 4, Amb KD-Standardization and Rev of Mil Characteristics, with 2 inds. AG: 451.2. (2) Ord Tec Cmtee, Item 23100, 9 Mar 44. HD: 451.8. Limited standard vehicles were usable substitutes for standard vehicles and were issued as long as the supply on hand lasted.
18Ltr, WPB to ASF, 9 Jun 44. SG: 451.8-1.
19(1) Memo, CG ASF for SG, 21 Jun 44, sub: Street Amb for Use in US, with 2 inds. (2) Memo, CG ASF for SG, 20 Jul 44, sub: Amb, Metropolitan, -ton, 4 x 2, with 2 inds. Both in SG: 451.8-1.


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ASF headquarters to authorize the development of "substitute standard" metropolitan ambulances by the conversion of light sedans which the War Department had on hand. The Ordnance Department began such a project, but the war ended before it was completed.20

Multipatient Ambulances

Toward the end of the war the Medical Department succeeded in getting a multipatient ambulance and thus achieved, in part at least, a goal toward which it had worked in the early war years. From 1939 until the middle of 1943 the Surgeon General's Office and the Medical Department Equipment Laboratory had conducted almost continuous experiments to develop a single large vehicle that could serve not only as a multipatient ambulance both in the zone of interior and in combat areas but also as housing for mobile laboratories, operating rooms, and wards and as a means of transporting surgical, shock, and other specialized teams to areas where they were critically needed.21 They had experimented with 2-ton (4 x 2) front-wheel-drive bus-type vehicles, van-type semitrailers pulled by 1-ton and 2-ton tractors, and 2-ton (6 x 6) trucks.22 These experiments failed mainly because an attempt was being made to use a single vehicle for several purposes, and none possessed all of the characteristics required. For example, the front-wheel-drive bus was a nonstandard vehicle and lacked sufficient traction for cross-country use, while the semitrailer lacked maneuverability in combat areas and was too rough for patients. The 2-ton (6 x 6) truck, on the Army's standard list, was successfully used in the development of a surgical truck for armored divisions, but the Quartermaster Corps thought that it would be unsatisfactory as an ambulance because full loads of ambulatory patients would overload its front axles and wheels. Thus the Medical Department reached the middle of 1943 without having developed a standard multipatient ambulance. Meanwhile its Equipment Laboratory converted eight experimental, nonstandard, front-wheel-drive bus-type vehicles, which had been procured in 1940 and 1941 and had been found unsatisfactory for field use, into multipatient ambulances for service at ports in the United States. In June four apiece were issued to Letterman and Halloran General Hospitals in place of the passenger buses requested by Letterman, and instead of the additional standard general-service ambulances requested for Halloran by the second Service Command.23 The next month the Laboratory recommended that the project for the development of a multipatient ambulance be continued, but Surgeon General

20(1) Ltr, SG to all SvCs, 26 Sep 44, sub: Amb, Metropolitan, -ton, 4 x 2, Reqmts, with replies. SG: 451.8-1. (2) Ltr, SG to CG 7th SvC, 15 Sep 44, sub: Trans of PW Pnts in Carry-alls, with 7 inds. Ord: 451.8-39. (3) Ord Tec Cmtee, Item 27294, 20 Mar 45, sub: Amb, -ton, 4 x 2, Light Metropolitan. HD: 451.8.
21Ltr, MD Equip Lab to SG, 27 Dec 45, sub: Hist of Amb, Bus-Type, Experimental, MD Equip Lab Proj F 2. HD: 451.8.
22For documents on these experiments see files for 1940-43 as follows: SG: 451.8-1 (Carlisle Barracks), 451.8-1, 451.2-1, and AG: 451.8.
23(1) Ltr, Letterman Gen Hosp to 9th SvC, 22 Mar 43, sub: Req for Passenger Buses, with 2 inds. SG: 451.8-1 (9th SvC). (2) Memo, 2d SvC Ord Br for DepCofOrd Tank-Auto Ctr (Detroit), 24 Apr 43, sub: Motor Vehs, with 6 inds. SG: 451.8 (2d SvC). (3) Ltr, SG to CG ASF, 14 Jun 43, sub: Conversion of Surg Hosp Vehs to Bus-Type Ambs. SG: 451.2-1 (Carlisle Bks).


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Kirk directed that it be dropped.24 During the following year his Office and the Laboratory concentrated on the development of such special purpose vehicles as mobile medical and dental laboratories, optical repair units, and dental and surgical operating trucks.25

In the second half of 1944 the question of furnishing multipatient ambulances was reopened. In July Letterman General Hospital asked for the replacement of the four worn-out multipatient ambulances which it had received in mid-1943. To this request Ninth Service Command headquarters added four more for other debarkation hospitals on the west coast (two for Birmingham General Hospital and two for Fort Lewis). By October the number requested for the Ninth Service Command was doubled.26 Meanwhile, during July and early August, Mitchel Field, which served as a debarkation point for air evacuees, converted four Ordnance maintenance trucks into special multipatient ambulances for the transportation of patients from planes to the Mitchel Field Hospital and from that installation to Halloran General Hospital.

To meet the need thus demonstrated, the Surgeon General's Office proposed on 11 September 1944 the development of a special ambulance to be used only in the United States and to carry twelve to sixteen litter patients. This limitation was expected to eliminate difficulties encountered earlier in attempts to develop multi-patient ambulances that could carry either litter or ambulatory patients in both the zone of interior and combat zones. At first ASF headquarters was reluctant to approve a developmental project for a vehicle in small demand. It proposed, instead, that The Surgeon General submit a list of standard military vehicles that would be satisfactory, when modified, for the use intended. Believing that no standard military vehicle was suitable, the Ordnance and Medical Departments decided that front-wheel-drive bus-type vehicles of the kind procured for experimental purposes in 1940 and 1941 should be used. An important factor in this decision was the statement by the company making such vehicles that it had "open production facilities" and could therefore "offer favorable delivery," if standard engines, transmissions, and axles were made available to them.27 In addition, The Surgeon General pointed out, a pilot model had already been developed in 1940. He requested, therefore, that the Chief of Ordnance be authorized to procure twenty-four such vehicles for Medical Department use. This request was approved by ASF headquarters on 4 November 1944.28

24(1) Ltr, SG to MD Equip Lab, 6 Jul 43, sub: Dropping and/or Suspension of Dev Projects, with ind. SG: 451.8-1. (2) Ltr, SG to CG ASF (Reqmts Div), 22 Jul 43, sub: Bus-Type Amb (Project F-2 and Mobile Hosp Ward (F 15.01)). Same file. (3) Memo, Chief Fld Equip Dev Br SGO for Chief Research Coord Br SGO, 27 Jul 43, sub: Experimental -ton Amb. Off file, Research and Dev Bd SGO, "Bus-Type Amb, F-2."
25For full discussions of these projects, see John B. Johnson, Jr, and Graves H. Wilson, A History of Wartime Research and Development of Medical Field Equipment (1946), pp. 295-730. HD.
26(1) Memo, CG Letterman Gen Hosp for CG 9th SvC, 20 Jul 44, sub: Repl of Ambs, Bus-type, with 3 inds. SG: 451.8 (9th SvC). (2) Ltr, SG to CG Letterman Gen Hosp, 26 Sep 44, sub: Multi-litter Ambs (Bus-Type), with 2 inds. Same file.
27Having "open production facilities" meant that the company's plant could begin production immediately without having to await the completion of other orders.
28Ltr, CG ASF (Dir of Sup) to CG 2d SvC, 21 Jun 44, sub: Trucks, 1-ton, (4 x 4) Ord Maintenance, for Mitchel Fld, with 12 inds. SG: 451.8.


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EXTERIOR VIEW OF MULTIPATIENT METROPOLITAN AMBULANCE, 1945

Production of the new 12-litter ambulances began almost immediately after the contract was awarded late in December 1944. Preliminary work on blueprints and specifications had already been completed, and on 8 January 1945 construction of the first model began. At the end of February it was road-tested by Ordnance and Medical Department representatives. By late March the first two were delivered to the Army, and during May-the month when the greatest number of patients arrived from theaters of operations-other multipatient ambulances were ready for delivery to hospitals.29

Meanwhile, the Surgeon General's Office had surveyed requirements and found that additional ambulances of this type would be needed-forty-seven for service commands and fifty-one for the Air Forces. In June 1945 ASF headquarters approved their procurement. The next month the Ordnance Department began the process of standardizing the new ambulance. Before this was done in Sep-

29(1) Ltr, SG to CGs SvCs, 26 Feb 45, sub: Amb, 1-ton, 4 x 2, 12 litter, Metropolitan Front Drive, with replies. SG: 451.8 (SvCs). (2) See letters on development and inspections, modifications in litter supports, and changes in rear springs in Off file, Research and Dev Bd SGO, "Amb, Bus-Type, Experimental, F-2."


369

INTERIOR OF THE MULTIPATIENT METROPOLITAN AMBULANCE

tember 1945, V-J Day occurred and the contract for ninety-eight additional multipatient ambulances was canceled.30

Hospital Trains

At the beginning of 1939 the Medical Department had no hospital trains on hand and only indefinite plans for procuring them in the event of war. The Army had disposed of its World War I hospital cars because it was cheaper to transport the few patients who required movement in peacetime in Pullman cars and tourist sleepers of regularly scheduled trains. Thereafter the Medical Department had assumed that three types of trains would be used in the event of another war: (1) trains made up entirely of government-owned cars; (2) "semipermanent" trains composed of one government-owned administrative car, called a unit car, and an appropriate number of commercial baggage cars, Pullman cars, tourist sleepers, and chair cars; and (3) improvised trains

30(1) Ord Tec Cmtee, Items: 28530, 26 Jul 45; 29055, 13 Sep 45; 29740, 8 Oct 45, sub: Amb, 1-ton, 4 x 2, 12-litter Metropolitan. HD: 451.8. (2) Memo, SG for CG ASF (Reqmts and Stock Control Div), 6 Sep 45, sub: Ambs. SG: 451.8.


