Contents

CHAPTER XXIII

Providing the Means for Evacuation by Sea

Most of the patients evacuated from theaters of operations to the zone of interior were transported in surface vessels. It is therefore important to consider in the following discussion the types of vessels used, reasons for their employment, and problems encountered in suiting them to the transportation of patients, along with difficulties in furnishing such vessels with the supplies, equipment, and attendants required for the care of patients en route.

Ships' Hospitals and Hospital Ships

At the beginning of 1939 the Army had four transports in which to return patients from overseas bases, such as Hawaii and the Philippines. With the expansion of existing bases and the establishment of new ones in the Atlantic during 1939 and 1940, additional transports were added to the Army's fleet, and efforts were made to enlarge and improve their hospital facilities. These efforts were only partially successful, because funds for such work were limited. Furthermore, the ships themselves were too old to warrant extensive alterations, and the speed with which some were put into transport service left no time for major changes.¹ In view of this situation as well as the probability that large numbers of patients would be evacuated in subsequent months, the New York Port of Embarkation proposed in the fall of 1940 that the U.S. Army Transport Chateau Thierry should be converted into a part-time hospital ship, to carry freight and troops on outbound voyages and return with full loads of patients.² On recommendation of the chief of his Hospital Construction Subdivision, The Surgeon General disapproved, stating that the proposed transport was not suitable for conversion, that its use would violate the terms of the

¹The United States Army Transports U. S. Grant, St. Mihiel, Chateau Thierry, and Republic had been in almost continuous service since World War I. The Hunter Liggett, Leonard Wood, and American Legion were added in 1939. Others added to meet Army expansion needs were the Irwin, Kent, Munargo, Orizaba, and President Roosevelt (Joseph T. Dickman.) For their histories, see Roland W. Charles, Troopships of World War II (Washington, 1947), pp. 1-68. Information on problems of providing hospital facilities on these ships may be found in SG files: 560-69 (BB), 632.-1 (BB), 632.-2 (BB), 721.5-1 (BB) under name of transport; AG: 571, 573.27; TC: 571.4; and in surgeons' reports attached to voyage reports filed in TC: 721.1. Also see Chester Wardlow, The Transportation Corps: Responsibilities, Organization, and Operations (Washington, 1951), pp. 136-44, in UNITED STATES ARMY IN WORLD WAR II.
²(1) Ltr, Supt ATS NYPE to QMG thru CO NYPE, 27 Sep 40, with 1st ind. TC: 632 (Chateau Thierry). (2) Ltr, CG NYPE to QMG, 26 Nov 40, sub: Inadequate Hosp Fac on Trans. AG: 573.27 (11-26-40). (3) Ltr, Port Surg NYPE to SG, 29 Nov 40, sub: Inadequate Hosp Fac on Trans. SG: 632.-1 (Chateau Thierry)BB.

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Geneva and Hague Conventions,³ and that its employment in the evacuation of small numbers of patients from scattered areas would be uneconomical. He recommended instead that "the idea of developing a hospital ship be given further study," and that the Army continue to use transports for the evacuation of its sick and wounded from overseas areas.⁴

During 1941 the question of whether or not hospital ships would be provided remained unanswered. The question also arose of whether the Army or the Navy would be responsible for the evacuation of Army patients. Existing plans called for the control of all water transportation by the Navy beginning on M-Day (Mobilization Day), and during the early part of 1941, under policies announced by the President, the Navy began to take over Army transports on which hospital areas had been enlarged and improved. Disturbed by this loss to the Navy of evacuation space and fearing a repetition of World War I experiences, when the Navy failed to evacuate patients to the satisfaction of the Army, the surgeon of the New York Port in October 1941 proposed that a hospital ship should be provided for the Army.⁵ Reaction in Washington was mixed. Some officers in the G-4 Division of the General Staff, in the Office of The Quartermaster General, and in the Surgeon General's Office were favorably impressed; but the chief of the Surgeon General's Hospital Construction Subdivision doubted "the wisdom and productivity of this proposal."⁶ In transmitting it to the General Staff, The Surgeon General asked for decisions as to the policy on evacuation and as to whether the Army or the Navy would be responsible for transporting the Army's patients.⁷ The Japanese attack on Pearl Harbor occurred before further action was taken on the New York Port's proposal.

Basic Decisions on Water Evacuation in 1942

Entry of the United States into the war made necessary both immediate and long-range plans for facilities for the evacuation of patients from theaters of operations. An agreement between the Army and Navy soon after Pearl Harbor for the Army to continue to operate transports despite prewar plans to the contrary partially solved this problem,⁸ for the Army could continue to evacuate patients aboard them. Other questions remained to be answered: (1) whether or not hospital ships would be

³The Geneva Conventions of 1864, 1906, and 1929 established principles for belligerents to follow in the care, treatment, and transportation of the sick and wounded of land warfare; the Hague Conventions of 1899, 1904, and 1907 adapted to maritime warfare the provisions of the Geneva Conventions. The Hague Convention of 1907 was signed by the representatives of forty-three countries, among them the United States, China, France, Great Britain, Germany, Italy, and Japan. In 1942 the Medical Department published an article on the Conventions, along with copies of their texts. Albert G. Love, "The Geneva Red Cross Movement: European and American Influence on its Development," Army Medical Bulletin, No. 62 (1942).
⁴(1) Memo, Lt Col John R. Hall, SGO, for Planning and Tng Div SGO, 10 Dec 40, sub: Conv of USAT Chateau Thierry into a Hosp Trans Ship. (2) 2d ind, SG to QMG, 28 Dec 40, on Ltr, CG NYPE to QMG, 26 Nov 40, sub: Inadequate Hosp Fac on Trans. Both in SG: 632.-1 (Chateau Thierry)BB.
⁵(1) Ltr, Surg NYPE to SG thru CG NYPE, 29 Oct 41, sub: Hosp Ships, with 4 incls. HRS: G-4/29717-100. (2) Memo, ACofS G-4 WDGS for ACofS WPD WDGS, 19 Nov 41, sub: Trf of ATS to Navy. HRS: G-4/29717-51.
⁶Memos, Col A[rthur] B. Welsh for Col [Howard T.] Wickert, undated; Col Wickert for Cols [Harry D.] Offutt and [John R.] Hall, 7 Nov 41, sub: Hosp Ships. HD: 560.2.
⁷2d ind SGO 541.-2 (BB), SG to AG, 24 Nov 41, on Ltr, Surg NYPE to SG thru CG NYPE, 29 Oct 41, sub: Hosp Ships. HRS: G-4/29717-100.
⁸Wardlow, op. cit., pp. 200-201.

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used, and (2) if so, the extent to which they would be used and whether or not the Army or Navy would control them.

Opinions on these points differed during the first half of 1942. General Headquarters approved the use of both transports and hospital ships for evacuation, but believing that the enemy would not respect the terms of the Hague Convention granting hospital ships immunity from attack, GHQ recommended that all plans for evacuation should be prepared with that probability in mind. GHQ also recommended that a decision be sought on whether the Army or Navy would operate hospital ships.⁹ Taking the position that transports could be used for evacuation from areas with ample shipping, as demonstrated in World War I, The Surgeon General recommended a continuation of that method for all large theaters; but because of disruption by the war of peacetime transport schedules, he now proposed that two hospital ships (one for the Atlantic and one for the Pacific) should be provided for the evacuation of patients from small scattered bases. He made the latter recommendation contingent upon respect by the Axis Powers for the terms of the Hague Convention-the primary consideration, in his opinion, in any decision to use hospital ships. The Surgeon General also announced that he preferred to evacuate Army patients in ships operated solely under Army control. In any case, he wanted no division of responsibility. The agency responsible for operating ships for evacuation should be responsible also, in his opinion, for the medical care and administrative control of patients aboard them.¹⁰ The Quartermaster General recommended the conversion of two Army transports into vessels that could be used either as hospital ships or as ambulance transports. If employed in the latter capacity they could be operated by the Army Transport Service and would sail under convoy, carrying troops on outbound voyages and returning full loads of patients to the United States.¹¹ A group of officers in G-4, most of whom were later transferred to SOS headquarters and among whom was a Medical Corps officer (Maj. William L. Wilson), maintained that Convention-protected hospital ships-at least six-should be used in addition to transports to evacuate Army patients from major theaters despite uncertainty about the attitude of the Axis Powers toward the Convention. Furthermore, having ascertained that the Navy had no plans for providing hospital ships for the Army and being convinced by World War I history of the futility of depending upon the Navy for evacuation, this group wanted the Army both to own and to operate the vessels procured for use as hospital ships.¹²

In the first half of 1942 the G-4 group pressed for approval of its plans. After the Bureau of the Budget disapproved supplemental estimates for funds for six hospital ships submitted in January 1942, because the Maritime Commission stated

⁹(1) Memo, Chief Surg GHQ for CofS GHQ, 9 Jan 42, sub: Return of Sick and Wounded from Foreign Theaters. HD: 541 (Trans). (2) Memo, GHQ for ACofS G-4 WDGS, 14 Jan 42, sub: Hosp Ships. . . . HRS: G-4/29717-100.
¹⁰(1) Memo, SG for ACofS G-4 WDGS, 5 Jan 42, sub: Plan for Water Trans for Sick and Wounded. SG: 541.2. (2) Memo, SG for JCS (Col [Russell I.] Vittrup), 6 Jun 42, with inclosed notes. SG: 560.-2.
¹¹Ltr, QMG to TAG, 14 Feb 42, sub: Hosp Space on Army Trans. TC: 632 (Army Trans).
¹²(1) Memo, ACofS G-4 WDGS for TAG, 24 Jan 42, sub: Hosp Space on Army Trans. HRS: G-4/ 29717-100. (2) Memo, CG SOS for CofSA, 28 Apr 42, sub: Hosp Ships, with 9 incls. HD: Wilson files, "Book IV, 16 Mar 43-17 Jun 43." (3) The Medical Department . . . in the World War (1923), vol. I, pp. 357-71.

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that it would procure ships required by the Army, G-4 requested the Commission on 12 February 1942 to procure six hospital ships, along with several vessels of other types, for the Army's use. When the Commission replied that hospital ships fell "properly under the cognizance of the Navy Department," G-4's Transportation Branch disagreed and asked the Commission to reconsider its opinion. Receiving no reply to this request by late April 1942, SOS headquarters (recently established and containing many officers formerly in G-4) pursued the matter further. In letters prepared for the signature of the Secretary of War, it urged the Maritime Commission to procure six hospital ships for the Army, whether to be operated by the Army or Navy, and called upon the Secretary of the Navy to settle with the Army this question of jurisdiction. The administrator of the recently established War Shipping Administration, who was also chairman of the Maritime Commission, replied that he could not allocate vessels for use as hospital ships until the Army and Navy had agreed upon "strategic requirements." Because of its close relation to other shipping problems, the Secretary of the Navy proposed that the whole question be referred to the Joint Staff Planners, a group working under the Joint Chiefs of Staff.¹³

The investigation conducted by the Joint Staff Planners and the joint Chiefs of Staff covered not only the strategic shipping situation but also other matters: the probability of enemy respect for the Geneva and Hague Conventions, the British practice of evacuating patients by sea, and the estimated evacuation requirements for operations in the Pacific and for BOLERO (the build-up of American troops in the United Kingdom for an invasion of the European continent). The views of the Chief of the Bureau of Medicine and Surgery of the Navy and of The Surgeon General of the Army were also sought. The latter restated the position which he had taken earlier. The former believed that both Army and Navy patients should be evacuated by transports that were manned and operated by the Navy but were supplied with enough Army officers and enlisted men to care for Army medical records. If hospital ships should be used, he disapproved painting and marking them as international conventions stipulated. Rather he proposed that they be painted like transports for travel in convoy and reveal their identity as hospital ships only under "desirable" circumstances. In view of agreement between the two medical services on the use of transports for evacuation and in the interest of economy in shipping, the Joint Chiefs of Staff announced on 25 May 1942 that the normal means of evacuating patients from areas with "more or less continuous transportation service" would be by returning troop transports. Since the Army and Navy disagreed on the question of hospital ships, the Joint Chiefs announced a compromise decision in June 1942. Three vessels would be procured and operated as hospital ships under the Hague Convention. They would be built according to plans supplied by the Army, would be operated under the "general direction" of the Army, and would be provided with Army medical complements, but would be converted under supervision of the

¹³(1) Memo, ACofS G-4 WDGS for CofSA, 8 Feb 42, sub: Supp Ests "D," FY 1942. AG: 111 (1-31-42). (2) Ltrs, CofSA for US Mar Comm, 12 Feb, 7 Mar, 1 May 42; US Mar Comm to CofSA, 24 Feb, 4 May 42. SG: 560.-2. (3) Ltr, SecNav to Sec War, 6 May 42, sub: Basis of Responsibility for Procurement and Opr of Hosp Ships. AG: 573.27 (5-6-42).

