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Chapter IV

Contents

CHAPTER IV

Changes in Organization and Responsibilities for Hospitalization

Since most changes occurring early in the war in the responsibilities of various agencies for hospitalization resulted from the reorganization of the War Department in March 1942, major outlines of the new organization must be described briefly here.1 In this connection one should understand that difficulties in hospitalization and evacuation resulting from the reorganization were aspects of a larger problem involving activities of the Medical Department in general and that similar problems were often encountered by other technical and supply services.

Reorganization of the War Department

Under the new setup the General Staff was relieved of some of its administrative and operative functions in the zone of interior by the creation of three major commands-Army Air Forces, Army Ground Forces, and Services of Supply (called Army Service Forces after March 1943). The divisions of the General Staff were to devote themselves to planning, to the general supervision of matters for which they were traditionally responsible, and to the strategic direction of forces in theaters of operations. The three major commands were all subject to the supervision and control of the General Staff, under the Chief of Staff, General George C. Marshall. War Department charts placed them all on the same level, but differences of opinion subsequently developed over whether or not they were actually coequal in authority.

The Army Air Forces, which had been established in June 1941 and had attained a great deal of practical autonomy, had taken the lead and supplied the drive for the reorganization as a means of protecting and regularizing its current position. Colonel Grant continued as the Air Surgeon. The Army Ground Forces comprised the arms (such as Infantry, Cavalry, and Artillery) and was responsible for

1Fuller discussions may be found in other volumes: (1) John D. Millett, The Organization and Role of the Army Service Forces (Washington, 1954), pp. 23-42, 93-97, 132-37, 148, 298-309, Ray S. Cline, Washington Command Post: The Operations Division (Washington, 1951), pp. 61-74, 90-95, 111-19, and Kent R. Greenfield, Robert R. Palmer, and Bell I. Wiley, The Organization of Ground Combat Troops (Washington, 1947), pp. 142-45, 268-71, all in UNITED STATES ARMY IN WORLD WAR II. (2) Wesley Frank Craven and James Lea Cate, eds., The Army Air Forces in World War II (Chicago, 1948), Vol. I, pp. 257-67. (3) Blanche B. Armfield, Organization and Administration (MS for companion vol. in Medical Dept. series). HD.


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preparing the ground army for combat. General Headquarters was now liquidated and much of its personnel was transferred to AGF headquarters. Colonel Blesse then became Chief Surgeon of the Army Ground Forces (or the Ground Surgeon). He remained in that position until December 1942, when he was succeeded by Col. William E. Shambora, and returned to it again in May 1944 for the rest of the war.

To the Services of Supply were assigned the corps areas, the technical and supply services such as the Medical Department and the Quartermaster Corps, certain War Department administrative services, and some of the functions and personnel of G-4. Lt. Gen. (later General) Brehon B. Somervell, Assistant Chief of Staff, G-4, of the War Department General Staff since 25 November 1941, became Commanding General, Services of Supply. Under his jurisdiction was The Surgeon General, the head of the Medical Department.

The Surgeon General's New Position

Uncertainty developed about the effect the reorganization had or should have on responsibilities and authority for hospitalization and other medical activities. While General Magee recognized that there were "changes in the flow of control from the Secretary of War to the Medical Department," he did not believe that the reorganization had altered the responsibility of The Surgeon General for the health and medical care of the entire Army.2 Apparently he did not comprehend at the outset the full impact on his office of the interposition of an intermediate headquarters between himself and the General Staff. According to SOS doctrine General Somervell was responsible for all activities, including hospitalization, within the Services of Supply and was at the same time staff adviser to-and in some instances spokesman for-the Chief of Staff on supplies and services, including medical, for the entire Army.3 In his new position, The Surgeon General was an adviser to General Somervell. In this capacity the extent to which General Magee could discharge what he considered to be his responsibilities depended primarily upon the degree to which General Somervell accepted his recommendations (1) regarding SOS medical matters as the basis of command decisions and (2) regarding Army-wide medical matters as a basis for action or advice to the Chief of Staff. So far as hospitalization and evacuation in particular were concerned, it depended-partially, at least-upon the role of a medical section in SOS headquarters.