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consisting of any available commercial rolling stock. Trains of the last type were considered undesirable because they lacked accommodations for the emergency treatment of patients and for train administration. There were doubts that those of the first type could be constructed in sufficient numbers during wartime. Hence, emphasis was placed upon planning for the conversion of commercial cars into unit cars. Such plans were drawn during the twenties and approved by the General Staff in 1931.31

Development of the "Ideal" Unit Car

During 1939 more specific planning for hospital trains was inspired by planning for rail transportation undertaken by the Army Engineers, urged on by the deteriorating international situation. As a part of a more general project to furnish lightweight trains for use on damaged or poorly laid tracks in theaters of operations, the Engineers in January 1939 proposed a government-owned hospital train built from standard military cars (20-ton, 28-foot-long, four-wheeled box cars). It was to consist of a personnel car, a dressing (or operating) car, nineteen ward cars, and a kitchen car, and was to be used, according to the Engineers, to transport patients "from the front line to any point in the Communications Zone or Zone of Interior." The Surgeon General's Office and the Medical Department Board agreed to adopt this train "for planning purposes," believing that they were not thereby eliminating the possibility of using other types of trains in communications zones. On 4 August 1939 the Engineers announced that they were basing plans for all trains in theaters of operations on the use of 20-ton railway cars. Shortly afterward, before committing itself further, the Surgeon General's Office turned to a study of trains used during World War I both in theaters of operations and in the zone of interior.32

This study showed that trains made up entirely of government-owned cars had been used effectively in Europe but that the semipermanent, or unit-car, type of train had been more successful in the United States. The unit car had had a kitchen large enough to feed 250 people, space for transporting 28 litter patients, and quarters for 1 officer, 2 noncommissioned officers, and 2 cooks. Among its advantages had been its flexibility, its economy of procurement and operation, and its provisions for feeding patients. As a single car attached to a regularly scheduled train, it had been used to transport twenty-eight or fewer patients; with one or two Pullman cars, it had been attached to regularly scheduled trains to carry more patients; and it had been used, along with Pullman cars, tourist sleepers, chair cars, and baggage cars, to make up a special hospital train with accommodations for over 200 patients. Conversion of a Pullman car into a unit car was thought to have been cheaper than the construction of cars for an entire train. Moreover, since other cars used in connection with it had been owned either by railroads or by the Pullman Company, only the unit car

31(1) Ltr, QMG to SG, 29 Dec 21, sub: Disposition of Hosp Cars, with 5 inds. Natl Archives, SG: 531.4-1. (2) Ltr, Bd of Engr Equip to CofEngrs, 9 Mar 31, sub: US Army Specifications, Car, Unit, Hosp, with 2 inds. CE: 531.43, pt 1. (3) US Army Specification 43-13, with drawing 43190, 30 Jul 31. SG: 453.-1. (4) Ltr, SG to Comite International de la Croix-Rouge, Geneve, 15 Feb 36. Natl Archives, SG: 322.2-5.
32(1) Memo, Engr Bd for CofEngrs, 12 Jan 39, sub: SP 70, Type Plans and Specifications for Motive Power and Rolling Stock on Standard Gauge Rys (Rpt 559, Prelim Rpt on Hosp Tns, Engr Bd, 23 Dec 38), with 9 inds. SG: 453.-1. (2) Rpt, MD Bd MFSS Carlisle Bks, Pa, 30 Mar 39. Same file.


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had had to be "deadheaded" (returned empty) to the trains' point of origin. Furthermore, the unit car's kitchen facilities had helped to solve one of the major problems of World War I-the feeding of patients. Because of these advantages, and since the Engineers were already working on plans for cars for completely government-owned trains, the Surgeon General's Office concentrated in the winter of 1939-40 on the development of plans for an "ideal" unit car.33

The plans drawn were for a car that differed considerably from the unit car of World War I and to some extent from one that had been planned in 1931. The latter presumably represented an improvement over the World War I car. It was to have side doors for loading patients and, in addition to the kitchen, an operating or dressing room and more space for attendants, but its capacity for patients had been reduced from twenty-eight to ten. In the fall of 1939 the Surgeon General's Plans and Training Division decided to eliminate all spaces for patients, in order to increase the feeding capacity of the kitchen to 500, enlarge the operating room and make an aisle around it, provide roomier quarters for more medical attendants, and furnish storage space for foods and medical supplies. These changes were intended to produce a car which would have most of the facilities planned by the Engineers for the several administrative cars (dressing, kitchen, and personnel) of the proposed overseas train and would be "ideal" for use in mass evacuation in the United States.34

After preliminary plans for the unit car had been drawn, the Medical Department Board and the Surgeon General's Office studied "in a new light" the Engineers' proposal to use only lightweight trains in theaters of operations. They found that the General Staff had "not specifically approved" the 20-ton car for a hospital train, but that it had approved (in 1931) the unit car. Moreover, they considered the train proposed by the Engineers to be "unsatisfactory" and "a reversion to that [type] used prior to 1863." Finally, they had an alternative to offer: the unit car "included all the necessary facilities for the care of the sick and wounded" and could be used with commercial cars to make a complete hospital train either in the zone of interior or in theaters of operations. The Surgeon General and the Engineers then reached a compromise on 8 May 1940. The latter agreed with The Surgeon General that, as a first choice, hospital trains in theaters of operations should consist of the unit car and other heavy cars appropriate to it. The Surgeon General agreed that hospital trains of lightweight cars could be used in areas where the construction of roadbeds made the use of heavier equipment impractical.35 Thereafter, the Surgeon General's Office and the Medical Department Board collaborated with the Quartermaster General's Office and the Pullman Company in completing specifications for the unit car, and with the Engineers in

33(1) Memo, Maj H[erbert] E. Tomlinson (SGO) for Col [Robert Du R.] Harden, 25 Aug 39, sub: Hosp Tns in World War. SG: 453.-1. (2) The Medical Department . . . in the World War (1923), vol. I, pp. 334-35; (1923), vol. V, pp. 180-86; (1925), vol. VIII, pp. 37-41.
34(1) Memo, SG (Capt Joe A. Bain) for QMG, 4 Oct 39, sub: Hosp Unit Car. SG: 453.-1. (2) Memo, SG (Col James E. Baylis, Exec Off) for MD Bd, 6 Feb 40. Same file.
35(1) 9th ind, SG to CofEngrs, 15 Apr 40; 10th ind, CofEngrs to SG, 4 Jun 40; 11th ind, SG to MFSS, 8 Jun 40, on Memo, Engr Bd for CofEngrs, 12 Jan 39, sub: SP 70, Type Plans and Specifications for Motive Power and Rolling Stock on Standard Gauge Rys. SG: 453-1. (2) Notes on Conf on Hosp Tns, TofOpns, by Capt Bain, 8 May 40. Same file.


372

STATIONARY BEDS IN HOSPITAL WARD CAR, 1941

making preliminary designs for cars for the lightweight train.36

In the fall of 1940, when the establishment of Army bases in the Atlantic and the prospective passage of selective service legislation created a potential need for hospital trains, the Surgeon General's Office requested that two Pullman cars be converted into unit cars. This request was approved. Furthermore, in December 1940 the Engineers ordered, along with other railway equipment, enough 20-ton cars to test some for use in hospital trains.37

Need for Ward Cars and Their Development

About the time the first unit cars were delivered, the Surgeon General's Office found, contrary to its expectations, that government-owned hospital cars of another type would be needed. When the decision was made to eliminate spaces for patients in the unit car, the Planning and Training Division had expected that litter patients would be carried in tourist sleepers. About a year later, in February 1941, it discovered that tourist sleepers, like

36(1) Memo, SG for TAG, 6 May 40, sub: Hosp Unit Car. TC: 531.4. (2) Rpts, MD Bd No 190, 27 Aug 40, Hosp Unit Car; No 174, 27 Aug 40, Hosp Tn, Combat Area; No 174, 9 Sep 40, Berth for Hosp Tn. SG: 453.-1.
37(1) Memo SG for TAG, 5 Sep 40, sub: Hosp Tns, with 4 inds. SG: 453.-1. (2) Purchase Order 51536, 16 Dec 40, Haffner-Thrall Co, Chicago. CE: 453, Pt 6. (3) Extract from History of the Development of Railroad Equipment, prep by Hist Staff, Engr Bd, Ft Belvoir, Va. HD: 531.4.