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Navy and would be operated by Navy crews.¹⁴ Although authorized in the middle of 1942, the first of these ships was not placed in service until June 1944.

In the course of these protracted negotiations, the Army-believing that the general problem of evacuating patients from ground operations in overseas theaters was one for solution within the War Department-partially took matters into its own hands.¹⁵ In March 1942 the earlier proposal of The Quartermaster General to convert transports into vessels that could be used either as hospital ships or as ambulance transports was revived by the Transportation Corps. The Surgeon General reversed his prewar position in opposition to the use of ambulance transports and in April supported this proposal as a means of caring for immediate needs. Even if hospital ships should be authorized, he pointed out, their construction would require at least eighteen months.¹⁶ SOS headquarters approved, and late in May 1942 the Acadia was withdrawn from regular transport service. From June to October it underwent conversion at the Boston Port of Embarkation, emerging with a capacity of approximately 1,100 troops outbound and 530 patients inbound. Making its first trip as an ambulance transport in December 1942, the Acadia continued to sail as such until placed under the protection of the Hague Convention as a hospital ship in May 1943.¹⁷

Providing Facilities for Evacuation by Transports Early in the War

In view of shipping shortages, uncertainty about the use of hospital ships, and the decision for the Army to continue to operate troop transports, the most obvious method of meeting immediate evacuation needs was the use of transports. Existing regulations required each to have a hospital with beds equal in number to 1 percent of its passenger capacity for cases of sickness en route.¹⁸ Before the war the number of hospital beds on most transports had been increased to provide additional space for patients being evacuated from overseas areas. In March 1942 the Office of the Chief of Transportation proposed that the larger bed capacities be officially authorized for all transports-those to be procured as well as those already in service. Both the Surgeon General's Office and SOS headquarters approved, and in June 1942 the higher ratios were authorized. Changes were made in the fall of that year in the proportion of beds for different types of patients, but not in the total number authorized. The first eight months of the year had shown that 75 percent of the patients evacuated to the United States were mental cases. To provide more accommodations for them SOS headquarters on 8 September 1942 directed the

¹⁴(1) JMTC 4/M, 9 May 42, Evac of Sick and Wounded from Overseas. SG: 704.-1. (2) JCS 52, 21 May 42; JCS 52/1, 29 Jun 42. Records and Admin Br, Off ACofS G-3 WDGS. (3) Ltr, Bu of Med and Surg USN to JPS, 4 Jun 42, sub: Evac of Sick and Wounded from Overseas. SG: 704.-l. (4) Memo, SG for JCS (Col Vittrup), 6 Jun 42. SG: 560.-2.
¹⁵Ltr, SecWar to SecNav, 1 May 42, sub: Evac of Army Sick and Wounded from Overseas. AG: 560.
¹⁶Memo, CofT for CG SOS, 13 Mar 42, sub: Hosp Space on Army Trans, with 2d ind, SG to CG SOS, 8 Apr 42. SG: 632.-1 (BB).
¹⁷(1) Sailing Orders 82, Vessel: USAT Acadia, Outbound Voyage 5, 18 May 42. TC: 565.3 (Acadia). (2) Ltr, Surg NOPE to Col John R. Hall, SGO, 18 May 42, with reply dtd 20 May 42. HD: 560.2 "Hosp Cons Br SGO-Hosp Ships." (3) Memo, Chief Misc Br SOS for Gen [Le Roy] Lutes, 24 Jun 42, sub: Hosp Ships. HD: Wilson files, "Book I, 26 Mar-26 Sep 42." (4) TC: 561-565 (Acadia); and OPD: 370.05. 
¹⁸AR 30-1150, 19 Sep 41.

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Chief of Transportation to convert a portion of general ward beds of each ship's hospital into beds for mental patients.¹⁹ Thus during 1942 ratios (expressed in percentages) of hospital beds to troop berths were authorized for various types of transports as follows:

Meeting standards set for ships' hospitals on vessels converted into troop transports depended upon the time available to ports for modifications and improvements. Throughout 1942 transports were hastened into service and sent out heavily loaded, sometimes with numbers of troops that exceeded ships' rated capacities by 10 percent.²⁰ Changes in hospital areas of such vessels could be made only while they were undergoing initial conversions for the transport service or were in port between voyages for maintenance and repairs. Hence their hospital facilities varied. On some, completely new hospital areas were constructed. On others, existing hospitals were enlarged and improved. As a rule the Transportation Corps submitted to the Surgeon General's Hospital Construction Division for review the plans for hospital areas of vessels being converted. This Division sometimes approved plans that would not have been acceptable under ordinary conditions, but it disapproved others in part or in whole, and thus conversions were sometimes delayed. To prevent such delays and to standardize improvements made at different ports on different types of vessels, the Surgeon General's Office in November 1942 prepared a list of general specifications for ships' hospitals.²¹ Early in 1943 the Water Division of the Office of the Chief of Transportation sent it to all ports for use as a guide. Minimum standards thus established were as follows: a "suitable" surgical suite, minimal facilities for pharmacy and laboratory, adequate toilets for the hospital area with separate toilets for isolation wards, safety devices for wards for mental patients, a small X-ray unit with darkroom, berths of not more than two tiers, and beds equal in number to those authorized by SOS headquarters. Preferably, the hospital was to be located slightly aft of midship, not more than one deck below the uppermost "continuous weather deck," adjacent to cabins whose berths could be used for patients, and relatively close to lifeboats. It was to be well ventilated and lighted and was to

¹⁹(1) Memo, CofT for SG, 28 Mar 42, sub: Basic Plan for Evac of Sick and Wounded. HD: 705. (2) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: Opr Plans for Mil Hosp and Evac, with incl. HD: 705.1. (3) Memo, ACofS for Oprs SOS for CofT, 8 Sep 42, sub: Fac for Care of Mental Pnts on Trans. HD: 705 (MRO, Fitzpatrick Daybook).
²⁰For example, see Memo, Oprs Off OCT for Water Div OCT, 15 May 42, sub: Increased Trp Capacities. TC: 541.1.
²¹(1) Ltr, SG (Hosp Cons Div) for CofT, 26 Nov 42, sub: Gen Specifications for Hosp Areas on Converted Trans. SG: 632.-1 (BB). (2) Memo, Maj John C. Fitzpatrick for Chief Hosp and Evac Br Plans Div SOS, 17 Sep 42, sub: Rpt of Surv of Ships and Ships' Hosps. HD: 705 (MRO, Fitzpatrick Ref file). (3) Ltr, CofT to Supt ATS NYPE, 3 Oct 42, sub: Hasty Convs. SG: 632.-l (BB).

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have passageways wide enough for the removal of patients on litters.²²

Construction of new transports offered the possibility of assuring suitable ships' hospitals provided there was effective coordination among the Surgeon General's Office, the Office of the Chief of Transportation, and the Maritime Commission. For a time, plans drawn by the Maritime Commission were not submitted to the Surgeon General's Office and the latter considered hospitals on some of the new vessels unsatisfactory. After a series of conferences early in 1943 the Maritime Commission agreed to submit its plans thereafter to the Transportation Corps and the Surgeon General's Office for review and comment.²³

Early in 1943 a significant change was made in accommodations for mental patients on transports. Until that time some berths had been enclosed with wire cages, making spaces approximately 6 x 3 x 3 feet each in which seriously disturbed mental patients might be placed to avoid endangering themselves and others. In January 1943 the New York Port surgeon proposed the elimination of such "unnecessary and inhumane" accommodations. The neuropsychiatry section of the Surgeon General's Office supported this proposal. It pointed out that advances in medical practice, such as the use of sedation, hydrotherapy, and diversional activity, with minimum mechanical restraint, made it possible to care for mental patients in specially constructed wards. The Chief of Transportation therefore requested the Maritime Commission to eliminate metal cages from future transports and directed port commanders to remove existing ones and provide suitable security-ward space instead on other transports. Although surgeons of several ports argued that they would then be unable to care for mental patients, especially on long voyages in tropical areas, the Transportation Corps and The Surgeon General remained firm.²⁴ To guide transport and port surgeons in caring for seriously disturbed patients without metal cages, they issued a memorandum on the care of mental patients on transports in July 1943.²⁵ Later in the war, as will be seen below, the Army reverted to the use of individual cells for severely disturbed patients.

In the fall of 1942 British vessels, such as the liners Queen Mary and Queen Elizabeth, which since early 1942 had been carrying American troops overseas,²⁶ were brought within the program for enlarging the patient-capacity of transports. Since the British did not move helpless patients in transports, the Queens had inadequate laboratory and surgical equipment and each had only 175 beds for patients. In October 1942 the Army started arrangements for the installation of a 300-bed hospital on each ship. British officials in Washington were at first unsympathetic to

²²Ltr, CofT (Water Div) to CGs PEs attn ATS, 26 Jan 43, sub: Gen Specifications for Hosp Areas on Converted Trans, with incl. TC: 632.
²³Correspondence on ships' hospitals of troop ships and reports of conferences with Maritime Commission representatives are found in SG: 632.-1 (BB) and TC: 632.
²⁴(1) Ltr, Surg NYPE to SG (Col Tynes), 19 Jan 43, sub: Psychotic Pnts on Army Trans. TC: 632. (2) Memo, SG for CofT 15 Feb 43, sub: Elimination of Cages for Care of Mental Cases on US Army Trans. SG: 632.1 (BB). (3) Ltr, CofT to US Mar Comm, 27 Feb 43. TC: 632. (4) TC Cir 35, 1 Mar 43, Elimination of Cages for Mental Pnts. (5) Letters from port surgeons at San Francisco and New Orleans containing objections to removal of cages are filed in SG: 632.-1 (BB) and TC: 632.
²⁵Ltr, CofT (Mvmt Div) for CGs PEs, 10 Jul 43, sub: Care of Mental Pnts on US Army Trans. TC: 370.05 (Army Vessels).
²⁶(1) Wardlow, op. cit., pp. 6, 222-24. (2) Charles, op. cit., p. 309.