When SOS headquarters was established in March 1942 a medical officer, Lt. Col. William L. Wilson,4 was transferred from G-4 along with General Somervell, Brig. Gen. (later Lt. Gen.) LeRoy Lutes, and others. For several months he served in the Miscellaneous Branch of the SOS Operations Division under General Lutes. In July 1942, when SOS headquarters was reorganized, a

2(1) Ltr, SG to CG SOS, 25 Mar 42, sub: Med Serv of Army. HD: 321.6-1. (2) Cmtee to Study the MD, 1942, Testimony, p. 2055. HD.
3(1) Ltr, Gen Brehon B. Somervell to Col R[oger] G. Prentiss, Jr, ed, Hist of the MD in World War II, 13 Nov 50. HD: 314 (Correspondence on MS) III. (2) Ltr, Lt Gen LeRoy Lutes to same, 8 Nov 50. Same file. (3) The SOS viewpoint is explained in Millett, op. cit., pp. 143-47.
4Colonel Wilson received his promotion from major to lieutenant colonel on 18 April 1942 but it was retroactive to 1 February 1942. This accounts for the fact that documents signed by him and cited in the footnotes show him as a major until the middle of April.


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Hospitalization and Evacuation Branch was established in General Lutes' office and Colonel Wilson was made its chief. This Branch gained additional medical officers and by October 1942 it had, in addition to its chief, one Medical Administrative Corps and three Medical Corps officers. Lt. Col. William C. Keller, a physician formerly with the Pennsylvania Railroad, was in charge of a railway evacuation section. Maj. (later Col.) John C. Fitzpatrick, who had had experience as a transport surgeon, was in charge of a sea evacuation section. Maj. (later Lt. Col.) Henry McC. Greenleaf devoted his attention to hospitalization. The administrative officer, Maj. (later Col.) Harry J. Nelson, was in charge of office administration.5

The SOS statement of the functions of this Branch-to review plans for, co-ordinate activities related to, and insure the means for hospitalization and evacuation-was subject to different interpretations. General Magee believed that his Office was best equipped to decide upon medical matters and that his advice should be given preponderant weight. Accordingly, in his opinion any medical officer in a staff position of a higher headquarters should be a representative of The Surgeon General and should receive his instructions and advice from the Surgeon General's Office. He interpreted establishment of the Hospitalization and Evacuation Branch as representing a desire in SOS headquarters for a section to co-ordinate activities of various Army agencies in the transportation (or evacuation) of patients.6

The SOS viewpoint was different. In July 1942 General Lutes informed corps area commanders that the "Hospitalization and Evacuation Branch lays down the policies to the Surgeon General on Hospitalization and Evacuation," and that it then visited their areas to see if "policies and plans as laid down to the Surgeon General" were satisfactory and were being followed.7 Colonel Wilson took the position that hospitalization and evacuation required supervision by a higher headquarters than the Surgeon General's Office. In explaining his position as chief of the SOS Hospitalization and Evacuation Branch, he emphasized that he had no authority as a staff officer to make decisions or to issue orders concerning hospitalization and evacuation (that could be done only by General Somervell or General Lutes) but that it was his responsibility to gather and evaluate information on such matters and to present it, along with recommendations for action, to Generals Lutes and Somervell. If his advice differed from The Surgeon General's, he stated, he gave the latter's opinion as well as his own.8 In view of different conceptions of their respective responsibilities, it was perhaps inevitable that conflicts would develop between the SOS Hospitalization and Evacuation Branch and the Surgeon General's Office.9

5(1) WD Cir 59, Orgn Chart, SOS Orgn, 2 Mar 42. (2) Cmtee to Study the MD, 1942, Testimony, pp. 1274-76. HD. (3) History of Planning Division, ASF, Vol. 1, p. 77. HRS.
6(1) Cmtee to Study the MD, 1942, Testimony, pp. 1973-2022. HD. (2) Verbatim transcription of notes employed by Maj Gen James C. Magee in conf in HD AML, 10 Nov 50. HD: 314 (Correspondence on MS) III.
7Rpt, Conf of CGs, SOS, 2d sess, 30 Jul 42, pp. 52-53. HD: 337.
8(1) Memo, Maj W. L. Wilson for Gen Lutes, 18 Apr 42, sub: Hosp and Evac Oprs, SOS. HD: Wilson files, "No 472, Hosp and Evac, 1941-42." (2) Cmtee to Study the MD, 1942, Testimony, pp. 1910-11, 1956-57. HD. See also pp. 1869-1964, 1271-1339. (3) Memo, Col W. L. Wilson for Col R. G. Prentiss, Jr. HD: 314 (Correspondence on MS) III.
9See below, pp. 63-67, 151-60.