373

Pullman cars, had washrooms at either end, instead of straight through-and-through aisles, and that patients on litters could therefore not be carried from sleepers to unit-car operating rooms.38 For the latter to be of any use, it was necessary to develop a special ward car. During the spring of 1941 the Pullman Company, following recommendations of the Medical Department, prepared plans for converting standard Pullman cars into ward cars. This was to be done by removing existing washrooms and installing other toilet and washing facilities in such a way as to leave a straight aisle; by adding wide side doors to permit easy loading and unloading of litter patients; and by replacing the Pullman berths with sixteen two-tiered stationary beds made by the Simmons Company. Such beds were chosen, instead of Glennan adjustable beds used during World War I, because they were thought to be more comfortable and cheaper to procure. In July 1941 the General Staff approved a request from The Surgeon General for four cars of this type, and contracts were let with the Pullman Company in September. It was then anticipated that a hospital train would consist of one government-owned unit car, two government-owned ward cars, a baggage car, and a variable number of standard Pullman or chair cars. The four ward cars were delivered in November and December 1941.39 (Table 17)

When the Japanese attacked Pearl Harbor, the Army had two unit cars and four ward cars-enough government-owned equipment to serve as the nuclei of two hospital trains. The unit cars had not been used during 1941 because they were not air-conditioned and no ward cars were available for use with them. The ward cars just delivered had not been used either, but they had been favorably received by Medical Department officers who had seen them. Enough rail equipment for six additional hospital trains was needed, according to previous plans, for a full mobilization of the Army.40

Ward Dressing Cars Replace Unit Cars

Early in January 1942 the Surgeon General's Office began to plan for additional hospital cars. In the course of a few months the concept of the types of cars needed changed radically. Despite lack of experience with the new unit cars, the Surgeon General's Planning and Training Division decided to abandon them as a type. In view of earlier statements and subsequent experience it is probable that the following factors accounted for this decision. The unit car developed in 1940 had no space for patients. Capable of feeding up to 500 persons, its kitchen could be used to capacity only with trains consisting of about eighteen cars. On such trains, serving food from a unit car to patients in other cars was a real problem. Moreover, since patients transported in the United States did not normally require surgery en route, the operating room of the unit

38(1) Ltr, SG (Col Albert G. Love) to Hq 8th CA (Col A[lbert] P. Clark), 19 Mar 40. Off file, Research and Dev Bd SGO, "Unit Car." (2) Memo, Capt Bain for Brig Gen Albert G. Love, 6 Feb 41, sub: Hosp Unit Car. Same file.
39(1) Ltrs, SG to Pullman Co, Chicago, 4 Mar, 20 Mar, 2 May, and 9 May 41; Pullman Co to SG, 14 Mar, 22 Apr, 24 Apr, 5 May, and 27 May 41. SG: 453.-1. (2) Ltr, SG to CofEngrs, 31 May 41, sub: Hosp Ward Cars. CE: 453, pt 6. (3) Ltr, SG to TAG, 31 May 41, same sub, with 4 inds. SG: 453. (4) Memo, CofEngrs for QMG, 25 Nov 41, same sub. CE: 453, pt 6.
40(1) Rpt, Observer, Second and Third Army Maneuvers, Sabine-Red River-Louisiana-Area, 15-26 Sep 41. SG: 354.2-1 (Maneuvers, Gen). (2) Memo, SG for TAG, 6 May 40, sub: Hosp Unit Car. SG: 453.-1.


374

TABLE 17-HOSPITAL CAR PROCUREMENT PROGRAM, 1940-45

Ordered

Type of Car

Delivered

Numbers Assigned

Declared Surplus

Date

Number

Total

380

---

---

---

---

November 1940

2

Unit

February 1941

1 and 2 (Changed to 8200-8201, Jul 42 and to 89200-201, Aug 44)

November 1945-February 1946

September 1941

4

Ward

November-December 1941.

1-4 (Changed to 8900-8903, Jul 42).

November 1945-February 1946

March 1942

6

Ward Dressing

July-August 1942.

8917-8922 (Changed to 89000-005, Apr 43).

November 1945-February 1946

March 1942

12

Ward

July-August 1942.

8904-8915

November 1945-February 1946

January 1943

32

Ward Dressing

September - December 1943.

89006-89037

November 1945-February 1946

January 1943

64

Ward

September - December 1943.

8916-8979

November 1945-February 1946

August 1943

40

Kitchen

March - September 1944.

8731-8770

March-June 1946

May 1944

100

New Unit

November 1944-May 1945.

89300-89399

March-June 1946

January 1945

100

New Unit

May-August 1945.

89400-89499

Retained

February 1945

20

Kitchen

March-July 1945.

8711-8730

October - November 1945


Sources: Hosp. Cars in Interchange Service-All Standard Gauge. HD: 453.1 (Hosp. Car Procment). (2) Correspondence filed in AG Technical Records: SG 453.1 and 531.4; TC, same file numbers.

car was larger and more elaborate than was needed.41

To replace the unit car the Surgeon General's Office and the Pullman Company developed a ward dressing car in the early months of 1942. It contained a small surgical dressing room and space for thirty litter patients, but it lacked kitchen facilities. It differed from the ward car only in the replacement of a toilet and berths for two patients with an operating or dressing room. This room, which could also be used as a loading room, was equipped with an operating or dressing table, a washstand, a sterilizer, and a locker for surgical instruments. The dressing table could be used in the center of the room, moved down the aisle of the car to a patient's berth, or stored at the side of the car. Food would come from commercial dining cars. Thus the Medical Depart-

41(1) Rpt of MD Bd to consider MD Bd Project No 190, Hosp Unit Car, 8 Jul 41. SG: 453.-1. (2) Ltr, SG (Maj Thomas N. Page) to Pullman Co, 13 Jan 42. Off file, Research and Dev Bd SGO, "Hosp Ward Car." (3) Ltr, SG (Lt Col H[oward] T. Wickert) to Pullman Co, 13 Feb 42. SG: 453-1. (4) Ltr, Lt Col Thomas N. Page to Modern Hosp Pub Co, Chicago, 1 Dec 42. Same file.


375

ment placed its reliance early in World War II, as it had in World War I before the unit car was developed, upon railroad and Pullman companies for feeding patients. Instead of stationary Simmons beds, two-tiered Glennan adjustable berths were to be used in both ward and ward dressing cars. Chief advantage of the latter was that upper berths could be pulled down to form backs for lower berths and thus make places for patients to sit. To provide enough government-owned equipment for six hospital trains, in addition to that already available for two, the Engineers ordered six ward dressing cars and twelve ward cars in March 1942. They were delivered to the Charleston, New Orleans, San Francisco, and New York Ports in July and August.42 (See Table 17.)

DRESSING ROOM IN HOSPITAL WARD DRESSING CAR, 1942

Air-Conditioning Hospital Cars

About a month before the new cars were delivered, the Surgeon General's Office initiated action to get them air-conditioned. In response to a hospital train commander's request, that Office asked SOS headquarters in June 1942 to have air-conditioning equipment installed in all hospital cars. Action on this request was delayed because of differences of opinion about the more desirable kind of equipment between the Surgeon General's Office on the one hand and the Engineers and the Transportation Corps on the other. Both the Engineers and the Transportation Corps favored the use of ice-activated air-conditioning equipment, apparently because it was simpler to install and because it was commonly used on Pullman cars at the time. The Surgeon General's Office preferred a type of mechanical air-conditioning equipment which was thought to insure more even temperatures and was not dependent upon batteries for operation when hospital cars were standing.43 A mechanical system of this type, produced by Mountain Aire Products, Incorporated, was installed in one hospital car for testing in the fall of 1942. Subsequently, as a result of these tests, differences of opinion arose

42(1) Ltrs, Pullman Co to SG, 13 Jan, 26 Jan, 10 Feb 42, with blueprints, Plan 4103-A, 4103-B. SG: 453.-1. (2) Specifications for Remodeling 18 Pullman Parlor Cars to Hosp Ward Cars for WD, from Pullman Co, 30 Jan 42. Off file, Research and Dev Bd SGO, "Hosp Ward Cars."
43(1) Ltr, Med Sec 1927 CASU, Hosp Tn No 1 (San Francisco) to Surg 9th CA, 22 May 42, sub: Air-Conditioning for Hosp Tn No 1, with 5 inds. SG: 453.-1. (2) Memo SPOPM 673, ACofS for Oprs SOS for CofEngrs, 18 Jun 42, sub: Mechanical Air Conditioning for Unit Cars. Same file.


376

PLANS FOR HOSPITAL CARS, 1941-42


377

even within the Transportation Corps as to whether this or an ice-activated system was desirable but officially the Transportation Corps in December 1942 recommended installation of ice-activated systems and "declined to accept responsibility" for the performance of Mountain Aire systems. Despite this "veiled threat," the Surgeon General's Office requested that Mountain Aire equipment be installed in all ward and ward dressing cars. SOS headquarters resolved this deadlock by directing the Chief of Transportation to install air-conditioning equipment in all cars and by allowing him to determine the type of equipment that would meet performance requirements recommended by The Surgeon General.44 After the Transportation Corps and the Medical Department agreed upon desirable performance standards, the former in the spring of 1943 had ice-activated air-conditioning equipment installed in the ward and ward dressing cars which had been delivered during 1941 and 1942. The installation of such equipment in hospital cars ordered after the fall of 1942 raised no problem, because they were procured with the air-conditioning systems normally used by companies supplying the cars-some mechanical and some ice-activated.45 Later, during 1945, the Mountain Aire system was removed from the car in which it had been installed and was replaced with an ice-activated system.46 Toward the end of the war the Transportation Corps as well as the Surgeon General's Office came to prefer mechanical air-conditioning systems, because of the difficulty of icing cars en route and the fear of ice shortages, but they considered a change undesirable at that time lest it delay completion of additional cars being ordered.47

Disagreement About the Type and Number of Cars

Soon after the Surgeon General's Office first requested air-conditioning for hospital cars, SOS headquarters raised the question of whether those being procured were of the proper type and number. At that time neither the Surgeon General's Office nor SOS headquarters had had experience in the operation of hospital trains during World War II. Moreover, with the majority of troops still in training in the United States, the ultimate strength of theaters of operations and the number of casualties to be returned to the zone of interior were not yet fully envisioned. Nor was the strain which the war was to put on commercial transportation entirely comprehended. Nevertheless, officers concerned with secret planning for the North African invasion were anticipating the reception of casualties from that operation, and those intimately involved in transportation problems were beginning to be aware of some of the difficulties