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the American plan for putting larger hospitals aboard, but changed their attitude after American officials explained that shortages of shipping and lack of hospital ships made it imperative to evacuate patients on transports. Final agreement was that the United States would install a 300-bed hospital on each ship while in an American port. The proportion of beds in general wards, isolation wards, and mental wards would be the same as that already established for hastily converted transports. When completed, each hospital would be operated by American Army personnel. The construction of new hospital areas began early in November when the Queen Mary came into port. Several months later work was begun on the Queen Elizabeth.²⁷

Renewed Efforts to Get Army Hospital Ships, 1942 -43

Neither the policy announced by the Joint Chiefs of Staff in the spring of 1942 nor efforts to supply evacuation facilities in compliance with this policy silenced demands for Army hospital ships. As early as April 1942 General Hawley (then Colonel), Chief Surgeon of the U. S. Army Forces in the British Isles (later the European Theater of Operations), announced in a letter to The Surgeon General the policy upon which the European theater was to insist: helpless patients would not be evacuated on ships subject to enemy attack (transports) but only on hospital ships plainly marked and operated under the terms of the Hague Convention. Repeatedly thereafter the European theater requested hospital ships of the War Department, stating in August 1942 that five would be needed by April 1943 and five more by the following September.²⁸ To these demands were added, in the fall of 1942, requests for hospital ships from ports in the United States that were responsible for evacuating patients from scattered island bases.²⁹ Some bases were not on the itinerary of regularly scheduled transports and hence needed other means of evacuation. The most logical seemed to be the use of hospital ships on a "pick-up" service. In response to these needs, the Surgeon General's Office in October 1942 recommended the procurement of three hospital ships, in addition to the three already authorized by the Joint Chiefs of Staff. They would be used to collect patients from scattered island bases, to evacuate casualties from large-scale landing operations, or to supplement transports in evacuating patients from the more distant and larger theaters.³⁰ The Chief of Transportation referred this recommendation to the Joint Staff Planners. Earlier, in August, a request for three Convention-protected ships which General Eisenhower

²⁷(1) Memo, ACofS for Oprs SOS for SG, 6 Oct 42, sub: Med Equip and Sups for US Hosp Fac aboard HMT Queen Mary and Queen Elizabeth. SG: 475.5-1 (BB). (2) Memo, ACofS for Oprs SOS for CofT, 6 Oct 42, sub: Instl of US Hosp Fac on HMT Queen Mary and Queen Elizabeth. HD: 705 (MRO, Fitzpatrick Daybook). (3) Memo, SOS Hosp and Evac Br for ACofS for Oprs SOS, 2 Nov 42, sub: Add Hosp Fac on Two British Ships. SG: 705.-1 (BB).
²⁸(1) Ltr, USAFBI (Chief Surg, Col Paul R. Hawley) to SG, 25 Apr 42. SG: 560.2 (Gr Brit). (2) Rads CM-IN-4037 (11 Aug 42), CM-IN-6044 (17 Aug 42), CM-IN-7813 (21 Aug 42), USASOS (London) to AGWAR; CM-OUT-5084 (16 Aug 42), CMOUT-7479 (24 Aug 42), AGWAR to USASOS (London). OPD: In and Out Messages.
²⁹(1) Diary, Misc Br SOS (Col [William L.] Wilson), 20 Jul 42, HD: 705 (MRO, Extracts from Hosp and Evac Br SOS Diaries). (2) Ltr, CG CPE to CofT, 25 Sep 42, sub: Hosp Ship for the CPE, with 2 inds. SG: 560.-2.
³⁰1st ind, SG to CG SOS, 23 Oct 42, on Memo, CG SOS for SG, 16 Oct 42, sub: Rpt of Progress. SG: 632.-1 (BB).

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wanted by the end of September for the North African invasion had also been referred to that group. In both instances, the Joint Staff Planners, weighing the need for vessels to transport troops and cargoes against the need for hospital ships, decided that additional vessels could not be spared for the latter purpose and reaffirmed the existing policy of using transports as the normal means of evacuation. On 12 November 1942 the Joint Chiefs of Staff disapproved requests for additional hospital ships.³¹

Early in 1943 events caused a change in existing policy. To demands of the European theater were added requests of the Southwest Pacific and North Africa for hospital ships not only for evacuation to the zone of interior but more particularly for intratheater use. In February 1943 the Southwest Pacific informed the War Department that it was converting a Dutch ship, the Tasman, into a hospital ship, and asked that it be certified under the terms of the Hague Convention.³² The North African theater, like the European, had adopted a policy of evacuating no helpless patients in transports. Early in March 1943 it refused to load litter patients on the Acadia, which was making its second trip as an ambulance transport. Later that month this theater cabled Washington for two hospital ships for use in evacuating patients to the United Kingdom.³³ Concurrently, evidence was accumulating that the enemy would respect the terms of the Hague Convention. Germany and Italy permitted British hospital ships to operate unmolested in the Mediterranean, and they, along with Japan, had announced they were operating their own hospital ships. Furthermore, several Allied Governments, as well as the U. S. Navy, had followed the lead of the British and placed hospital ships under Red Cross (Hague Convention) protection.³⁴

Along with insistent demands of theaters for hospital ships and growing evidence of enemy respect for the Hague Convention, it appeared in the first half of 1943 that loss of transport and cargo space through conversion of vessels to hospital use was a less cogent reason than formerly for not authorizing hospital ships. By that time the troop ship fleet had grown through new construction and the conversion of freighters. Moreover, British hospital ships were occasionally being used to transport American patients from the European theater to the United States. A request by that theater in January 1943 that medical personnel and equipment be

³¹(1) Memos, CofT for JPS, 21 Aug and 2 Nov 42, sub: Hosp Ships. TC: 564. (2) JPS 27/5/D, 24 Aug 42; JCS 52/2, 29 Aug 42. HD: 705 (MRO, Fitzpatrick Ref file, Aug 42-May 43). (3) JCS 52/3, 12 Nov 42. Records and Admin Br, Off ACofS G-3 WDGS.
³²Rad CM-IN-9207, SWPA to AG WAR, 18 Feb 43. HD: 705 (MRO, Fitzpatrick Daybook, Apr 42-Jun 43). For conversion plans for these ships see HD: SWPA 560.2 (Tasman and Maetsuycker); for letters about certifying the Tasman see: TC: 561-565.1 (Tasman).
³³(1) Rpt, 204th Hosp Ship Co, USAT Acadia, voyage 2 (8 Feb-11 Mar 43). TC: 721.5 (Acadia). (2) Rad CM-IN-14498, NATO to WD, 27 Mar 43. SG: 560.-2 (N. Africa). (3) An Rpt Med Sec NATOUSA, 1943. HD.
³⁴(1) Memo, CinC US Fleet, for JCS, 26 May 43, sub: Hosp Ships, incl A to [JPS] 360-9 (JCS 315/2) Memo, JPS for JCS. Records and Admim Br, Off ACofS G-3 WDGS. (2) See list of hospital ships (US Army and Navy, Allied Governments, and Axis Powers) in State Dept file 740.00117 Eur War 1-1648. By May 1943 Japan had 20 hospital ships, while Germany and Italy had 33. The British Commonwealth of Nations had about 30 hospital ships for use in the Atlantic, Mediterranean, and Indian Ocean. The U.S. Navy had converted the Solace into a modern hospital ship, and it was at Pearl Harbor on 7 December 1941. It was designated as a Convention-protected ship on 31 October 1942. The Navy ship Relief was likewise designated as a hospital ship on 5 February 1943.

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transported by these ships on return trips led to a study of the legality of such action by the Army Judge Advocate General. In March 1943 he issued an opinion that hospital ships, whether British or American, might be used for the transportation of medical personnel and equipment without violating the provisions of the Hague Convention.³⁵ This meant that space on hospital ships could be used for medical transport purposes to compensate, in part at least, for the loss of vessels to ordinary transport service.

Still another factor influencing decisions about hospital ships early in 1943 was the tardiness with which the three ships authorized by the Joint Chiefs of Staff in June 1942 were being made available. The delay was caused largely by division of responsibility for them between the Army and Navy and subsequent misunderstandings over submission of plans and selection of types of hulls. Even the most optimistic estimated in the spring of 1943 that they would not be ready until mid-1944.³⁶

In view of these circumstances The Surgeon General raised anew the hospital ship question. He now proposed that hospital ships be provided for the evacuation of all helpless patients. On 30 March 1943 he recommended that the Acadia should be registered immediately as a hospital ship under the Hague Convention, "in view of the urgency of the situation in the African theater"; that a second transport should be converted into a hospital ship as soon as possible; that completion of the three ships being built by the Navy should be "expedited"; and that five additional vessels should be procured for use as hospital ships by 1 July 1944.³⁷ Subsequently, in April 1943, representatives of the Chief of Transportation, the Surgeon General's Office, and the ASF Hospitalization and Evacuation Branch discussed additional details of the proposed program. They agreed that vessels selected for conversion should be suitable for use as hospital ships but should also have some characteristics, such as excessively slow speeds, which made them undesirable for service as transports with convoys. They agreed also that the Army should procure and operate hospital ships and that Army hospital ships should be provided with facilities for emergency diagnosis and treatment only, rather than with elaborate facilities for definitive surgical and medical care as on Navy hospital ships. Finally, they decided that the first step in achievement of this program would be to request the Joint Chiefs of Staff to amend the policy on evacuation facilities established in May 1942. Subsequently, Colonel Fitzpatrick prepared an impressive study for submission on 24 April 1943 to the General Staff. Its crux was the recommendation that the Joint Chiefs of Staff (1) should approve the use of Convention-protected hospital ships as the normal means, when available, of evacuating the helpless fraction of sick and

³⁵(1) Ltr, CG SOS ETO to CG SOS, 4 Jan 43, sub: Util of Hosp Ships for Trans Med Units and Sups, with 2 inds. HD: 705 (MRO, Fitzpatrick Daybook). (2) Memo SPJGW 1943/1760, JAG War Plans Div for JAG, 18 Mar 43, sub: Hosp Ships. SG: 560.2.
³⁶(1) Memos, CG SOS for VCNO, 14 Jul and 10 Sep 42, sub: Hosp Ships for Evac of Sick and Wounded from Overseas. TC: 564. (2) Memo, Col A[chilles] L. Tynes for SG, 11 Sep 42, sub: Rpt on Conf on Cons of Hosp Ships. SG: 632.-1 (BB). Reports of progress in planning and converting these ships were made currently by OCT to SG and SOS. See files HD: 560.2 (Hosp Cons Br, Hosp Ships, Hope, Mercy, and Comfort). (4) Ltr, VCNO to CofSA, 18 Dec 42, sub: Procedure for Acquisition and Conv of USS Comfort (AH-6), USS Hope (AH-7), USS Mercy (AH-8). SG: 560.2.
³⁷Memo, SG for ACofS OPD WDGS thru CG ASF, 30 Mar 43, sub: Hosp Ships, with 2 inds. SG: 560.-2.

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wounded, (2) should authorize steps to implement this revision of policy at the earliest practicable date, and (3) should approve the use of hospital ships on outbound voyages for the transportation of medical supplies and personnel. The War Department General Staff approved this recommendation and forwarded it on 12 May 1943 to the Joint Chiefs of Staff.³⁸

The provision of hospital ships for the North African theater did not await this recommendation. In response to North Africa's request for two hospital ships, the Operations Division of the General Staff offered on 7 April 1943, after consultation with both the Chief of Transportation and The Surgeon General, to convert the Acadia into a hospital ship if the theater was willing to forego its use in the transportation of troops. After both the Combined and Joint Chiefs of Staff had considered the theater's acceptance of this offer, North Africa was notified on 22 April that the Acadia would be converted into a hospital ship. A second ship, the Seminole, was selected and approved for use as a hospital ship a week later.³⁹ Both ships were stripped of armament and other belligerent features; their hulls were painted white with a horizontal green band on each side; and red crosses, which could be illuminated at night, were painted on their sides, decks, and funnels. On 6 May the Secretary of War informed the Secretary of State of the designation of the Acadia as a hospital ship; four days later, of the Seminole. Structural work required in the conversion of the Seminole delayed her departure until September 1943, but the Acadia, which had already been fitted out as an ambulance transport, sailed from New York to North Africa on her maiden voyage as a hospital ship on 5 June 1943.⁴⁰

Six days later the Army received full authority to procure and operate its own fleet of hospital ships. On 11 June 1943 the Joint Chiefs of Staff amended the earlier policy, announcing that the helpless fraction of patients would be evacuated in hospital ships if they were available. At the same time they approved the use of hospital ships for the transportation of medical supplies and personnel on outbound voyages. To permit observance of the amended policy, the Joint Chiefs authorized the conversion of slow-speed passenger vessels and of EC-2 cargo ships (Liberty ships) to provide a total of 15 hospital ships by 31 December 1943, 19 by 30 June 1944, and 24 by 31 December 1944. All but three-those already authorized for construction by the Navy-were to be procured, converted, manned, and operated by the Army alone. Since it had already sent the Acadia on its maiden voyage as a hospital ship and had begun the conversion of the Seminole, the Army thus had authority to place nineteen ad-

³⁸(1) Ltr, CG ASF for ACofS OPD WDGS, 24 Apr 43, sub: Hosp Ships, with 9 incls. OPD: 573.27. (2) Memo, CofT for CG ASF, 11 May 43, sub: Hosp Ships. TC: 564. (3) Memo, CofSA for Secretariat JCS, 12 May 43, sub: Hosp Ships, with incl. OPD: 573.27.
³⁹(1) Rads CM-IN-14498 (27 Mar 43); CM-IN-6760 (12 Apr 43); CM-IN-12911 (21 Apr 43), NATOUSA to WD. (2) Rads CM-OUT-3358 (8 Apr 43); CM-OUT-5910 (14 Apr 43); CM-OUT-9291 (22 Apr 43); CM-OUT-12622 (30 Apr 43), WD to NATOUSA. OPD: In and Out Messages. Under the CCS plan the British would furnish 10 hospital ships and 6 hospital carriers, and the United States would provide 2 hospital ships as soon as available.
⁴⁰(1) Memo, ACofS OPD WDGS for CofS, 5 May 43, sub: Designation of USAT Acadia as Hosp Ship. OPD: 573.27. (2) Ltrs, SecWar to SecState, 6 and 10 May 43. Same file. For plans and problems of conversion see file SG: 632.-1 (BB) and HD: 560.2 (Hosp Ships, Hosp Cons Br).