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The extent to which The Surgeon General could discharge his responsibility for the health and medical care of the Army depended also upon willingness of commanders of the Ground and Air Forces to admit that the Commanding General, Services of Supply, or one of his subordinates, had any authority-even technical and professional-over matters for which they were responsible and upon which their own surgeons could advise them.

So far as hospitalization in the United States was concerned, this involved mainly the Air Forces. Since the Ground Forces were to occupy and use stations operated by the Services of Supply, AGF headquarters readily accepted the dictum that the "Medical Department under the command of the Commanding General, Services of Supply," would furnish all of its hospitalization and evacuation in the United States except that provided by field medical units operating under tactical control. On the other hand, it will be recalled that the Air Forces already had a separate set of hospitals and the reorganization placed them, along with stations they served, under command of the Commanding General, Army Air Forces.

Several documents issued after the reorganization purported to clarify the respective responsibilities of the commanders of the Air and Service Forces and the relationships of the Air Surgeon and The Surgeon General. A General Staff directive charged all commanders with "command responsibility for the operation of all medical facilities under their control and for future planning in connection therewith." It also charged the Commanding General, Army Air Forces, "with development and operation of air evacuation," and the Commanding General, Services of Supply, with providing "for the evacuation of sick and wounded delivered to his control," and with "administrative responsibility for the coordination of the plans of all commands for evacuation of the sick and wounded to be delivered to his control, and for coordination of plans for hospitalization within the continental United States." An SOS directive on 18 June 1942 charged The Surgeon General with "the initial preparation and the maintenance of basic plans for military hospitalization and evacuation operations, and the coordination of the plans therefor of all commands concerned." An announcement of an agreement between the Air Surgeon and The Surgeon General, approved by G-3, had stated earlier that the "routine conduct of medical activities with the Army Air Forces" was a "responsibility of each local surgeon acting under the Air Surgeon, who is responsible to The Surgeon General for the efficient operation of Medical Department technical activities with the Air Forces." It had also stated that the Air Surgeon would not duplicate activities of the Surgeon General's Office, "with the exception of those procedures necessary for the proper control of Medical Department personnel and activities under the jurisdiction of the Army Air Forces."10

None of these documents specifically stated that the Services of Supply was to

10(1) Ltr, SG to CG SOS, 25 Mar 42, sub: Med Serv of Army. HD: 321.6-1. (2) Memo, CG SOS for ACofS G-3 WDGS, 26 Mar 42, sub: Med Activities under WD Cir 59, 1942, with Memo for Record. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42." (3) Ltr, CG SOS to all CA Comdrs and SG, 26 May 42, sub: Med Activities under WD Cir 59, 1942. SG: 020.-1. (4) Ltr AG 704 (6-17-42) MB-D-TS-M, TAG to CGs AGF, AAF, SOS, All Def Comds, All Depts, All Theaters, and All Sep Bases, 18 Jun 42, sub: WD Hosp and Evac Policy. HD: 705.-1. (5) 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. SG: 705.-1.


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exercise authority over AAF hospitalization and all of them were sufficiently vague to permit a variety of interpretations. Difficulties that arose from Air Forces' resistance to SOS claims of authority and from the Air Surgeon's strivings for completely separate AAF hospitalization will be discussed later.11

The division of responsibility for hospital units being prepared in the United States for overseas service was clearer. This problem involved mainly the Army Ground Forces, for the Air Forces at that time had no such units and made no bid for them.12 Moreover, in February 1942 General Magee had secured Staff approval of a policy of "providing over-all hospitalization for task forces, instead of attempting to provide separate hospitalization for the air and ground components thereof. . ."13 While it was clear that the reorganization placed medical units that were organic elements of air and ground combat forces under AAF and AGF headquarters respectively, responsibility for nonorganic service units, such as hospitals, was left to be "directed by the War Department."14

The Ground Surgeon believed that medical units normally used in combat zones in close support of ground troops should be assigned to the Ground Forces and those normally used in communications zones, to the Services of Supply.15 Mindful of his position as chief medical officer of the Army, The Surgeon General wanted all hospital units-those that served in combat as well as in communications zones-and certain other medical units that normally served as parts of field armies, such as medical laboratories and depots, to be under the jurisdiction of the Services of Supply.16 On the recommendation of its Hospitalization and Evacuation Branch, SOS headquarters first requested that only general and station hospital units be placed under SOS control but later adopted The Surgeon General's position.17