44(1) Memo, Engr Bd for CofEngrs, 7 Oct 42, sub: Air Conditioning of Pullman Type Hosp Cars, with 2 inds. SG: 453.-1. (2) Memo, CofT (Rail Div) for SGO (Lt Col J. B. Klopp), 12 Dec 42, sub: Mountain Aire Air-Conditioning System, with 4 inds. Same file. (3) Memo, Col H. T. Wickert for Gen [Larry B.] McAfee, 5 Jan 43. Off file, Research and Dev Bd SGO, "Hosp Tns, Air Conditioning."
45(1) Memo, CofT (Rail Div) for SG (Col J. B. Klopp), 4 Feb 43, sub: Air Conditioning for Hosp Cars, with incl "Mil Characteristics of Air Conditioning for Hosp Cars." SG: 453.-1. (2) Ltr, CofT for CGs 1st, 2d, 3d, 4th, 8th, and 9th SvCs, 10 Feb 43, sub: Air Conditioning of Hosp Cars. TC: 531.4 (Hosp Cars).
46(1) Memo, CofT for SG, 21 Nov 44, sub: Air Conditioning on Ward Dressing Car 89002. SG: 453.1. (2) Memo, CofT (Rail Div) for Procmt Div OCT, Cincinnati, 13 Mar 45, sub: Cooling Syst on Hosp Car 89002. TC: 531.4.
47Memo, Sup Div OCT to Rail Div OCT, 19 Jan 45. TC: 531.4.


378

railroads would encounter in meeting transportation needs of both the civilian population and the armed forces. In this atmosphere the Assistant Chief of Staff for Operations of SOS headquarters, to whose Hospitalization and Evacuation Branch a Medical Corps officer, Lt. Col. William C. Keller, had recently been assigned for the purpose of advising on rail evacuation, issued a directive on 23 July 1942 that provoked a re-examination of the hospital train program. It called upon the Engineers to develop a new type of hospital car, called a rail ambulance car, and suggested that twenty-seven of them-three for each of the nine service commands-should be procured by 1 January 1943. The reason for this directive, apparently, was a belief in SOS headquarters, first, that the hospital cars being procured were of an unsatisfactory type because they had to be supplemented with commercial Pullmans, sleepers, diners, and baggage cars, and second, that available railway facilities would be inadequate when patients began to arrive from theaters in large numbers. The proposed car was to have spaces for twenty to thirty-three patients, depending upon whether berths were two-or three-tiered; quarters for medical attendants, including one officer, one nurse, and four enlisted men; kitchen facilities capable of feeding both patients and attendants; and a dressing room and pharmacy. Because of a developing shortage of Pullman cars and tourist sleepers, lounge cars were to be used for conversion. Each lounge car thus converted would decrease demands of the Medical Department for commercial sleepers and would, at the same time, relieve the railway dining service of some of its load. From seven to eighteen cars of this type could make up complete hospital trains; or single cars, attached to regularly scheduled trains, could move patients in small groups.48

The Surgeon General objected both to the proposed type of car and to the suggestion that additional hospital cars were needed. He pointed out that small numbers of patients could still be moved in Pullman cars of regularly scheduled trains. For the mass movement of patients he preferred a complete train made up of government-owned ward and ward dressing cars and commercial baggage, sleeping, and dining cars to one consisting entirely of government-owned rail ambulance cars. A train of the latter type, he contended, was wasteful of both personnel and equipment. One having 10 cars would have 10 dressing rooms and 10 kitchens and would require 10 officers, 10 nurses, and 40 enlisted men. The Surgeon General stated that patients were not put on trains until doctors felt reasonably sure that they would need little treatment in transit. Hence so many dressing rooms were not needed. Moreover, he believed that regular dining car service could be used for feeding patients either in Pullman cars of regularly scheduled trains or in the cars of complete hospital trains. In his opinion the transportation of sick and wounded would rate so high a priority that the Medical Department would always be able to get sufficient commercial cars for its use. Furthermore, the Surgeon General's Office opposed the use of three-tiered berths because it was difficult to get litter patients into the top one.49

48(1) Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrs thru SG, 23 Jul 42, sub: Proposed Rail Amb Car. SG: 322.2-5.
491st ind, SG to CofEngrs, 1 Aug 42, on Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrs thru SG, 23 Jul 42, sub: Proposed Rail Amb Car; also 2d ind, CofEngrs to CG SOS thru SG, 24 Aug 42; and 3d ind, SG to CG SOS, 29 Aug 42 (init Col H. T. Wickert). SG: 322.2-5.


379

After first stating that the eight hospital trains which his Office had planned would be sufficient, The Surgeon General reviewed requirements about a month and a half later and concluded in October 1942 that additional trains would be needed. On the basis of four litter patients per 1,000 troops per month from a total overseas strength of 2,500,000, he estimated that 10,000 litter patients would have to be moved from ports to hospitals each month. The eight trains (twenty-four cars) already planned, making three 1,000-mile trips per month, could move 2,160 litter patients per month. For the remainder, The Surgeon General estimated that thirty-two additional hospital trains would be needed. He recommended, therefore, that instead of rail ambulance cars thirty-two ward dressing cars and sixty-four ward cars be procured.50 This recommendation, as well as types of hospital cars in general, was discussed on 9 October 1942 in a conference of representatives of the Surgeon General's Office, the Engineers, the Transportation Corps, and the SOS Hospitalization and Evacuation Branch.51 The Surgeon General later expressed the belief that this conference had settled the issue in favor of ward and ward dressing cars.

Before giving The Surgeon General's recommendations formal approval, SOS headquarters asked the Transportation Corps about the prospective availability of commercial diners and sleepers. In this connection it called attention to World War I experience, especially to difficulties in feeding patients.52 In reply the Transportation Corps emphasized the burden already placed upon commercial dining car service by wartime travel and troop movements and, in addition, raised a new point. Instead of using one ward dressing and two ward cars as the nucleus of a complete hospital train, the Transportation Corps proposed that one rail ambulance car be used for that purpose. If this should be done only 32 hospital cars would be needed, instead of 96, and the remaining 64 cars could be used for regular troop movements.53 It seems that the Transportation Corps believed that commercial dining cars would not be available in sufficient numbers but that Pullman and tourist sleepers would. SOS headquarters therefore decided not to approve The Surgeon General's recommendation, but directed the Engineers instead to procure thirty-two self-contained rail ambulance cars.54

The Surgeon General's Office, which "considered the controversial matter [of the types and numbers of hospital cars required] finally settled" by the 9 October 1942 conference, was displeased with this action and on 18 November asked for another conference "to arrive at a complete and final decision."55 During that meeting The Surgeon General's representative stated that he preferred ward

504th ind SPOPH 322.15, ACofS for Oprs SOS to SG, 25 Sep 42; 5th ind SPMCP 322.2-5, SG to CG SOS, 10 Oct 42, on Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrs thru SG, 23 Jul 42, sub: Proposed Rail Amb Car. SG: 322.2-5.
51Rpt, Conf, 9 Oct 42, sub: Adequacy of Hosp Tn Equip. SG: 453.-1.
52Memo SPOPH 322.15, CG SOS for CofT, 22 Oct 42, sub: Rail Amb Cars. TC: 531.4.
53(1) Memo, Mvmts Div OCT for Maj Gen C[harles] P. Gross, 29 Oct 42, sub: Rail Hosp Tns. TC: 531.4. (2) Memo, CofT (Maj Gen C. P. Gross) for ACofS for Oprs SOS, 30 Oct 42, sub: Rail Amb Cars. Same file.
546th ind SPOPH 370.05, ACofS for Oprs SOS to CofEngrs thru SG, 6 Nov 42, on Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrs thru SG, 23 Jul 42, sub: Proposed Rail Amb Car. SG: 453.-1. 
55(1) Diary, SOS Hosp and Evac Br (Keller), 16 Nov 42. HD: Wilson files, "Diary." (2) Memo, SG for CG SOS, 18 Nov 42. HRS: Hq ASF Control Div file, "Evac."


380

and ward dressing cars, regardless of the number procured, to rail ambulance cars. In addition the Surgeon General's Office went on record as preferring to feed patients from kitchens improvised in railway baggage cars, if diners should not be available, rather than to agree to the procurement of rail ambulance cars. After this conference SOS headquarters reversed its decision and on 24 November directed the Transportation Corps to procure not less than forty and, if practical, as many as ninety-six ward and ward dressing cars. Contracts for the higher number were let in January 1943.56 (See Table 17.)