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ditional hospital ships in operation by the end of 1944.⁴¹

The Hospital Ship Program, 1943-45

Selection of vessels for conversion into hospital ships was important to The Surgeon General because their basic characteristics largely determined the success of conversion. The width of a ship's beam determined whether passageways would be wide enough to permit the handling of litter cases. The size of its superstructure determined whether patients could be located above the water line in areas that had natural ventilation and from which patients might be removed easily if it became necessary to abandon ship. The cruising range of a vessel determined whether it was suitable for transoceanic service, and its speed determined the number of trips per month and thus the number of patients it might evacuate. In June 1943, therefore, The Surgeon General arranged with the Chief of Transportation for joint inspection of vessels before selection for conversion.⁴²

The ships chosen represented a compromise. In several instances, vessels were rejected by the Surgeon General's representatives, either because they had speeds of less than ten knots, had fewer than three decks above the water line, or were of too narrow beam. On the other hand, despite its objection to their slow speed and low deck heights, the Surgeon General's Office had to agree to the conversion of six EC-2 cargo ships. The remaining fifteen ships (including the Acadia and Seminole) were of varying ages and speeds. Seven had been built between 1901 and 1919; seven, between 1920 and 1926. Six had speeds of 10 to 12 knots; four, of 13 to 14 knots; and five, of 15 to 16 knots. Some had been coastwise vessels only and later proved unsuitable for use in the Pacific during stormy seasons.⁴³(Table 18.)

All of the vessels selected were converted into hospital ships according to plans approved by the Surgeon General's Hospital Construction Branch. Plans for the conversion of the six EC-2's were drawn by Cox and Stevens, naval architects in New York City; those for the remainder, by the Maintenance and Repair Branch of the Water Division, New York Port of Embarkation. A civilian architect from the Surgeon General's Office, assigned temporarily in New York, represented the Medical Department in the initial stages of planning. Subsequently, completed plans were referred to the Surgeon General's Hospital Construction Branch for final approval. In all planning, emphasis was placed on the number of patients' berths that could be provided rather than upon elaborate clinical facilities.⁴⁴

A major problem in planning hospital ships was the location and arrangement of the surgical suite and other professional rooms, wards for different types of patients, and quarters for the ship's crew and

⁴¹(1)JCS 315, 13 May l943; JCS 315/1, 30 May 43. Records and Admin Br, Off ACofS G-3 WDGS. (2) Memo, JCS for ACofS OPD WDGS, 11 Jun 43, sub: Hosp Ships. OPD: 573.27. (3) Memos, Dir of Oprs ASF for SG and CofT, 18 Jun 43, sub: Hosp Ships. SG: 560.-2.
⁴²Memo, Maj Gen Norman T. Kirk (SG) for Lt Col John C. Fitzpatrick, 30 Jun 43, sub: Hosp Ships. SG: 560.-2 (BB).
⁴³For correspondence dealing with the hospital ship conversion program, inspection of and acceptance or rejection of certain transports (e.g., Robin Adair, Manuel Arnos, Utahan, William L. Thompson), revision and changes in plans for hospital areas, problems of construction, and Medical Department inspections during conversion, see TC: 564, SG: 632.1 (BB), SG: 560.2, and HD: 560.2 (Hosp Ships, Hosp Cons Br).
⁴⁴Tynes, Construction Branch, pp. 94, 113.

406

TABLE 18-UNITED STATES ARMY HOSPITAL SHIPS IN WORLD WAR II

407

medical complement. Experience in planning ships' hospitals for transports and in converting the Acadia and Seminole served as a guide at first. More satisfactory standards evolved as additional experience accumulated with later conversions. Normally the Surgeon General's Office preferred to have the following located on decks above the water line: quarters for officers, nurses, and medical attendants; the surgical suite; clinical and administrative areas; and wards for litter patients, for patients who had communicable diseases, and for those who were seriously disturbed mentally. Decks at the water line, or just below it, were considered suitable for wards for neuropsychiatric and ambulatory patients, for quarters for the ship's crew, and for galleys and mess rooms. Storerooms, the morgue, and the laundry were placed in lower areas, including the hold. To achieve maximum stability, the surgical suite-consisting of two operating rooms, a sterilizing room, a scrub-up area, rooms for sterile and non-sterile supplies, and an X-ray and darkroom-was preferably placed on the main deck slightly aft of center. To insure freedom from unnecessary traffic, isolation and mental wards were considered best located when they were aft. Clinical and administrative areas, including the dressing room, pharmacy, laboratory, surgeon's office, medical records office, chaplain's office, Red Cross office, transportation agent's office, post exchange, and commissary, were considered best located on the deck above the water line near the forward gangway or side-port entrance, to permit easy access when the ship was in port.⁴⁵

Wards were provided on all ships for patients with communicable diseases, and for mental, medical, and surgical cases. Because of the large number of mental patients requiring evacuation, the Movements Division of the Transportation Corps proposed in the fall of 1943 to devote approximately half the capacity of each hospital ship to accommodations for them. Wards for such patients were equipped for safety with concealed radiators and pipes, shatterproof electric light fixtures, heavy doors with viewing panels, locks which could be operated by a master key, and protective bars over all portholes. For the care of acutely disturbed patients there were steel cells 3 to 4 feet wide and 7 feet long. For patients with mild neuropsychiatric disorders, large wards with minimum security devices were used. Isolation wards for patients with communicable diseases were separated into rooms accommodating no more than eight (and preferably four) patients, and were equipped with separate bathrooms, diet kitchens, linen closets, utility rooms, and scrub-up areas. All wards had two-tiered berths and were provided with adequate administrative areas, such as utility rooms, diet kitchens, and offices.⁴⁶ In the summer of 1945 mesh wire enclosures were constructed on the decks of some hospital ships to provide areas where mental patients could get fresh air and exercise.⁴⁷

In addition to the general arrangement of hospital facilities, the Surgeon General's

⁴⁵Letters dealing with recommendations made by the Hospital Construction Branch are found in SG: 632.1 (BB), HD: 560.2 (Hosp Cons Br, Hosp Ships, Gen), and HD: 560.2 (Hosp Cons Br, file for each hosp ship). Blueprints and photographs of each hospital ship are located in above files.
⁴⁶(1) Tynes, Construction Branch, pp. 101, 107ff. (2) Memo, CofT for SG, 9 Oct 43, sub: Hosp Ships. SG: 560.2. (3) Memo, SG for CofT, 4 Jan 44, sub: Mental Fac Aboard Hosp Ships. SG: 632.1 (BB).
⁴⁷Memo, CofT for SG, 12 Apr 45, sub: Proposed Location of Mental Pnt Incls on Hosp Ships. SG: 632.1 (BB).

408

SURGICAL WARD ON USAHS SHAMROCK

Office was also interested in features of construction that promoted sanitation and comfort. As a safety precaution and as a buffer against noise, it insisted that bulkheads should be of double-thick fireproof material that was easy to clean. White tile was considered necessary for the decks of washrooms, operating rooms, sterilizing and workrooms, dressing stations, cleaning gear rooms, utility rooms, diet kitchens, prophylactic stations, pharmacies, laboratories and autopsy rooms. For the rest of the hospital area a deck covering of cement composition or of heavy linoleum was considered satisfactory. Deckheads of a material similar to that used for bulkheads were needed as protection against dust in operating rooms, sterilizing rooms, dressing rooms, and smaller wards, and, in addition, as a safety measure-for covering exposed pipes and fixtures-in all mental wards.⁴⁸

Numerous difficulties were encountered in converting the vessels into hospital ships. Lacking a suitable table of organization for hospital ship complements at the beginning of the program, the Medical Department had to estimate the number of officers, nurses, and attendants for whom quarters would be needed on each ship. Late in 1943, when The Surgeon General revised the existing table of organization, some of the conversion plans

⁴⁸(1) Tynes, Construction Branch, pp. 101, 106. (2) Memo, SG for CofT, 26 May 43, sub: Steel Bulkheading in Hosp Ships. SG: 632.1 (BB). (3) Ltr, Water Div NYPE to CofT, 2 Nov 43, sub: Hosp Ships, with 4 inds. Same file.

409

SURGICAL WARD ON USAHS LOUIS A. MILNE

already prepared had to be modified to provide different sets of quarters.⁴⁹ About the same time, the decision to devote 50 percent of each hospital ship's capacity to accommodations for mental patients caused further revisions in plans already drawn. Changes in the size of the merchant marine crews, along with friction between maritime unions on the one hand and the Transportation Corps and Surgeon General's Office on the other about the size and location of crew quarters, tended to cause revisions in plans. In some instances changes in approved plans were requested by representatives of the Surgeon General's Office (Maj. Howard A. Donald and Lt. Col. Achilles L. Tynes) as they inspected work in progress at various ports.⁵⁰ Of perhaps even greater importance were delays in shipyards. Some had difficulty in hiring enough workmen to keep conversion moving along rapidly. Others failed to get materials when they were needed. Still others, heavily committed to the Navy, devoted their workers and materials to naval landing craft with higher priorities.⁵¹

As a result of these difficulties the entire

⁴⁹For example, see Memo, Lt Col A. L. Tynes for SG, 27 Oct 43, sub: Rpt of Insp of SS Ernest Hinds. HD: 560.2 (Hosp Cons Br, Hosp Ship file).
⁵⁰(1) Tynes, Construction Branch, pp. 95-116. (2) Correspondence concerning conversions are filed in SG: 560.2, 632.1 (BB), and in HD: 560.2 (Hosp Cons Br, Gen), 560.2 (Hosp Cons Br, under name of each hosp ship).
⁵¹(1) Memo, SG for ASF Dir of Mat, 17 Feb 44, with inds. SG: 632.1 (BB). (2) Memo, Col R. M. Hicks (Water Div OCT) for Howard Bruce, 23 Feb 44, sub: Hosp Ship Convs. TC: 564.

410

DRESSING STATION ON USAHS LOUIS A. MILNE

program was delayed. Only three Army hospital ships were in service by the end of 1943. One per month was placed in service from February through May 1944, and one of the three ships being constructed by the Navy was commissioned the next month. Thus by the end of June 1944 there were nine hospital ships serving the Army, instead of the nineteen anticipated. The next month seven more were completed and in August and September two additional Army hospital ships and the two remaining hospital ships being constructed by the Navy for Army use were ready for their first trips. The final two ships of twenty-four authorized in June 1943 were placed in service in March and April 1945. (Table 18) Meanwhile the Southwest Pacific had converted two vessels, the Tasman and Maetsuycker, for intra-theater use. Although controlled by the American Army, these vessels were Dutch hospital ships, sailing under Dutch registry and certified under the Hague Convention by the Netherlands Government.⁵²

As Army hospital ships were readied for service, the problem of naming them arose. The Navy named its hospital ships for abstract qualities and hence designated the three ships it was building for the Army as the Comfort, Hope, and Mercy.