After considerable investigation and study of the larger problem of jurisdiction over service units in general, G-3 took a view that coincided with the Ground Surgeon's. On 30 May 1942 it announced that the three major commands would, in general, train the nondivisional service units which they used.18 On 8 July 1942 this principle was extended to cover acti-

11See below, pp. 106-09, 117-20, 173-76, 182-88.
12In March 1942 AAF Headquarters concurred in the SOS proposal that SOS have jurisdiction over general and station hospital units and AGF over all other field medical units. Memo, CG SOS for ACofS G-3 WDGS, 26 Mar 42, sub: Med Activities under WD Cir 59, 1942. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42."
131st ind SGO 322.4-1, SG to TAG, 5 Feb 42, and 2d ind AG 320.2 (1-29-42) MSC-C, TAG to SG, 18 Feb 42, on Memo, C of Air Staff for SG, 29 Jan 42, sub: Expansion Program of AAF for Calendar Year 1942. HD: 320.3 (Trp Basis).
14WD Cir 59, 2 Mar 42.
15Cmtee to Study the MD, 1942, Testimony, pp. 409-13. HD.
16(1) Memo, SG for CG SOS, 16 Mar 42. SG: 020.-1. (2) Memo, Act SG for Tng Div SOS, 31 Mar 42. SG: 322.3-1. (3) Ltr, SG to CG SOS, 28 Oct 42, sub: Recomds in Regard to Activation, Control, and Tng of Med Units, with 1 incl. SG: 320.3-1.
17(1) Memo for Record on Draft Memo, CG SOS for ACofS G-3 WDGS, 26 Mar 42, sub: Med Activities under WD Cir 59, 1942. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42." (2) Memo SP 020 (3-28-42), CG SOS (init WLW[ilson]) for ACofS G-3 WDGS, 17 Apr 42, same sub. Same file. (3) Memo, CG SOS for ACofS G-3 WDGS, 14 May 42, sub: Responsibility for Tng. HRS: G-3/353 (Only) vol. II. (4) For a discussion of the general problem, see Robert R. Palmer, Bell I. Wiley, and William R. Keast, The Procurement and Training of Ground Combat Troops (Washington, 1948), pp. 499-511, in UNITED STATES ARMY IN WORLD WAR II.
18Memo WDGCT 353 (5-30-42), ACofS G-3 WDGS for CGs AGF, AAF, and SOS, 30 May 42, sub: Responsibility for Tng. HRS: G-3/320.2 "Activation, vol. I."


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vations also.19 As a result, for the rest of the war the Services of Supply was responsible for activating and training communications zone units. Among them were fixed hospitals, such as general, station, and hospital center units, and certain evacuation units, such as hospital trains and hospital ship companies. The Army Ground Forces was similarly responsible for combat zone units, including surgical and evacuation hospitals as well as such units as medical regiments, medical battalions, medical detachments, and medical supply depots.

With division of responsibility for activating and training service units, AGF headquarters assumed responsibility for recommending the number of mobile units to be included in the troop basis, while The Surgeon General and SOS headquarters concentrated on units for fixed hospitals. Subsequently, responsibility for preparing tables governing the organization and equipment of hospital units was also divided. Since mobile hospitals were designed for use in combat zones, AGF headquarters felt that it should be free to make such changes in personnel and equipment of these hospitals as it found desirable for tactical reasons.

In September 1942 G-4 proposed that AGF headquarters should be given responsibility for the preparation of tables for all AGF service units.20 General Somervell feared that the chiefs of technical services, including The Surgeon General, might be bypassed if this proposal were adopted. On his recommendation, G-4 amended its original proposal to require AGF to consult with SOS when preparing tables for service units.21 Thereafter, responsibility for the preparation of tables of organization, tables of equipment, and tables of basic allowances for numbered hospital units was divided, as that for their activation and training had been earlier, between AGF and SOS headquarters.22