Development of a Hospital Train for Overseas Use

In the course of discussions about the numbers and types of hospital cars needed for the zone of interior, the question of trains for theaters of operations came up. Before mid-1942 the Engineers had switched from a 20- to a 40-ton car as the standard for overseas military trains. After studying blueprints and proposals for 40-ton cars, the Surgeon General's Office and the SOS Hospitalization and Evacuation Branch agreed in August 1942 to use them in hospital trains built for theaters of operations.57 Following Medical Department recommendations, the Engineers completed preliminary drawings and specifications for a combat-zone hospital train of twenty-one 40-ton cars (operating, personnel, kitchen, and ward cars) by the end of November 1942. The Surgeon General's Office then suggested changes in the proposed specifications and in January 1943 recommended to the Chief of Transportation that one train of 40-ton cars should be constructed immediately for service testing and that all trains included in the Army supply program should be procured as soon as possible after completion of such tests.58

In February 1943 the Army supply program included forty overseas hospital trains of twenty-one cars each for procurement in 1943 and 1944, but none had been ordered and SOS headquarters doubted that these figures actually represented requirements. The SOS Hospitalization and Evacuation Branch therefore conferred on 18 February 1943 with representatives of the SOS Requirements Division, the Surgeon General's Office, and the Transportation Corps. The Surgeon General's representative informed SOS headquarters that only fifteen overseas trains would be needed in 1943 and five more in 1944. On 23 February 1943 SOS headquarters directed Transportation Corps to procure that number, plus one additional train of ten cars for experimental and training purposes. Soon afterward the War Department learned that the European theater was procuring twenty-three hospital trains in the United Kingdom and on 8 April 1943 the Surgeon General's Office requested the Transportation Corps to have only the experimental train constructed.59

56(1) Memo SPAOG 370.05, ACofS for Oprs SOS for CofT, 24 Nov 42, sub: Ward Cars (Med). TC: 531.4. (2) Memo SPMC 322.2-5, SG for CG SOS, 25 Nov 42. Same file.
57(1) Diary, SOS Hosp and Evac Br (Keller), 6-7 Aug 42. HD: Wilson files, "Diary." (2) Memo, ACofS for Oprs SOS for CofT, 10 Aug 42, sub: Conf on Rail Evac. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42."
582d ind, SG to CofT (Rail Div), 8 Jan 43, on Memo, Engr Bd for CofT (Rail Div), 30 Nov 42, sub: Lightweight, Combat Zone, Hosp Tn, with 10 drawings and 10 specifications. SG: 453.-1.
59(1) Memo, SOS Reqmts Div for SOS Plans Div Hosp and Evac Br, 11 Feb 43, sub: Hosp Cars, with Memo for Record. AG: 531.43 (9-29-42). (2) Memo, SOS Reqmts Div for CofT, 23 Feb 43. AG: 322.38. (3) Memo, CofT for SG, 25 Mar 43, sub: Hosp Tn for Tng Purposes, with 2 inds. SG: 453.-1.


381

During the latter half of 1943 this train was completed and exhibited to the public on a cross-country trip. It was then used for the evacuation of patients from the California-Arizona Maneuver Area, returned to Hampton Roads for two test runs, sent to Camp Ellis (Illinois) for use in training hospital train units, returned to the manufacturer for the correction of deficiencies, and displayed as a part of the Fifth War Bond Drive in New York City. Complaints about the mechanical aspects of the train were numerous, but the most important from the viewpoint of patient evacuation were that the ward cars were poorly ventilated, crowded even when they carried a normal load of patients (sixteen in each car), and uncomfortably rough even at speeds of less than thirty-five miles per hour.60 Finding no further need for this train in the United States, the Technical Division of the Surgeon General's Office in July 1944 drafted messages in which the War Department queried the European and North African theaters as to whether or not they could use it. The latter agreed to accept the train and in September 1944 it was taken to Hampton Roads for shipment to southern France.61

 Improvement of Existing Cars and Procurement of Kitchen Cars

In late 1942 and the first half of 1943, while the types and numbers of hospital cars needed for the zone of interior were being discussed and the program for trains for theaters was being re-examined, experience made it possible to evaluate the hospital unit, ward, and ward dressing cars. The unit cars had proved to be of little use, for reasons already explained. Ward and ward dressing cars appeared to fulfill their purposes and required only minor modification, such as the installation of storage lockers, floor lights, bulletin boards, and bedside holders for patients' food trays. These changes were incorporated in specifications for new cars. They were also made in the ward and ward dressing cars already delivered.62

Two major problems in the operation of hospital trains appeared: safeguarding neuropsychiatric patients during transit and feeding patients and medical attendants from commercial diners. Hospital train commanders found that in transporting mentally disturbed patients either restraints and sedation had to be used or additional attendants had to be assigned. As a partial solution to this problem, they recommended the use of wire screens inside car windows.63 Throughout late 1943 and early 1944, the Medical Department collaborated with the Transportation Corps and the Pullman Company in developing a standard screen to meet this need. It was made of heavy mesh wire and was designed to fit inside the windows of standard tourist and Pullman cars. It was re-

60(1) Memo, Col I. Sewell Morris, OCT for Mvmt Div OCT, 4 Nov 43, sub: Hosp Tn for Calif-Ariz Maneuver Area. HD: 453.1 (10-Car Hosp Tn, Overseas). (2) Ltr, CO 3d Hosp Tn to SG, 15 Dec 43. TC: 531.4. (3) Memo, CofT for SG, 20 Apr 44, sub: Ten-Car Hosp Tn. . . . SG: 453.-1. (4) Ltr, CofT to SG, 4 Apr 44, sub: Hosp Tn, Contract W-2789-tc-1201. TC: 531.4.
61(1) Draft rad prepared by Tec Div SGO for dispatch to ETO, 1 Jul 44. SG: 322 (Hosp Tn)H. (2) Weekly Diary, Tec Div SGO, 29 Jul-4 Aug 44. HD: 453.1 (10-Car Hosp Tn, Overseas). (3) Routing Forms, AAR, 13 Sep 44. TC: 511 "Main 39595."
62(1) Memo, SG for CofT, 4 Mar 43, sub: Hosp Car Changes. SG: 453.-1. (2) Memo SPTSY 453, CofT for SG, 8 Mar 43, sub: Hosp Cars, with Rpt of Insp of Cars being Air-Conditioned. Off file, Research and Dev Bd SGO, "Hosp Tns, Air Conditioning."
63(1) Ltr, Hq 2d SvC to Hosp Tn No 2, Ft Monmouth, N.J., and Hosp Tn No 1, Tilton Gen Hosp, Ft Dix, N.J., 3 Apr 43, with 4 inds. SG: 322.2-5. (2) See other train reports, SG: 322.2-5 and TC: 531.4 (Hosp Tn Mvmts).


382

movable and could be locked in place by means of the standard bunk key carried by all Pullman porters. Issued on the basis of a set of thirty-two (enough for one car) for each hospital train, these guards were helpful in preventing patients from hurting themselves on car windows and from attempting to escape.64

The feeding problem was more complicated. Train commanders were almost unanimous in complaints about difficulties of feeding patients from commercial diners. These diners often failed to meet Army standards of sanitation, carried no foods for special diets, served meals that became monotonous, provided midmorning or midafternoon nourishment for patients only at excessive costs, were not open for meals for attendants on night duty, and were often uncoupled at junction points, leaving both patients and attendants without meals for the remainder of their journeys.65 Moreover, the fear that dining cars would be unavailable for all needs-expressed by SOS headquarters and the Transportation Corps in the fall of 1942-was becoming a reality. The entire problem was discussed in February 1943 in a series of conferences on railway rates between railroad officials and representatives of the Surgeon General's Office, the Transportation Corps, and the SOS Hospitalization and Evacuation Branch. At that time the railroads agreed to supply hospital trains with dining cars or, if diners were not available, with baggage cars that could be used as kitchen cars.66 Soon afterward the Transportation Corps asked the General Staff for authority to convert twenty-one idle Coast Artillery kitchen cars into hospital kitchen cars. After spending several months modifying and testing one, the Medical Department and the Transportation Corps decided that they were too small and lightweight to operate with fast passenger trains. In July 1943, therefore, they agreed to seek authority to procure forty kitchen cars of the type being built for use with troop trains. Since cars in that number would provide one kitchen car for each group of three ward and ward dressing cars-the same ratio by which kitchen cars were provided for troop cars-ASF headquarters approved the request on 16 August 1943. By December one hospital kitchen car was delivered for service testing, and the remainder, incorporating minor changes made as a result of this test, were delivered during 1944.67 (See Table 17.)

Development of a "New-Type" Unit Car

Within two months after ASF headquarters approved the procurement of hospital kitchen cars and before all ward

64(1) Ltr, SG (Tec Cmtee) to CG ASF (Reqmts Div), 22 Jul 43, sub: Window Guards for Hosp Tns. SG: 453.1. (2) Ltr, SG to MD Equip Lab, 15 Sep 43, sub: Window Guards for Tourist and Hosp Ward Cars. Same file. (3) Ltr, SG for CGs all SvCs, 26 Apr 44, sub: Window Guards for Hosp Tns. SG: 453.1 (SvCs).
65Reports of hospital train movements are replete with descriptions of difficulties involved. See TC: 531.4 (Hosp Tn Rpts) and scattered rpts in SG: 322.2-5 and 453.1.
66(1) Ltr, Interterritorial Mil Cmtee Rail Carriers to CofT (Tfc Control Div), 25 Jan 43, with incls. TC: 531.4. (2) Diary, SOS Hosp and Evac Br (Keller), 24-26 Feb 43. HD: Wilson files, "Diary." (3) Ltr, Interterritorial Mil Cmtee Rail Carriers to SG, 6 Apr 43, with incl. SG: 453.1. (4) Memo W55-33-43, sub: Trans of Hosp Cars and Tns, 10 Aug 43. AG: 531.4 (6 Aug 43).
67(1) Memo, CofT (Tfc Control Div) for ACofS OPD WDGS, 2 Mar 43, sub: Kitchen Cars. TC: 531.4. (2) Memo, SG for CofT, 7 May 43, same sub. Same file. (3) Memo, SG for CofT, 29 Jul 43, same sub. SG: 453.1. (4) Memo, Dep Dir of Oprs ASF for CofT, 16 Aug 43, same sub. HD: Wilson files, "Day File, Aug 43." (5) Rpt, 1247 SCSU for CG 2d SvC, 23 Dec 43, sub: Rpt of USA Kitchen Car, 8731. Same file.