⁵²For further information on these vessels, see TC: 565.l-DB (Tasman); HD: SWPA 560.2 (Tasman and Maetsuyker); and State Dept: 740.00117 Eur War 1939/1-1648 (Netherlands Hosp Ships). Also see WD Memo W40-21-43, sub: Use of SS Tasman as a Hosp Ship, 20 Oct 43, in AG: 560 (16 Oct 43).

411

THE USAHS LARKSPUR

Trying not to trespass upon this system and at the same time trying to designate Army hospital ships appropriately, the Surgeon General's Office proposed in July 1943 that they be named for flowers. Transportation Corps officials believed that this might complicate rather than simplify their identification as hospital ships. Since all of the vessels being converted were well known in the world's shipping registers, an enemy encountering one could identify it, if designated as a hospital ship under its existing name, by its ascribed physical characteristics and silhouette. It was therefore decided to retain names that were not "entirely inconsistent" with the vessels' new mission and to name others for flowers. In the spring of 1944 the Coast Guard objected to this practice fearing that the Army's naming of hospital ships for flowers would cause confusion with Coast Guard ships carrying the same names. As a result, at the suggestion of the Surgeon General's Office most hospital ships commissioned thereafter were named for deceased Army medical officers and nurses.⁵³ (See Table 18.)

⁵³(1) Memos, SG for CofT, 1 Jul 43; CofT for SG, 22 Jul 43, sub: Names for Hosp Ships. (2) Ltrs, USCG to CofT, 3 Mar 44; CofT to USCG, 9 Mar 44. (3) Memos, CofT for SG, 14 Mar 44, 8 Jan 45, sub: Names for Hosp Ships. All in TC: 569.61. (5) TC Cir 80-4, 5 Feb 44, with supp, 25 Mar, 30 May 44, and 10 Feb 45.

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Continuation of Efforts To Insure Adequate Hospital Facilities on Transports, 1943-45

Although standards for ships' hospitals had been established by the middle of 1943, meeting these standards continued to involve certain problems. One was to obtain desired modifications of Maritime Commission plans. In reviewing them the Surgeon General's Office sometimes found major faults: failure to comply with directives about the percentage of hospital beds to be provided; unsatisfactory location of hospital areas, as for example in the stern two decks below the lifeboat loading deck, instead of nearer midship and one deck higher; improper arrangement of certain medical facilities, such as the combination of the surgical suite and the dispensary; and failure to provide such accommodations as utility rooms and dressing stations. Unless construction of ships was too far advanced, the Commission generally made the revisions requested by the Surgeon General's Office.⁵⁴

Less success was achieved in negotiations with the British to improve hospitals on their transports. Normally they followed a policy of making few if any structural changes in ex-passenger vessels. In December 1943 this problem was referred to the Combined Military Transportation Committee and, as a result, the Transportation Corps and the Medical Department had to approve specifications for hospital areas aboard British transports that were considerably lower than those for American transports. For example, according to a decision of the Committee, British transports were not required to have wards for mental patients or separate operating and sterilizing rooms. Instead of the latter, they had one room which served as a combination surgeon's office, records room, sterilization room, dressing station, and emergency operating room.⁵⁵

Increases in the number of mental patients to be evacuated and in the proportion of seriously disturbed cases required further changes in transports' hospitals. In the fall of 1943, on the recommendation of the Surgeon General's liaison officer, the Chief of Transportation directed that capacity for mental patients should be increased by 3 percent of the troop capacity of each Army-owned and chartered transport. He also requested the War Shipping Administration to make similar changes on ships it operated for the Army. This meant an increase in authorized accommodations for mental patients from 2 to 5 percent of the troop capacity of Army-owned transports and from 1½ to 4½ percent of that of chartered transports. The percentage of berths for patients of other types remained unchanged. In order to provide additional accommodations for mental patients without diminishing troop capacity, staterooms that were used on outbound voyages for officers and noncommissioned officers were to be altered. "Potential weapons" were to be removed and electrical fixtures supplied with guards; suitable doors were to be installed

⁵⁴(1) Tynes, Construction Branch, p. 117. (2) Ltr, SG to CofT, 16 Sep 43, sub: Gen Arrangement Plans for Hosp Sec on C4-S-B2 Mar Comm Trp Trans. (3) Memo, SG for CofT, 27 Sep 43, sub: Hosp Facs on US Army Trans, C-3 Type. (4) Ltr, Mar Comm to SG, 28 Sep 43, sub: C4-S-B2 Trp Trans, Hosp Spaces. All in SG: 632.-1 (BB).
⁵⁵(1) Ltr, CofT to SG, 18 Dec 43, sub: Proposed Hosp Revision Aboard HMT Queen Mary. SG: 632.-1 (Queen Mary)BB. (2) Memo, SG for CofT, 17 Feb 44, sub: Comments on Proposed Agreement Conc Minimum Standards Aboard Brit and Amer Trp Ships. SG: 560.-1 (Gr Brit). (3) Ltrs, CofT to CGs PEs, 15 Mar 44; CofT to CGs TofOpns, 19 Apr 44, sub: Minimum Standards on Brit and Amer Trans, with Rpt CMTC, 18 Feb 44, 82d Mtg. TC: 337 (Trp Trans).

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and bars placed across portholes; and berths were to be modified so that the lower two could be fixed by bolting or welding and the top one removed before the loading of patients.⁵⁶

About a year later action was taken to provide more suitable accommodations for severely disturbed patients. On 25 October 1944, the Operations Division, War Department General Staff, in a meeting with representatives of the Chief of Transportation, The Surgeon General, and others, decided that transports should have locked cells for some patients and small wards for others. Subsequently, the Transportation Corps announced that individual cells would be provided on transports sailing to the Southwest Pacific equal in number to .75 percent of their troop capacities and on those sailing to other areas equal to .30 percent of their capacities. Approximately half the remaining accommodations for mental patients were to be in small locked wards holding twelve or fewer patients.⁵⁷

A study in the winter of 1944 of the anticipated patient load indicated that, among other measures, fuller use would have to be made of the British Queens and "maximum loading" of certain transports would have to be authorized. A series of conferences among Medical Department, Transportation Corps, and British representatives in the European Theater of Operations and in Washington resulted in arrangements in January 1945 to use the Queen Elizabeth and the Queen Mary on westbound trips primarily for the evacuation of patients. To increase their patient-carrying capacities to 3,500 and 3,000 respectively (the number of patients who could be fed three meals a day from the ships' kitchens), additional pantries had to be installed, accommodations for more medical personnel provided, and facilities for patients modified. These changes were limited mainly to installing rails alongside patients' berths, furnishing additional bedpan washers and sterilizers, and providing food carts for serving hot meals to patients unable to attend mess formations.⁵⁸

To permit the "maximum loading" of seventeen Army and three Navy transports-that is, loading them with the maximum number of patients who could be properly fed and otherwise cared for regardless of lifeboat restrictions-similar changes had to be made aboard these vessels. In March 1945 the Chief of Transportation established the following standards for such changes: additional diet kitchens, food-serving pantries, and food carts should be provided to insure the serving of food in a palatable condition; sufficient bedpan washers and sterilizers should be installed to care for all litter patients; additional mattresses and pillows should be provided; lee rails should be attached alongside the berths of all litter patients and all ambulatory patients who

⁵⁶(1) Ltr, CG USAFFE to TAG, 24 Aug 43, sub: Evac of Psychotic Cases to US, with 2 inds. AG: 704.11. (2) Ltr, CofT to CGs PEs, 18 Nov 43, sub: Increase in Mental Pnt Capacity on Trans. TC: 632 (Army Vessels). (3) Ltr, TAG to CGs AAF, AGF, ASF, Theaters, Def and Base Comds, etc., 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comd. AG: 704.11 (3 Jun 44). (4) See pp. 399-400.
⁵⁷(1) Memo OPD 370.05, ACofS OPD WDGS for CG ASF, 27 Oct 44, sub: Evac of Mental Pnts from the SWPA. HRS: ASF Planning Div and Program Br file 370.05, "Hosp and Evac." (2) Memo, Mvmt Div OCT for Water Div OCT, 6 Nov 44, sub: Mental Accommodations on Trp Trans. SG: 705.
⁵⁸(1) Rads CM-OUT-72113 (3 Dec 44); CM-OUT-76241 (12 Dec 44), WD (prepared by Lt Col J[ohn] C. Fitzpatrick) to Hq ComZ ETO. SG: 560.2. (2) Rpt, CMTC 67, 16 Jan 45, sub: Return of Pnts and Other Pers West-Bound on the Queen Elizabeth and Queen Mary. SG: 705.

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could not care for themselves without assistance; and additional dispensaries and surgical dressing rooms should be constructed for the routine dressings and emergency care patients might need en route.⁵⁹ These changes increased the capacities of seven transports to an average of more than 1,300 patients each, including mental and litter cases.⁶⁰

Additional Hospital Ships and Modifications for Pacific Service

In authorizing five additional Army hospital ships in December 1944 to help handle the patient load in 1945, the Joint Chiefs of Staff directed that changes in vessels selected should be kept to the minimum necessary to fit them as "ambulance-type hospital ships." Recognizing the necessity of this policy, The Surgeon General agreed that existing deck structures of these ships should be used to the greatest possible extent, but insisted that each ship should have a proper surgery and X-ray department, adequate messing facilities for feeding bed patients, and suitable office space.⁶¹ In this instance the Joint Military Transportation Committee selected the vessels to be used and once again the Surgeon General's Office collaborated with the New York Port of Embarkation in the preparation of plans for conversion. One of these ships was ready for service by April 1945; another, two months later; and the third, in September 1945.⁶² Work on the remaining two was suspended after V-J Day and they were again placed in the transport service to return troops from overseas areas.

While plans were being made to put five additional Army hospital ships in service, steps were taken to prepare those already available for Pacific duty. During 1944 the surgeons of some complained that ventilation of these vessels was so poor that patients often found the heat and odors almost unbearable. Early in 1945 representatives of The Surgeon General and the Chief of Transportation agreed that it would be ideal to have hospital ships completely air conditioned, as were those of the Navy, but in view of shortage of time they decided that only portions of them, such as operating rooms, clinics, and certain wards, should be air conditioned and that efforts should be made to increase the exhaust ventilation of other areas. This program was approved for the five newly authorized ships, and during May, June, and July 1945, at least eight others were routed to the New York Port of Embarkation for the installation of air-conditioning equipment.⁶³

Medical Attendants for Service on Transports

Determining a Method of Supplying Personnel

The question of how medical attendants were to be supplied to care for patients

⁵⁹(1) Memo, CofT for Dir Nav Trans Serv, 22 Feb 45, sub: Pnt Capacity Mt. Vernon, Wakefield and West Point. (2) Rads, WD for CGs PEs, UK Base Sec, Hq ComZ ETO, POA, MTO, SWPA, 14 and 22 Mar 45. (3) Ltr, CG NYPE to CofT, 20 Apr 45, sub: Increase of Litter Capacity of Trp Ships. All in TC: 569.
⁶⁰Total patient capacities of the vessels varied from 404 on the Borinquen to 2,618 on the George Washington. See list of maximum capacities in History . . . Medical Regulating Service . . . , sec 6.
⁶¹(1) JCS 1199, 16 Dec 44, Hosp Ship Program; JCS 1199/1, 5 Feb 45, same sub. (2) Memo, Col A[chilles] L. Tynes for SG, 21 Dec 44, sub: Plans for Proposed Conv of French Ships, Athos II and Colombie, into US Army Hosp Ships. Both in SG: 560.2.
⁶²See Table 18.
⁶³(1) Memo SPTOM 560, Mvmt Div OCT for Water Div OCT, 31 Mar 45, sub: Surv of Ventilation Systs Aboard Hosp Ships. HD: 705 (MRO, Newman Staybacks). (2) Memo, Mvmt Div OCT for Gen R[obert] H. Wylie, 14 Jul 45, sub: Repair Status of US Army Hosp Ships. SG: 705.