383

and ward dressing cars already ordered had been delivered, the Surgeon General's Office in October 1943 requested that additional cars of still another type be provided. The reason was that a change was gradually being made in the distribution of patients among general hospitals. Establishment of a policy of caring for patients from theaters of operations in hospitals near their homes and designation of particular hospitals for the specialized treatment of certain disabilities meant that patients arriving on a single ship would be distributed among many different general hospitals. For a time the practice of sending a complete trainload of patients (from 200 to 300) to one general hospital continued, and it was often necessary to retransfer patients to other hospitals. During the latter half of 1943, however, the Second Service Command began to try to send patients directly from the debarkation hospital in New York to the general hospitals in which they would receive treatment. This was done by making up trains in sections which could be cut off at intermediate points for routing to different general hospitals. Each section consisted of a combination of ward cars, ward dressing cars, and commercial sleeping cars. The chief difficulty encountered in this practice was in feeding patients. Until kitchen cars were delivered, the entire train had to depend upon uncertain commercial dining car service. Even if kitchen cars had been available, each section separated from the main train would have still been dependent upon commercial dining service.68 On 15 October 1943, therefore, the Surgeon General's Office requested the Transportation Corps to provide fifty "new type unit cars" by May 1944. These cars, for which a sketch had been drawn by the Hospital Construction Branch, were to be similar to the rail ambulance car designed by the Engineers in the fall of 1942.69 They were to be used as parts of complete hospital trains; for secondary movements from the main, or primary routes of hospital trains; and for the transportation of small groups of patients on nonhospital trains. Although ASF headquarters had formerly advocated the use of such cars, it replied in November 1943 that no new developmental project should be started unless it was essential to winning the war and directed, as a preliminary step to further action on The Surgeon General's request, an evaluation of the passenger traffic problem with particular reference to the transportation of patients. The next month this headquarters modified its position by authorizing the conversion of the two unit cars that had been delivered to the Army in 1941 into pilot models for the new type.70

Reappraisal of the Hospital Train Program

Before the pilot models were completed for service testing, the Surgeon General's Office re-examined the entire hospital train program. Early in 1944, it will be recalled, a group in this Office had completed a detailed study of the anticipated patient load.71 It was estimated that 30,000 patients per month would have to be moved by train by October 1944 and that at least 75 percent of them would have to be moved in government-owned

68(1) Ltr, CO 1247 SCSU 2d SvC to SG, 2 Oct 43, sub: Cons of Hosp Unit Cars. TC: 531.4. (2) Memo, CofT for SG, 23 Sep 43, sub: Govt-Owned Hosp Cars, with 1 ind. Same file.
69Memo, SG for CofT, 15 Oct 43, sub: Unit Car, New Type, with Drawing (7 Oct 43). TC: 531.4. See above, pp. 377-80.
70Memo, SG for CofT, 18 Sep 43 (corrected 18 Oct 43), sub: Unit Car, New Type, with 5 inds. TC: 531.4. 
71See above, pp. 323-25.


384

PLANS FOR RAIL AMBULANCE CAR AND NEW HOSPITAL UNIT CAR


385

cars. Assuming that each car could carry twenty-five patients per trip and could make four trips per month, 225 cars would be needed. Since 120 were already available or authorized, The Surgeon General requested 105 additional hospital cars of the new unit type. At the same time he asked that buffet kitchens be installed in all ward and ward dressing cars. The Transportation Corps agreed with The Surgeon General as to the type of cars desired but believed, on the basis of a study just made, that as many as 200 additional hospital cars would be needed. On 11 April 1944 representatives of ASF headquarters, the Surgeon General's Office, and the Transportation Corps agreed that it would be quicker and more economical to construct new cars than to try to lease commercial cars for conversion. Two weeks later ASF headquarters approved both the alteration of ward and ward dressing cars and the procurement of 100 new cars. Additional ones would not be authorized, it was stated, until military requirements became "firmer."72 Contracts for altering old cars and building new ones were let with the American Car and Foundry Company in May 1944, and by late fall of that year cars of both types were ready for trial runs.73

The new unit car was similar to the unit car of World War I and to the rail ambulance car proposed in 1942 in that it had space for both patients and attendants as well as facilities for caring for patients and for feeding all passengers. It was different in that it was built specifically as a hospital car, instead of being converted from existing rolling stock, and was equipped "with every travel luxury." Ten feet longer than Pullman cars, its body was of steel and was mounted on easy-riding six-wheel trucks. At one end was a stainless steel kitchen, with a refrigerator, an ice cream cabinet, a coal range, sinks, a steam table, and a coffee urn. Both the press and the Army called this the "principal innovation in the new car." Next to the kitchen was a pharmacy and receiving room, with wide doors on each side for loading litter patients. This room could be used also as an emergency operating or dressing room. Adjoining it were two sets of three-tiered berths that could be used for seriously ill patients, for mental patients, or for medical attendants. This section was separated from the main ward by a sterilizer room on one side of the car and a toilet and washroom on the other. The main ward section had a row of five three-tiered Glennan-type berths on each side. They could be adjusted to provide seating space, or the two lower berths could be used for litter patients and the upper berth for ambulatory patients or attendants. Between the main ward and the vestibule were storage lockers and a shower bath on one side of the car, and a roomette each for an officer and a nurse on the other. Each car was carpeted, equipped with special lighting fixtures, and air-conditioned.74 Although less luxurious and lacking specific accommodations for doctors and nurses, hospital ward and ward dressing cars, after the installation of the kitchenettes in space made available by removal of berths for four patients, could be used in much

72Memo, SG for CG ASF, 30 Mar 44, sub: Hosp Cars, ZI, with 4 inds. SG: 322.2-5 and TC: 453.9.
73(1) TC-3066, Specifications for Cons of Car, Hosp, 8 May 44. Off file, Research and Dev Bd SGO, "Unit Car, New Type." (2) Memo, CofT (Reqmts Div) for CG ASF (Dir of Mat), 14 Jun 44, sub: Hosp Cars, ZI, with 3 inds. SG: 322.2-5.
74(1) Railway Age, Vol. 117, No. 26 (1944), pp. 964-66. (2) American Car and Foundry Company, Report to Workers, pp. 76-79. Lib Congress. (3) For details of development see files SG: 453.1, TC: 531.4, and Off file, Research and Dev Bd SGO, "Hosp Unit Car."


386

WARD IN NEW HOSPITAL UNIT CAR, 1944 (note adjustable berths).

the same way as the new unit cars. Thus by the end of the war, the Medical Department had what were in effect only two types of hospital cars: unit cars and kitchen cars.

With development of the new unit car and modification of ward and ward dressing cars, a change occurred in hospital train movements. Gradually the practice developed of making up hospital trains for a number of destinations and of including in them variable numbers of hospital cars in different combinations. Ordinarily, regardless of the inclusion of hospital cars with kitchen facilities, hospital kitchen cars were used for feeding all patients so long as a number of hospital cars remained attached to the train. This practice was followed because it was more efficient to prepare food in one place than in many different places. All cars of a hospital train did not proceed to the same destination. At "gateways" (railway junctions) separate cars were cut away from the main route and were attached to commercial trains to carry loads of patients to different destinations. After delivering initial loads, cars were often diverted to transport additional groups of patients from one general hospital to another before being used again as parts of a complete hospital train. Whenever cars were separated from hospital trains, their buffet kitchens were used to feed patients.75 Thus the hospital cars

75(1) Rpts, Hosp Tn Conf, 15-16 Feb 45, Miller Fld, SI, N.Y.; 10-13 Jul 45, Presidio of San Francisco. HD: 531.4 (Conf). (2) Records of hospital train movements, filed in OCT, Tfc Control Div, form OCT 145.


387

RECEIVING ROOM IN NEW HOSPITAL UNIT CAR, 1944

finally in use in World War II possessed an adaptability which permitted them to be used along with other cars to make up a complete hospital train or singly to transport small groups of patients on commercial trains.

Procurement of Additional Hospital Cars

In the winter of 1944-45 the Surgeon General's Office reviewed the anticipated patient load and re-estimated the hospital and evacuation facilities that would be required. On the assumption that V-E Day would occur in June 1945, it was estimated in December 1944 that the number of patients returned to the United States each month from January through August 1945 would range from 32,000 to 36,000 and would decrease thereafter.76 A drop in the patient load would result in no less need for hospital cars, for after V-E Day the major portion of patients would arrive at Pacific ports and a car operating from one of them could make fewer round trips and carry fewer patients per month, because of the greater distance to general hospitals, than could one from an Atlantic port. At the same time, railroads were finding it increasingly difficult to supply the Army with enough commercial cars of the desired type. To assure adequate numbers of hospital cars, the Surgeon General's Office on 19 December 1944 asked for 100 additional unit cars as soon as possible. ASF headquarters approved this request,

76See above, pp. 327-28.


388

and contracts were let with the American Car and Foundry Company in January 1945.77 Meanwhile, it became apparent that more kitchen cars would be needed because the increasing number and changed type of hospital cars permitted the operation of more than forty trains at one time. On 22 January 1945, The Surgeon General requested the Transportation Corps to procure twenty troop kitchen cars from the Defense Plant Corporation for use with hospital trains. This request was approved, and the twenty cars were delivered within the next few months and put into use immediately, without significant alterations.78 (See Table 17.)

The peak of the patient load arriving from theaters of operations came before the second group of 100 unit cars was delivered. In May 1945, when the greatest number of patients in any single month arrived, the Army was using 120 old cars and 100 new unit cars, plus almost 60 kitchen cars. During that month, 47,044 patients were moved by train. This required the use of 1,200 Pullman cars to supplement government-owned cars.79 Thereafter, the number of patients declined rapidly and by late August 1945, when the last of the cars ordered in January had been delivered, the Medical Department declared surplus thirty-six modified ward and ward dressing cars. After V-J Day the decline in the patient load permitted the disposal of additional cars and by the middle of 1946 the Medical Department retained only 100 unit cars.80 (See Table 17.)

Problems in Manning Hospital Trains

At the beginning of the war the Medical Department had a table of organization for a hospital train unit. Revised early in 1942, it was reissued in April as Table of Organization 8-520. It provided for a self-sustaining unit to operate a complete hospital train with a capacity of 360 patients. To perform its own administrative, mess, and supply functions as well as to care for patients, each unit was authorized 4 Medical Corps officers, 6 nurses, and 33 enlisted men.81 Eight such units were organized between June 1942 and June 1943, and for a short time there was confusion about their purpose both in SOS headquarters and among service commands. In September 1942, on recommendation of the Surgeon General's Office, SOS headquarters made it clear that such units were intended for service in theaters of operations and were to be employed in the United States on training trips only.82

About the same time, there was concern about attendants for patients being transported by train in the United States. After the North African invasion, casualties began to arrive in increasing numbers. Furthermore, hospital cars which the Army had ordered early in 1942 were delivered

77(1) History . . . Medical Regulating Service. . . , Tab 5, Hospital Trains. (2) Memo, SG for CG ASF (Planning Div) thru CofT, 19 Dec 44, sub: Hosp Cars, ZI, with ind. SG: 322.2-5. (3) Memo, ASF Planning Div for ASF Reqmts and Stock Control Div, 21 Dec 44, same sub. HRS: ASF Planning Div Program Br file, "Hosp and Evac."
78(1) Memo, SG for CofT (Rail Div), 22 Jan 45, sub: MD Kitchen Cars. SG: 453.1. (2) Memo, Maj R. W. Tonning (OCT) for Rail Div OCT, 18 Jun 45, sub: Conv of 20 Trp Kitchen Cars. TC: 531.4.
79Information supplied by Troop Movements and Records Section, Traffic Control Branch, Passenger Division, OCT.
80(1) Memos, SG for CofT (Mil Ry Serv), 27 Sep 45, 27 Feb 46, and 2 Apr 46, sub: Release of Surplus Hosp Cars. SG: 453.
81T/O 8-506, 1 Nov 40; T/O 8-520, 1 Apr 42.
82(1) An Rpt, Oprs Serv SGO, 1943. HD. (2) 2d ind, CG SOS to CG 4th SvC, 22 Sep 42, with Memo for Record, on Memo, CG 4th SvC for CG SOS, 29 Aug 42, sub: Hosp Tn. AG: 322.38.


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and in August the entire fleet of twenty-four were assigned to service commands.83 In discharging responsibility for manning them, service commands encountered difficulty in determining how many doctors, nurses, and enlisted men were needed. SOS directives instructed them to use as a guide Table of Organization 8-520, but it applied to an entirely different situation. In the zone of interior hospital trains were to be composed of three hospital cars supplemented with such common-carrier equipment as Pullmans, diners, and baggage cars. They carried varying numbers of patients and depended upon the railroads in the early part of the war for mess service. To supply service command surgeons with a more appropriate guide, SOS headquarters on 24 December 1942 directed The Surgeon General to prepare a manning table for zone of interior hospital trains. Submitted six days later, this table indicated that 2 doctors, 1 nurse, and 14 enlisted men were needed for 100 patients; 2 doctors, 1 nurse, and 16 enlisted men for 200 patients; 3 doctors, 1 nurse, and 19 enlisted men for 300 patients; and 3 doctors, 1 nurse, and 21 enlisted men for 400 patients. Soon afterward SOS headquarters directed the Second Service Command-and presumably others-to use this guide in requisitioning personnel for use aboard hospital trains.84

As experience accumulated in transporting increasingly large numbers of patients, ASF headquarters in August 1943 issued a new guide-Table of Distribution 8-1520-which differed from the one prepared by the Surgeon General's Office in December 1942. Whereas the old guide had covered groups of patients ranging by hundreds from 100 to 400, the new one covered groups increasing by twenty-fours from 118 to 358. This change reflected the growing tendency to send small groups of patients to different hospitals instead of making mass movements from a port to one or two hospitals only. The old guide had called for 2 doctors, 1 nurse, and 16 enlisted men for 200 patients; the new one called for 3 doctors, 1 administrative officer, 3 nurses, and 11 to 16 enlisted men for 190.85 Despite a moderate increase in personnel in the new guide, it proved inadequate, at least in one service command, and was not followed. During the period from 15 March 1944 through 12 May 1944, seventeen hospital trains evacuated patients from Stark General Hospital in the Fourth Service Command. Each carried an average of 190 patients and had assigned as attendants an average of 6 doctors, 3 administrative officers, 5 nurses, and 57 enlisted men.86 Presumably other service commands also were free to use more attendants than the guide called for.

Another problem which service commands encountered was the manner in which train personnel should be handled administratively. Until the middle of 1943 all commands assigned such personnel to station or general hospitals. Difficulties caused by this procedure were illustrated by the experience of the Second Service

83See above, pp. 349, 375.
84(1) Ltr SPOPH 322.15, CG SOS to CGs and COs of SvCs and PEs, and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs, with incl. AG: 704. (2) 2d ind, CG SOS to SG, 24 Dec 42, with Memo for Record; 3d ind, SG to CG SOS, 30 Dec 42, with incl; and 4th ind, CG SOS to CG 2d SvC, 5 Jan 43, with Memo for Record, on Memo, CG SOS for CG 2d SvC, 21 Nov 42, sub: Auth to Activate Two Hosp Tns. AG: 320.2 (11-21-42).
85(1) T/D 8-1520, 12 Aug 43, Hosp Tn, ZI. (2) See pp. 347-48.
86Memo, 1st Lt Theodore Kemp, Control Div [4th SvC] for Maj Maxwell, 5 Jun 44, sub: Pers Reqmts for Hosp Tn. HD: 531.4 (Pers Reqmts). There is no indication in the document cited as to the organization to which Major Maxwell was assigned.


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Command. For example, officers, nurses, and enlisted men used to operate one of its trains were assigned to Halloran General Hospital. This hospital assigned them to ward duties, maintained their records, paid them, and considered them administratively a part of the hospital staff. In consequence, nurses and enlisted men often worked on wards until the departure time of trains, without opportunities to rest and prepare themselves for trips. To get enlisted men released from ward duties for train trips, the train commander had to request the permission of the commanding officer of the hospital medical detachment who, in turn, had to request permission of the chief of the section for whom these men worked in the hospital. Officers who were assigned to wards lost contact with patients they left behind while away on train trips. Working part of the time in the hospital and part on hospital trains, officers and enlisted men found it difficult to demonstrate to hospital authorities their fitness for promotion and were often passed over when promotions were made. Enlisted men who were absent from the hospital on paydays failed to receive their pay and, unless paid on a supplemental payroll, had to await the next regular payday a month later. The hospital considered this situation just as unsatisfactory as did the train commander because it had officers, nurses, and enlisted men upon whom it could not always depend for hospital service. Nevertheless this system kept all personnel fully occupied in the intervals between train movements, and perhaps some of the problems connected with it could have been solved by minor administrative changes. The Second Service Command however adopted a different solution by requisitioning additional personnel for train operations and assigning it, along with that already available, to a separate unit, the 1247th Service Command Service Unit.87

During 1944 other service commands followed this example. The organization of train units that were separate from hospital detachments was discussed at a service commanders' conference in February 1944 and was indorsed by the commanding general of the Service Forces. Afterward, in July 1944, the First, Third, and Ninth Service Commands organized separate train units. At least one of them, the First, placed its train unit under the direct control of the service command surgeon in the spring of 1945. The Fourth Service Command followed a different procedure. In September 1944 a receiving and evacuation detachment, consisting of litter bearers and clerks as well as train personnel, was organized at Stark General Hospital.88 The organization of separate units, if their members were kept fully occupied, was superior to the use of hospital personnel for train service, since it simplified administration in all respects.

Service command surgeons encountered difficulty in getting adequate personnel allotments for train operations. Having estimates of the potential patient load, the Surgeon General's Office attempted early in 1944 to forestall this difficulty. In April it submitted to ASF headquarters an estimate of medical attendants needed by each service command during 1944 for train operations. ASF headquarters took

87(1) Rpt, Hosp Tn 1, Halloran Gen Hosp to CG 2d SvC ASF (Med Br Sup Div), 5 May 43, sub: Rpt of Hosp Tn Mvmt, HT 16-21-1-11, Main 24025, 27-28 Apr 43, with Supp. SG: 531.4. (2) An Rpt, 2d SvC, 1943. HD.
88(1) Rpt, Conf CGs of SvCs, Dallas, Tex, 17-19 Feb 44. HD: 337. (2) An Rpts, 1st and 9th SvCs, McGuire and Stark Gen Hosps, 1944, HD. (3) GO 49, 14 Apr 45, Hq ASF, 1st SvC, Boston. HD: 531.4.