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being evacuated by Army troop transport arose early in the war. In January 1942, G-4 directed The Surgeon General and The Quartermaster General to include in plans for sea evacuation operations recommendations about the source and use of personnel for ships. In response The Surgeon General proposed the establishment of Medical Department pools at ports in the zone of interior and in theaters of operations. From such pools port commanders in the zone of interior could assign appropriate medical staffs to ships' hospitals on outbound transports and theater commanders could assign additional attendants to care for patients on return trips. After completing voyage assignments, the attendants could return to theater pools by the first available ship. When not on transport duty, they could be used to supplement the staffs of hospitals located near ports either in the zone of interior or in theaters of operations.⁶⁴

SOS headquarters at first partially approved The Surgeon General's plan. On 18 June 1942 it authorized port commanders to establish pools of Medical Department personnel, under control of port surgeons, from which to furnish complements for ships' hospitals. According to a guide supplied by The Surgeon General, the permanent complement aboard each transport was to consist of the ship's surgeon and twelve enlisted men. Before departure of a transport from the United States, a port surgeon was to estimate the number of patients it would return from theaters and, according to a graduated table in the guide, was to assign necessary attendants. In emergencies overseas commanders could supply additional attendants.⁶⁵ This system proved inadequate, perhaps for several reasons. Ports in the United States had trouble getting enough medical personnel to operate the system. In the absence of a large backlog of patients in theaters, it was impractical to estimate the number of evacuees to be returned. Finally, port pools were difficult to keep in operation because ships sometimes were diverted and did not return directly to home ports.

The SOS Hospitalization and Evacuation Branch therefore suggested a different plan in August 1942. Calling for the use of table-of-organization units listed in the troop basis, it promised to insure the availability of attendants at all times. Therefore SOS headquarters directed The Surgeon General to prepare an appropriate table. It was to provide not only for units to care for groups of 25, 50, 75, 100, 250, and 500 patients but also for units to serve as permanent medical complements of transports. The latter were to operate ships' hospitals on outbound trips and were to serve as administrative and technical nuclei around which supplementary platoons could function when patients were being returned to the United States. The Surgeon General prepared the table as directed, but protested against its adoption. Because table-of-organization units were inflexible, he contended, they were wasteful of personnel when used in operations characterized by variable factors, such as ships' destinations, length of voy-

⁶⁴(1) Memo AG 573.27 (10-29-41), TAG for SG, 26 Jan 42, sub: Hosp Space on Army Trans. HD: 541 (Equip for Trans). (2) Ltr, SG to TAG, 16 Feb 42, sub: T/O for Hosp Ship and Tabulation of Med Pers Reqmts for ATS to Evac from Overseas, with 5 incls. Same file. (3) Memo, SG to CG SOS (Dir of Oprs), 30 Apr 42. HD: 705 (Hosp and Evac, Col Welsh file).
⁶⁵(1) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: Oprs Plans for Mil Hosp and Evac, with incls. (2) Ltr, SG to CGs all PEs, 29 Jun 42, sub: Opr Plans for Mil Hosp and Evac, with 3 incls. Both in HD: 705 (Hosp and Evac).

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ages, outbound loads, and the number and type of patients on return trips. Nevertheless, the General Staff supported SOS headquarters and directed the activation of ten platoons in September. The next month, the table of organization for "Medical Hospital Ship Platoons, Separate," was published. It provided for a permanent complement of medical personnel that included one officer and twelve enlisted men for each transport, and for supplementary platoons varying in size from seven to eighty-eight officers, nurses, and enlisted men to care for different numbers of patients.⁶⁶

Publication of this table did not settle the question entirely. In November 1942, when SOS headquarters was about to activate thirty additional platoons, The Surgeon General again objected to their use. Whether because of this objection or for other reasons, SOS headquarters seems to have compromised. Supplementary platoons were organized to serve aboard transports carrying patients, but table-of-organization units to serve as the permanent medical complements were never activated. Instead, SOS headquarters continued to supply personnel for this purpose in allotments to port commanders.⁶⁷

Measures to Conserve Personnel

Steady and large increases in evacuation in the latter half of the war, along with other demands for shares of a limited supply of medical personnel, especially doctors, intensified the problem of providing attendants for patients aboard transports. In the fall of 1943 the use of inflexible table-of-organization units was questioned by the Surgeon General's Personnel Board and by ASF headquarters as being wasteful. The use of theater pools was again considered, but Lt. Col. John C. Fitzpatrick, liaison officer of The Surgeon General with the Chief of Transportation, defended the use of platoons. They constituted the surest way, he insisted, for ASF to discharge its responsibility for the care of patients after they left theater control. In October 1943 representatives of The Surgeon General, the Chief of Transportation, the General Staff, and ASF headquarters reviewed the entire question and decided that "platoons should be modified and retained." They agreed also that maximum use should be made of returning casual medical personnel to supplement the medical service on transports. These measures, they expected, would promote manpower economy.⁶⁸

Modifications were made not so much in platoons themselves as in their use. When the table under which they were organized was revised in October 1943, nurses were eliminated, as the Chief of Transportation recommended. Thereafter they were to be furnished, if needed, by theater commanders.⁶⁹ Of more importance, the Office of the Chief of Transportation in November 1943 developed a guide for theaters to use in placing platoons aboard transports. This guide took account of the fact that variations in types

⁶⁶(1) Memo, ACofS for Oprs SOS for SG, 28 Aug 42, sub: T/O for Med Pers on Amb Ships and Trp Trans, with ind. (2) Memo, ACofS for Oprs SOS for Dir Mil Pers SOS, 1 Oct 42, same sub. (3) Memo, SG for CG SOS (Mob Br), 19 Oct 42. All in SG: 320.3. (4) T/O 8-534, 27 Oct 42.
⁶⁷(1) Memo for Record, on Memo, CG SOS for TAG, 14 Nov 42, sub: Constitution and Activation of 30 Hosp Ship Plats, Sep. AG: 320.2 (1 Oct 42) (3). (2) Memo, Hosp and Evac Br Plans Div SOS for Mob Br Plans Div SOS, 8 Dec 42, sub: Med Pers on Army Trans. HD: 705 (MRO, Fitzpatrick Daybook, Aug 42-Jun 43). (3) Memo, CG SOS for CofT, 4 Jan 43, sub: Almts for Ships' Complements. SG: 320.3-1.
⁶⁸(1) Rpt, SG Pers Bd Mtgs, 16 Sep-29 Sep 43. SG: 334.7-1. (2) Rpt, SC Pers Bd to Oprs Serv SGO, 28 Oct 43, sub: Study of MD Pers. HD: 334 (Kenner Bd).
⁶⁹T/O&E 8-534, 21 Oct 43.

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of patients required variations in the number of attendants provided. For example, while two 100-bed platoons would be required to care for 100 mental or litter patients, a 25-bed platoon was sufficient for a like number of ambulatory or troop class patients. A 100-bed platoon could care for 150 patients if 75 percent were either ambulatory or troop class. This guide, which geared the size of platoons to the type as well as number of patients, was designed to permit a flexibility in use that would contribute to economy. In November 1943 it was sent to the European theater; the following March, to the North African. In June 1944 it was issued to all theaters in a revised directive on evacuation operations.⁷⁰

Another economy measure was the elimination of small platoons. With actual and anticipated increases in the patient load early in 1944, it was unlikely that those with less than 100-bed capacity would be needed. Small units-of 25-, 50-, and 75-bed capacities-were authorized one Medical Corps officer each, as was the 100-bed unit. Thus the use of small platoons to attend groups of patients numbering 100 or more was wasteful of Medical Corps officers. In April 1944 the Chief of Transportation requested ASF headquarters to convert all platoons of 25-, 50-, and 75-bed capacities, a total of 184, to 100-bed units. This action increased their table-of-organization capacity from 7,275 to 18,400 patients without any increase in the number of Medical Corps officers and with the addition of only 1,964 enlisted men and 184 Dental Corps officers. With the eighty-seven 100-bed platoons already organized, this gave a total table-of-organization capacity of 27,100 patients.⁷¹ When additional platoons were required later, none of less than 100-bed capacity was organized.

Another measure to supply attendants for patients evacuated by transport was the use of medical personnel returning to the United States in a duty status. The number of enlisted men, officers, and nurses in this category increased as the war lengthened and as they accumulated enough overseas service to return home on "rotation." Under an agreement reached in October 1943, the War Department on 8 June 1944 directed theater commanders to form such personnel into provisional medical hospital ship platoons and to return to the United States no Medical Corps officer below the grade of colonel and no nurse whatever without assuring the full use of his or her services en route. Subsequently, in the fall of 1944 and early in 1945, when the Chief of Transportation requested the activation of additional platoons, The Surgeon General disapproved, suggesting instead that theaters be directed to form more provisional platoons.⁷²

Other measures were also necessary to

⁷⁰(1) Ltr, CofT to CG ETOUSA 13 Nov 43, sub: Util of Med Hosp Ship Plat, Sep. HD: 705 (MRO, Fitzpatrick Stayback, 498). (2) Rad CM-OUT-7672, WD (Mvmt Div OCT) to CG NATOUSA, 18 Mar 44. SG: 322.8-1. (3) Ltr, TAG to CGs AAF, AGF, ASF, Theaters, Def and Base Comds, etc., 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comd, with incl 4. AG: 704.11 (3 Jun 44). 
⁷¹(1) Ltr, CofT to CG ASF thru SG, 1 Apr 44, sub: Reorgn of Med Hosp Ship Plat (Sep). HD: 705 (MRO, Fitzpatrick Stayback, 1077). (2) Memo, CofT for CG ASF, 20 Apr 44, sub: Request for Activation of Add Med Hosp Ship Plats, Sep, with 10 incls. HRS: ASF Planning Div Program Br file, "Hosp and Evac. vol. 3."
⁷²(1) Ltr, TAG to CGs AAF, AGF, ASF, Theaters, Def and Base Comds, etc., 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comd. AG: 704.11 (3 Jun 44). (2) Ltr, CofT to CG ASF thru SG, 25 Oct 44, sub: Request for Prov Med Hosp Ship Plats, Sep. HRS: ASF Planning Div Program Br file, "Hosp and Evac." (3) Memo, CofT for CG ASF thru SG, 24 Mar 45, sub: Request for Prov Med Hosp Ship Plats, Sep, with 2 inds. SG: 322 (Plat).

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provide, within the amount of medical personnel available, sufficient attendants for patients on transports. Attempts were made to increase the use of regularly organized platoons by reducing the time they spent in the United States and in returning to theaters. Although such units were assigned to the Chief of Transportation, for a time the commanders of ports actually controlled them while they were in the United States. In the fall of 1944 their control was centralized in the Movements Division of the Office of the Chief of Transportation. Knowing where platoons were needed as well as schedules of ships leaving from all ports, this Division could arrange for the return of platoons to theaters more quickly than could ports. Later, the War Department suggested that theaters might establish air priorities for them, in order to reduce the time normally required for their return. Another measure taken in the fall of 1944 was the deployment of platoons from "isolated theaters," such as the Middle East, India, and South Pacific, to other more active theaters, such as the European.⁷³

Problems in the Use of Platoons

Questions arose about the control of platoons. The first ten were assigned to the New York Port of Embarkation, but all others were assigned to the Chief of Transportation and were attached to ports. In December 1942 The Surgeon General asked where and how they were to be placed aboard transports carrying patients. Representatives of his Office, of the Office of the Chief of Transportation, and of SOS headquarters subsequently decided that platoons should be attached to overseas theaters on a temporary duty basis and that theater commanders should be responsible for placing them on transports as needed.⁷⁴ After attachment to theaters platoons came under the administrative control of theater commanders. This step gave rise to complaints that theaters employed them improperly when they were not escorting patients to the United States. One complained of being assigned to work in medical supply; another, of being required to sort mail. Nevertheless the War Department followed a policy of not interfering with theater commanders in the control of platoons attached to their commands and intervened only when the care of patients was affected.⁷⁵ When the Southwest Pacific failed to place sufficient attendants on transports evacuating patients during 1944, the Movements Division of the