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the position that service commands should determine their own needs and should submit requisitions accordingly.89 Under this system, service command surgeons apparently failed to get the strength actually needed for train operations. For example, at the end of 1944 the surgeon of the Second Service Command had an allotment of 589 for assignment to hospital trains, but used 1,175. To make up the difference, he attached to trains 586 persons from other medical installations in the command. The Surgeon General discussed this problem with the Chief of Staff at the end of 1944. As a result service commands got additional personnel. For example, the number assigned to train service in the Second Service Command increased by May 1945 to 1,322-58 physicians, 1 dentist, 75 other officers, 91 nurses, 1,053 enlisted men, and 44 civilians.90

Supplies and Equipment for Hospital Trains

Equipment for the care and comfort of patients on hospital trains had to be planned for each hospital car developed, and consideration had to be given to balancing the necessity of items for medical use against the limited amount of space available. Hence, large items of equipment that were fixed parts of hospital cars, such as berths, instrument cabinets, storage lockers, instrument sterilizers, bedpan washers and sterilizers, cooking ranges, refrigerators, coffee urns, and the like, were planned along with cars in which they were to be installed and became a part of the specifications for their construction. Builders of hospital cars normally procured and installed such items, but in some instances the Medical Department procured certain special ones, such as instrument sterilizers and operating tables, for installation by builders.91

Supplies and items of equipment that were not fixed parts of hospital cars were listed in tables of allowances and in Medical Department equipment lists. The latter were the more important, because hospital cars carried few items supplied by services other than the Medical Department. By the fall of 1940, when procurement of the first two unit cars was approved, the Surgeon General's Office had developed an equipment list for cars of that type. Like other Medical Department equipment lists, it included such items as drugs and biologicals, gauzes and bandages, surgical instruments, linens, office supplies, and mess equipment.92 Later, in 1942, when ward and ward dressing cars

89(1) Memo, Dep Dir Plans and Oprs ASF for Dir Pers ASF, 26 Apr 44, sub: Reqmts for Med Pers to Cover Rail Mvmts . . . , with incl. HRS: ASF Planning Div Program Br file, "Hosp and Evac, vol. 3." (2) Memo, Dep Dir Plans and Oprs ASF for DepCofS for SvCs ASF, 8 May 44, sub: Est of Numbers of Sick and Wounded Arriving from Overseas, with incl. Same file.
90(1) History, Office of the Surgeon, Second Corps Area and Second Service Command From 9 September 1940 to 2 September 1945. HD. (2) Notes for Gen Kirk on Conf with Gen Marshall, Summary: 25 Dec 44. HD: 024 (Resources Anal Div, Jul-Dec 44).
91(1) Gen Specifications for Hosp Unit Cars for WD, 4 Jun 40. TC: 453. (2) Rpt of MD Bd, Med Fld Serv Sch, 27 Aug 40. SG: 453.-1. (3) 1st ind, SG to MSO Carlisle Barracks, Pa., 10 Apr 41, on Ltr, MSO Carlisle Barracks, Pa., to SG, 7 Apr 41, sub: Car, Railroad, Hosp Unit, Unit Car No 2. Off file, Research and Dev Bd, SGO, "Hosp Unit Cars." (4) Specifications for Remodeling 18 Pullman Parlor Cars to Hosp Ward Cars for the WD, 30 Jan 42. Off file, Research and Dev Bd, SGO, "Hosp Ward Car." (5) TC US Army Specification No TC-3066, 8 May 44, Construction of Car, Hospital. Off file, Research and Dev Bd, SGO, "Unit Car, New Type." (6) Ltr, SG to CO Hosp Tn SCSU 1247, 27 Jun 45, sub: Sterilizers for Hosp Ward Cars. SG: 453 (2d SvC)AA.
92(1) Memo, [Col] A[lbert] G. L[ove] for Lt Col [Francis C.] Tyng, 10 Oct 40, sub: Hosp Unit Car. Off file, Research and Dev Bd, SGO, "Unit Car." (2) Med Equip for Hosp Unit Car, Oct 40. Same file.


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were developed, equipment lists were prepared for them also, and when their delivery was expected in the spring of that year the Surgeon General's Office requested SOS headquarters to approve the inclusion of assemblages, packed according to these lists, as authorized items in tables of allowances for hospital cars. Approval was given, and these lists became the official basis for the issuance of equipment and supplies to ward and ward dressing cars when they were first delivered to the Army in the late summer of 1942.93

These early equipment lists were necessarily theoretical in nature, because the Medical Department had had no experience, when they were prepared, in operating hospital cars of the types developed during World War II. In 1943 they were revised. Subsequently, as experience accumulated, hospital train commanders proposed further revisions. Their recommendations were at variance with one another, and the Surgeon General's Office had difficulty in deciding which to accept.94 Hence, at a hospital train commanders' conference in February 1945, a representative of the Surgeon General's Technical Division distributed a tentative equipment list, based upon recommendations already submitted, for consideration by officers who were responsible for the care of patients aboard hospital trains. After discussing the items listed, train commanders and The Surgeon General's representative agreed upon which should be retained, deleted, or added.95 New equipment lists for ward, ward dressing, unit, and kitchen cars were then published in March 1945.96 Several months later it appeared that train commanders were dissatisfied with the supplies and equipment agreed upon and at a conference in July 1945 they proposed changes. Some, such as in the substitution of twelve bath towels for twelve hand towels, the Surgeon General's Office approved. Others it refused to authorize because The Surgeon General insisted upon retaining in all hospital cars enough equipment of certain types, such as surgical instruments, to provide for emergencies or accidents that might occur as well as for the routine care of patients en route.97

In addition to revising equipment lists, the Surgeon General's Office either developed new items or permitted hospital train commanders to do so. For example, upon a recommendation of the Fourth Service Command, the Surgeon General's Office in 1944 developed a better mattress of a different size for use on hospital trains.98 Accepting a suggestion from the Second Service Command, it soon afterward developed an adjustable back rest. This item contributed to the comfort of patients by enabling them to change positions while

93(1) Memo, Lt Col Thomas N. Page for Lt Col Griffin and Lt Col Hays, 20 Apr 42. Off file, Research and Dev Bd, SGO, "Hosp Ward Cars." (2) Ltr, SG to Reqmts Div SOS, 10 May 42, sub: Med Equip for Hosp Tn, with ind. SG: 453.-1. (3) Memo, CG SOS for CGs 2d, 4th, 6th, 8th, and 9th SvCs and for SG, 26 Aug 42, sub: Control of Hosp Tns. HD: 531.4.
94(1) Ltr, CO 2d SvC Hosp Tns 1247th SCSU to SG, 2 Oct 43, sub: Changes to Med Equip, Ward and Unit Cars. SG: 453.-1. (2) Diary, Tec Div SGO, 25 Nov-1 Dec 44. HD. (3) Memo, Post Sup Off [Stark Gen Hosp] to SG, 21 Jan 45, sub: Mess Equip on Hosp Cars, with 2 inds. SG: 453.
95(1) Transcript of Proceedings, Hosp Tn Conf, 15-16 Feb 45. (2) Diary, Tec Div SGO, 17-23 Feb 45. HD.
96ASF Catalog Med 10-14, Med Equip List, 27 Mar 45.
97(1) Transcribed Mins of Hosp Tn Unit Comdrs' Conf, 10-13 Jul 45. HD. (2) Memo, Capt George R. Allen for Dir Tec Div SGO, 30 Jul 45. Off file, Research and Dev Bd SGO, "Unit Car, New Type."
98(1) Diary, Tec Div SGO, 3-9 Jun 44, 25 Aug-1 Sep 44. HD. (2) Transcript of Proceedings, Hosp Tn Conf, 15-16 Feb 45. HD.


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in train berths.99 Another example of new equipment was the bath tray. Fitting on the sides of hospital berths, this tray simplified the work of nurses in bathing patients in bed. It was first put in use by the Second Service Command in the latter part of 1944. The Surgeon General's Office adopted the idea and began a development project for such a tray but the war ended before it was standardized.100

Items included in the equipment lists of hospital cars were considered to be the minimum in type and quantity that should be kept aboard at all times. Hence, hospital car commanders were authorized to draw equipment and supplies, to replace those used, from any medical supply officer in the United States. Normally, however, home stations made replacements.101 To avoid bookkeeping, linen was exchanged on an item-for-item basis. Regulations early in the war required hospitals to exchange linen with hospital trains when patients were transferred to their control. It happened frequently that such exchange either delayed train schedules or was not made at all. At the train commanders' conference in February 1945, therefore, it was decided that the exchange of soiled for clean linen would normally be deferred until the end of a trip or until points were reached at which trains stopped for lengthy periods. In cases where soiled linen was not replaced by one of the hospitals to which patients were delivered, that hospital furnished a receipt for the linen it received so that train commanders could draw clean linen from general hospitals at the ends of trips.102

99(1) Ltr, SG to CO 2d SvC Hosp Tns 1247th SCSU, 11 Sep 44, sub: Back Rests. SG: 442.7 (2d SvC)AA. (2) Diary, Tec Div SGO, 28 Apr-4 May 45. HD.
100(1) Ltr, Chief Hosp and Evac Br 2d SvC to CG ASF attn SG, 14 Oct 44, sub: Hosp Tns, with incl. SG: 700.7-2. (2) Ltr, SG to CO 2d SvC Hosp Tns 1247th SCSU, 2 Dec 44. SG: 453 (2d SvC)AA. (3) Diary, Tec Div SGO, 21-27 Jul 45. HD.
101(1) Diary, Tec Div, SGO, 17-23 Feb 45. HD. (2) ASF Cirs 286 and 401, 1 Sep and 9 Dec 44.
102(1) Ltr, CG Lovell Gen Hosp to SG, 8 Feb 45, sub: Linen Exchange for Hosp Cars, with 2 inds and Memo for Record. HRS: Hq ASF Planning Div Program Br file, 370.05 "Hosp and Evac." (2) Transcript of Proceedings, Hosp Tn Conf, 15-16 Feb 45. HD.

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