⁷³(1) History . . . Medical Regulating Service. . . , sec 3. (2) Rad CM-OUT-69352, WD to CG USAF POA, 28 Nov 44. TC: 322 (Med Hosp Ship Plats). Similar messages were sent to other theaters. (3) Memo for Record, on draft Rad, WD to SWPA and POA, 26 Nov 44. HD: 705 (MRO, Gay Stayback, 151). (4) Memo, CG ASF for CofT, 8 Dec 44, sub: Request for Prov Med Hosp Ship Plats, Sep. HRS: ASF Planning Div Program Br file, "Hosp and Evac."
⁷⁴(1) Ltr, TAG to CGs NYPE, 1st, 4th, 5th, and 8th SvCs and to SG, 30 Sep 42, sub: Constitution and Activation of 10 Plats. AG: 320.2 (9-30-42) (10). (2) Ltr, TAG to CGs NYPE, 1st, 4th, 5th, 7th, and 8th SvCs and to SG and CofT, 16 Nov 42, sub: Constitution and Activation of 30 Plats (Sep) Ship Hosp. AG: 320.2 (1-10-42) (3) Sec 15. (3) Memo, CG SOS for TAG, 5 Jan 43, same sub. AG: 320.2 (11-21-42). (4) Memo, SG for Hosp and Evac Br Plans Div SOS, 21 Dec 42. SG: 200.3-1 (BB). (5) Diary, SOS Hosp and Evac Br, 22 Dec 42. HD: Wilson files, "Diary." (6) Memo for Record, on Memo, CG SOS for SG, 24 Dec 42, sub: Med Hosp Ship Plat, Sep. HD: Wilson files, "Book 2, 26 Sep-31 Dec 42." (7) Memo, CofT for CGs PEs, 17 Jun 43, sub: Mvmt Orders, Med Hosp Ship Plats, Sep. TC: 322 (Med Hosp Ship Plats).
⁷⁵(1) Ltr, CO 584th MHSP, HRPE to SG, 28 Jan 44, sub: Duties Performed by a Med Hosp Ship Plat Overseas. HD: 705 (Hosp Ship Plats). (2) Memo, MRO (Gay) for Col J[ames] T. McGibony, 15 May 45, sub: Misuse of Med Pers. HD: 705 (MRO, Newman Stayback, 159).

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Office of the Chief of Transportation initiated a War Department cablegram to that theater calling attention to "repeated reports" that it both overloaded transports and supplied insufficient medical personnel, even though platoons were available. This message pointed out that the Army would suffer serious criticism unless such practices were corrected.⁷⁶ In 1945 reports reached the Surgeon General's Office that nursing care on transports returning from the Pacific was below "desirable standards." Believing the cause of this situation to be an inclusion in provisional platoons of enlisted men not technically qualified to care for patients, the Chief of Transportation had a War Department message sent to the Pacific urging greater selectivity in choosing men for provisional platoons.⁷⁷

The medical hospital ship platoon, a wartime development, seems to have justified its existence. On V-E Day 176 regularly organized platoons were being used to attend patients returning from the European theater, and several months later there were 116 in the Pacific. Altogether there were 332 platoons in service in August 1945.⁷⁸ Officers familiar with their work agreed generally that they performed excellently, in view of the difficult mission and adverse conditions-long hours, arduous tasks, and a minimum of leave and recreational opportunities. Moreover, although some felt that dentists, pharmacists, and laboratory technicians were not really needed in such platoons, representatives of the Surgeon General's Office agreed in May 1945, in reviewing experience with such units, that their table of organization needed no change. After the war the Medical Regulating Officer proposed only one change-the second officer in each platoon might be of any branch of the Medical Department instead of specifically of the Dental Corps.⁷⁹

Hospital Ship Complements

Although the Army had no hospital ships in the first part of the war, as already pointed out, efforts were made to get them and the Surgeon General's Office drafted a table of organization for a medical hospital ship company early in 1942. Published in April, it provided for a unit of 14 officers, 35 nurses, 1 warrant officer, and 99 enlisted men to care for 500 patients, and for supplementary units of 2 officers, 4 nurses, and 11 enlisted men for each additional group of 100.⁸⁰ The approval in May 1942 of the conversion of the Acadia into an ambulance transport and a request in August 1942 by the European theater for three hospital ships made it appear that units organized under this

⁷⁶Draft Rad, WD (Mvmt Div OCT) to CinC SWPA, 9 Oct 44, sub: Evac of Pnts from Milne Bay. HD: 705 (MRO, Fitzpatrick Stayback, 1495).
⁷⁷Draft Rad, WD (Mvmt Div OCT) to CinC AFPAC, CGs SFPE, SPE, LAPE, 20 Jul 45. HD: 705 (MRO, Newman Stayback, 195).
⁷⁸Reports of locations, assignments, and movements of platoons were kept from March 1943 until their inactivation in 1945-46. See monthly reports in TC: 322 (Med Hosp Ship Plats); in HD: 705 (MRO, Stayback files: Fitzpatrick, Jun 43-Apr 44; Zolnaski, Mar-Nov 44), and in SG: 705, Plats, weekly Status Rpts, beginning in Mar 44.
⁷⁹(1) History . . . Medical Regulating Serv . . . , secs 3.7 and 3.8. (2) Memo for Record, Resources Anal Div SGO, 7 May 45, sub: Mtg of T/O Rev Cmtee for Redeployment. HD: 705 (MRO, Newman Stayback, 151). (3) Memo, MRO for Dir Hosp and Dom Oprs SGO, 23 Nov 45, sub: ASF MD T/O&E. HD: 705 (MRO, Hodge Stayback, 514). (4) George F. Jeffcott, A History of the United States Army Dental Service in World War II, Ch. X, pp. 35-42. HD.
⁸⁰(1) Ltr, QMG to TAG, 14 Feb 42, sub: Hosp Space on Army Trans. AG: 573.27. (2) T/O 8-537, 1 Apr 42.

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table would be needed. SOS headquarters therefore directed The Surgeon General to plan to supply personnel for them.⁸¹ As a result, four hospital ship companies were activated in October and November 1942. One was placed on the Acadia when it became an ambulance transport in December 1942. The other three were not used until the first of the Army's hospital ships went into service in the summer of 1943.⁸²

After the Army began to select transports for conversion under the 24-hospital-ship program, the table of organization for hospital ship companies had to be revised. It was designed to supply personnel for ships with 500 or more beds, but those to be converted were to have varying capacities, ranging from about 300 to 700. Moreover, experience aboard the Acadia returning patients from North Africa had revealed certain inadequacies in the old table. Furthermore, Army hospital ships were to be manned by both civilians and soldiers-the former to operate vessels and the latter to care for patients. But there were some services which might be performed by either group. Hence a decision had to be made as to which services each was to perform and military personnel had to be provided accordingly.⁸³

The division of responsibility for borderline services came up in July 1943 when plans were drawn for the conversion of the transport Agwileon into the hospital ship Shamrock. The Surgeon General's Hospital Construction Branch discovered that the New York Port of Embarkation had devoted much space considered desirable for litter patients-almost an entire deck located above the water line-to quarters for the merchant marine crew. To increase this vessel's capacity for litter patients, the Water Division of the Office of the Chief of Transportation directed reduction of the area occupied by the civilian crew by cutting down both the size of the crew and the space allowed each of its remaining members. The steward's department was then cut from seventy to thirty-five. Despite some reduction in original space allowance for individual members of the civilian crew, they continued to be provided with more commodious quarters than the Army allowed enlisted men. As a result, The Surgeon General and the Chief of Transportation agreed to use enlisted men as much as possible in order to save space for patients.⁸⁴ During the fall of 1943 the respective duties of the civilian and military crews were agreed upon and the table of organization for hospital ship companies was revised. It was published on 7 December 1943 as Table of Organization and Equipment 8-537T, Hospital Ship Complement.⁸⁵

While the new table provided for complements to serve on ships ranging in capacity, by hundreds, from 200 to 1,000

⁸¹(1) Memo, CG SOS for SG, 22 Aug 42, sub: Add Hosp Ships. SG: 560.-2. (2) Memo, SG for CG SOS, 24 Aug 42, sub: Request for Auth and Activation of Certain Req SOS Med Units. SG: 320.3-1.
⁸²(1) Memo, CG SOS for ACofS G-3 WDGS, 10 Oct 42, sub: Deletion of 107th Gen Hosp from Current Trp Basis, with Memo for Record. AG: 320.2 (10-10-42). (2) Diary, SOS Hosp and Evac Br (Fitzpatrick), 31 Dec 42. HD: Wilson files, "Diary." (3) See pp. 398, 403-04.
⁸³(1) Ltr, CO 204th Hosp Ship Co to CG NYPE thru Surg NYPE, 8 May 43, sub: Request for Change in T/O. TC: 320.3 (Acadia). (2) Harold P. James, Transportation of Sick and Wounded [1945]. HD.
⁸⁴Memo, Lt Col A[chilles] L. Tynes for SG, 3 Jul 43, sub: Revised Plans for Hosp Ship Agwileon. HD: 560.2.
⁸⁵(1) Memo for Record, by Maj Howard A. Donald, SGO, 27 Sep 43, sub: T/O for Hosp Ship
Cos. SG: 320.3-1. (2) Rpt of Conf, Med Hosp Ship Complement, 30 Sep 43. SG: 560.-2. (3) Memo, SG for CG ASF, 13 Nov 43, sub: T/O 8-537, Hosp Ship Complement. AG: 320.3 (20 Nov 43) (2).

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beds, it differed from the old primarily in the number of enlisted men authorized for nonmedical duties. A comparison of the complement authorized for a 500-bed ship under the new table with that for a vessel of the same capacity under the old one illustrates the changes made. The number of doctors-eight-remained the same. While the number of nurses was reduced from thirty-five to thirty-four, a hospital dietitian was added. The number of dentists was reduced from two to one, but Medical Administrative Corps officers were increased from two to three. One Sanitary Corps officer and one chaplain were added to the commissioned staff. Although the number of technicians was reduced by one, the number of medical supply and administrative men was increased from twelve to seventeen. Greatest changes affected enlisted men in the non-medical services and were governed by the division of duties between civilian and military crews announced by the Transportation Corps in December 1943.⁸⁶ Because the civilian crew was to prepare food for all persons aboard, with the exception of special diets for patients, the seventeen military cooks formerly authorized were reduced to one. Since the military crew was to furnish cooks' helpers, the latter were raised in number from ten to twelve. In addition, the military crew was to supply guards for certain sections of the ship (primarily those occupied by patients), operate the laundry, and supply dining room service for assigned enlisted men, patients, and both civilian and military personnel authorized to eat in the saloon mess. It was also to provide room service for all patients and military personnel. For these purposes forty-seven enlisted men were added. To permit them to serve in wards when not engaged in non-medical duties, thirty-one were to be trained and classified as ward orderlies.

Division of responsibilities between military and civilian crews in the fall of 1943 did not eliminate all problems involved in using both civilians and enlisted men on hospital ships. In February 1944 the crews of two threatened to strike unless civilians were placed in some of the jobs filled by enlisted men. To avoid an interruption in evacuation operations, The Surgeon General and the Chief of Transportation agreed to a compromise.⁸⁷ Responsibility for furnishing dining room service in the saloon mess (for both the civilian and military personnel eating there) and for supplying cooks' helpers was transferred to the civilian crew, and the average number of civilians in the steward's department was increased from about thirty-five to about forty-five. This change removed enlisted men from their point of greatest contact with the civilian crew and was expected to reduce friction between the two groups. While it was not reflected in a reduction of the military crew until early in 1945, the change did affect plans for the conversion of transports into hospital ships, for the drawings already made had to be modified to provide quarters for the additional civilians. Thereafter, the Chief of Transportation supplied the Surgeon General's Office with manning tables for each of the hospital ships being provided, so that accom-

⁸⁶OCT Cir 164, sub: Div of Responsibility Aboard US Army Hosp Ships, 10 Dec 43, (revised 15 Mar 44). HD: 705 (MRO, Fitzpatrick Staybacks, 840, 970).
⁸⁷(1) Memo, Dir Hosp Admin Div SGO for Chief Hosp Cons Br Hosp Div SGO, ca. Feb 44, sub: Qtrs for Civ Crews, Hosp Ships. HD: 560.2 (Hosp Ships, Hosp Cons Br). (2) Memo, SG (Fitzpatrick) for CofT (Water Div), 22 Feb 44, sub: Full Civ Crews Aboard Army-Opr Hosp Ships. HD: 705 (MRO, Fitzpatrick Stayback, 848).

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modations for the civilian crew might be planned and, at the same time, as much space as possible be saved for patients.⁸⁸

Early in 1945 the table of organization for hospital ship complements was revised. Two of the five additional hospital ships authorized in December 1944 were to have capacities exceeding 1,000 beds each. The revised table took this situation into account, providing for a complement for a 1,500-bed ship. It also reflected the shift of responsibility for providing cooks' helpers from the military to the civilian crew by reducing the number authorized for a 500-bed ship from ten to two. These two were kept to assist one military cook in the preparation of special diets for patients. The number of "basic" soldiers was also reduced-from twelve to seven. Nevertheless, the total number of enlisted men in the complement for a 500-bed ship was reduced by only five, because two men were added to perform nonmedical functions, the number of technicians was increased from forty-four to forty-eight, and four men were added to conduct educational and physical reconditioning programs. One nurse was eliminated. Otherwise the number of commissioned officers remained the same. The new table also reflected a function not originally anticipated for Army hospital ships-hospitalization of casualties resulting from the initial phases of landing operations. Unlike Navy hospital ships, which were fitted for definitive medical and surgical treatment at sea, Army hospital ships were planned and staffed to transport patients who had already received treatment in shore installations and needed only a minimum of medical and surgical care en route. After some had been used in support of amphibious operations, the suggestion was made that the tables of organization of complements of such ships should be revised to include an appropriate concentration of specialists. The Surgeon General's Office believed that the sporadic use of Army hospital ships for amphibious operations did not justify such action. Therefore the new table authorized the reinforcement of normal complements with special medical professional service teams when hospital ships were used in support of amphibious landings.⁸⁹

Since a hospital ship complement was assigned to each ship, the activation and training of complements was keyed to the program of converting transports to hospital ships. From the time the first four were activated in the latter part of 1942 until the end of January 1945, twenty-five additional complements were organized and trained. Three were used on the Hope, Comfort, and Mercy. Twenty-four were used on hospital ships operated by the Army, while two were never used because completion of the ships for which they had been organized was suspended when the war ended.⁹⁰

Problems in Providing Supplies and Equipment for Hospital Ships and Transports

Furnishing medical equipment and supplies for patients evacuated by sea depended upon many variable factors.

⁸⁸(1) Tynes, Construction Branch, pp. 96-100. (2) Ltr SPTOW 231.81, CofT to SG, 7 Mar 44, sub: Auth Manning Scales Aboard US Army Hosp Ships. SG: 320.4-1. (3) For other manning tables, see HD: 560.2 (Hosp Cons Br, under name of ship).
⁸⁹(1) T/O&E 8-537, 3 Mar 45. (2) Memo, MRO for SG (Orgn and Equip Allowance Br), 16 Jun 45, sub: Recomd Changes in T/O&E. HD: 705 (MRO, Hodge Stayback, 361).
⁹⁰History . . . Medical Regulating Service . . ., sec 4.21, with incl.

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Among them were the type of ship (troop transport, ambulance ship, or hospital ship), the size and patient capacity of each, the kinds of patients carried (litter, mental, and ambulatory), and the number of days at sea (determined by the speed of each vessel and the length of its voyage). For this reason the initial issue of medical items, as well as replacement issues after each voyage, required individual consideration by port surgeons and medical supply officers. Before the war they collaborated locally with transport surgeons in determining the needs of each transport and in supplying initial and replacement allowances of medical items.⁹¹ In connection with more general planning for sea evacuation operations early in 1942, The Surgeon General proposed that this system be continued, but that port surgeons be guided by lists of equipment to be supplied by his Office. SOS headquarters announced its approval of this proposal on 18 June 1942.⁹² Meanwhile in collaboration with transport surgeons, the medical supply officer of the New York Port had prepared typical requisitions for use in making initial issues of equipment and supplies to transports hurriedly placed in service after the war began.⁹³

The Surgeon General's guide, distributed at the end of June 1942, contained lists of equipment and supplies for 60-day voyages for 500-bed hospital ships, 500-bed ambulance ships, and transports carrying outbound troops in multiples of 1,000 and inbound patients in multiples of 100. Among the items included in each list were drugs and biologicals, surgical gauzes, surgical instruments, dental supplies and equipment, laboratory supplies and equipment, X-ray supplies and equipment, operating room equipment, and the like.⁹⁴ In the fall of 1942 the Surgeon General's Office revised these lists and in December issued them in a new form.⁹⁵

The problem of equipping and supplying hospital ships assumed new importance after the Army was authorized to provide and operate its own. Vessels selected for conversion under this program were to have patient capacities varying from about 300 to 700. It was therefore necessary for the Surgeon General's Supply Division to prepare individual equipment lists, at least for the first few ships converted.⁹⁶ After they were prepared the Transportation Corps was informed of fixed equipment and its dimensions, so that plans could be made for its installation, and medical depots were instructed to make initial issues of supplies and equipment to each hospital ship.⁹⁷ In the winter of 1943-44 the Surgeon General's Office developed standard equipment lists for hospital ships with 200-, 500-, and 1,000-bed capacities and for 100-bed expansion

⁹¹For example, see Ltr, Port MSO NYPE to SG, 30 Mar 42, sub: Med Equip of Trans. HD: 541 (Equip for Trans).
⁹²(1) 2d ind, Act SG to CG SOS (Dir Oprs), 8 Apr 42, on Memo, CofT for CG SOS, 13 Mar 42, sub: Hosp Space on Army Trans. SG: 632.-1 (BB). (2) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: Oprs Plans for Mil Hosp and Evac, with incl. AG: 704.
⁹³Ltr, Surg NYPE to SG thru CG NYPE, 18 Mar 42, sub: Standardized Initial Med Sups for Army Trans, with 2 inds. HD: 541 (Equip for Trans).
⁹⁴Ltr, SG to CGs PEs, 29 Jun 42, sub: Opr Plans for Mil Hosp and Evac, with 3 tables. HD: 705 (Hosp and Evac).
⁹⁵(1) Memo, ACofS for Oprs SOS for SG, 22 Aug 42, sub: Basic Equip Lists for Hosp Ships and Ships' Hosps. AG: 573.27 (8-22-42). (2) Instructions for Transport Surgeons, NYPE, 1943. HD: 560.2 (NYPE).
⁹⁶For example, see (1) Ltr, SG to SPE, 3 Nov 43, sub: Conv of S.S. President Fillmore into a Hosp Ship. HD: 560.-2 (Hosp Ships). (2) Ltr SPMC 632.-1 (BB), SG to SFPE, 3 Nov 43, sub: Conv of S.S. Ernest F. Hinds into a Hosp Ship. Same file.
⁹⁷Memo, SG for CofT, 26 Nov 43, sub: Med Equip for Ships. SG: 475.5 (BB).

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units.⁹⁸ These lists were revised, along with those for transports, in March 1944 and again in April 1945.⁹⁹

In addition to medical items ships needed other supplies and equipment. Medical Department units serving on ships needed certain organizational equipment. To meet this need, tables of equipment were issued early in 1943 for medical ambulance ship companies and for medical hospital ship companies.¹⁰⁰ Certain housekeeping items, such as mess equipment, beds, mattresses, and blankets, were required for ships' operating crews as well as for medical staffs and patients. During 1942 the Medical Department and the Transportation Corps worked out a division of responsibility for supplying them. In general the Transportation Corps agreed to furnish all nonmedical items and all mess equipment, beds, mattresses, blankets, and linens not used for "strictly medical" purposes.¹⁰¹

In planning to equip the Hope, Comfort, and Mercy, the Army and the Navy encountered difficulty in dividing items for which each was responsible. The Army understood that the Navy and its contractors were to supply all medical equipment that was fixed, or attached, to these ships and that the Army was to furnish all portable medical equipment. It turned out that the Army had to supply all, including fixed medical equipment, such as dental operating chairs, operating tables, and X-ray machines.¹⁰² Uncertainty existed for a while, also, over whether the Army or the Navy with its contractors was to supply housekeeping items. This matter was clarified in an agreement by which the Navy was to supply all portable messing equipment, linens, and blankets, and its contractors were to furnish all mattresses and pillows except those furnished by the Navy for enlisted crews employed in ships' operations.¹⁰³

During the first half of the war other problems developed in connection with the equipment of ships. The Surgeon General's Office believed that adjustable berths similar to beds used in hospitals were needed for seriously ill patients. As a result, a particular type of adjustable berth, known as a "gatch bed," was developed for use on Army hospital ships.¹⁰⁴ Alternating current (AC) electrical equipment, which the Medical Department had in stock and procured in the early part of the war, was unsuitable for use on ships which had direct current (DC) systems. To solve this problem direct current equipment was procured in a few instances, but generally converters were placed on ships so that equipment in stock could be used. Because of the possibility of creating signals that would reveal ships' positions to enemy naval craft, the use of electrotherapeutic equipment on transports was limited.¹⁰⁵

⁹⁸Equip Lists Nos 97239-05 (200 bed); 97239-10 (500 bed); 97239-15 (1000 bed); 97239-20 (100 bed expansion units), in ASF Med Sup Catalog MED 3, 1 Mar 44.
⁹⁹(1) ASF, MD Consolidated Equip List No 3, 5 Mar 44. (2) ASF Med Sup Catalog MED 10-4, Apr 45.
¹⁰⁰T/E 8-538, 20 Jan 43; T/E 8-537, 10 Apr 43. 
¹⁰¹Memo, SG (Tng) for CofT (Water Div), 14 Sep 42, sub: Med Equip for Hosp Ships, Amb Ships and Trans Ships. SG: 475.5-1 (BB).
¹⁰²Tynes, Construction Branch, p. 92.
¹⁰³See SGO (Hasp Cons Br) correspondence with Cox and Stevens, New York City and with the Navy (BuShips) in HD: 560.2 (Hosp Cons Br, Hosp Ships Hope, Mercy, and Comfort).
¹⁰⁴Ltr, SG (Tynes) to CofT (Water Div), 17 Nov 42, sub: Plans for Double Deck Hosp Berth With Gatch Bottom Berth. SG: 427.-4 (BB).
¹⁰⁵(1) Ltr AH6/S63(665-517), AH7/S63, AH8/-S63, BuShips to SupShip NY, and San Pedro, Calif, 28 Jun 43, sub: Hosp Ships, AH6 to 8, A.C. Power Sups for I.C. Sys. TC: 632 (Hosp Ships). (2) Memo, CG SOS (Lutes) for CofT, 8 Oct 42, sub: Electrotherapeutic and X-ray Equip Aboard US Army Vessels. HD: 705 (MRO, Fitzpatrick Daybook).

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A significant development occurred in the latter half of the war in connection with the laundries of hospital ships. Laundries aboard ships were necessary if the quantities of linens carried were not to be inordinate. Yet laundry operations consumed a tremendous volume of fresh water, and while hospital ships could not afford to curtail laundry operations it was imperative that fresh water for other uses receive higher priority. To solve this problem the Surgeon General's Office developed a salt-water washing process. In the summer of 1944 successful tests at the Naval Receiving Station and the Army Medical Center (both in Washington, D. C.) demonstrated that salt-water washing was both safe and efficient. The process that was developed involved the use of salt water and certain detergents for suds and first rinses and of fresh water for the final rinse and sour. This process, ultimately used on all Army hospital ships, reduced by about 80 percent the amount of fresh water ordinarily needed for laundry operations.¹⁰⁶

¹⁰⁶(1) Historical Record, Laundry Section, Hospital Division, [SGO], 1 July 1944, pp. 22-25, and exhibit 27. HD: 024. (2) Diary, Hosp and Dom Oprs SGO, 18 Aug 44, par 6, Laundry Sec. HD: 024.7-3.

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