Even so, The Surgeon General retained considerable authority over the medical equipment and supplies furnished all hospital units, mobile as well as fixed, for one item in each table of equipment was the unit assemblage. It contained all items of medical equipment required for a hospital, was packed according to Medical Department equipment lists, and was issued by Medical Department depots as a single item. While he customarily consulted with the Ground Surgeon when revising equipment lists, The Surgeon General alone was responsible for their preparation and for the packing of unit assemblages.23

Further changes affecting the manner in which The Surgeon General could discharge his responsibility for the medical care of the Army occurred as a result of the reorganization of the Services of Supply in the summer of 1942. At that time corps areas were renamed service commands and authority formerly concen-

19Memo WDGCT 320.2 (Activation) (7-1-42), ACofS G-3 WDGS for CGs AAF, AGF, and SOS, 8 Jul 42, sub: Responsibility for Activation of Units. HRS: G-3/320.3 "Activation, vol. I."
20Memo WDGDS 809, ACofS G-4 WDGS for CG SOS, 21 Sep 42, sub: Prep of T/Os and T/Es. AG: 320.3(3-13-42)(5).
21
(1)1st ind SPOPU 320.3(9-21-42), CG SOS to ACofS G-4 WDGS, 25 Sep 42, on Memo WDGDS 809, ACofS G-4 WDGS for CG SOS, 21 Sep 42, sub: Prep of T/Os and T/Es. AG: 320.3(3-13-42) (5). (2) DF WDGDS 867, ACofS G-4 WDGS to ACofS G-3 WDGS, 29 Sep 42, same sub. Same file.
22(1) AR 310-60, pars 8 and 16, 12 Oct 42. (2) WD Memo W310-9-43, 22 Mar 43, sub: Policies Governing T/Os and T/Es. HD.
23(1) Memo, SG for CG SOS, 5 Nov 42, sub: Make-up of Hosp Unit Assemblies. SG: 475.5-1. (2) Rpt of [SGO] Bd for Determining Possibilities of Deleting Certain Items in a 400-bed Evac Hosp [13 Nov 42]. SG: 475.5-1.


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trated in Washington was decentralized to them. Thus the control of all general hospitals, except Walter Reed, was transferred from The Surgeon General to commanding generals of service commands. For a while the former retained authority to determine staff allotments for general hospitals, subject to SOS approval; but in April 1943, on the recommendation of the SOS Control Division, that function was also decentralized to commanding generals of service commands.24 The reorganization also diminished the authority of service command surgeons and altered the Surgeon General's relationship with them. They no longer occupied the position of staff advisers to their commanders but were now subordinated as chiefs of medical branches to the chiefs of personnel or supply divisions of service command headquarters. Moreover, since command responsibilities were emphasized in the field, as in Washington, they could no longer be considered as field representatives of The Surgeon General and could therefore exercise no authority over hospitals not under service command control. Finally, The Surgeon General could-in theory at least-communicate with service command surgeons and hospital commanders only through command channels-that is, through General Somervell and the commanding generals of service commands. This indirect method of intercourse was somewhat offset by the practice of permitting informal direct communication between the Surgeon General's Office and service command surgeons.25

Changes in responsibilities for hospital construction and maintenance also occurred, but resulted only partially from the reorganizations discussed above. In December 1941, in conformity with an act of Congress, all of The Quartermaster General's construction and maintenance activities were transferred to the Chief of Engineers.26 About five months later the War Department concentrated in the latter responsibility which he had previously shared with The Surgeon General for the maintenance of hospital plants.27 After the War Department reorganization, recommendations of The Surgeon General for construction of new plants and for major alterations of existing plants were subject to review by both the Hospitalization and Evacuation Branch and the Construction Planning Branch of SOS headquarters. The former considered them from the viewpoint of medical needs; the latter, of Army-wide requirements. Both branches were guided by decisions and policies of the General Staff and by directives of the War Production Board. The selection of sites and the internal arrangements of new hospitals, as well as alterations of existing plants, continued to be a joint function of The Surgeon General and the Chief of Engineers. Insistence of the

24(1) SvC Orgn Manual, 22 Jul 42, sec 403.02, in WD Hq SOS SvC (formerly CA) Reorgn, 22 Jul 42. HRS. (2) Memo, SG for Dir Control Div SOS, 1 Aug 42. SG: 020.-1. (3) Cmtee to Study the MD, 1942, Testimony, Statement of Col H. D. Offutt, pp. 214-15. HD. (4) AR 170-10, par 6a(l)(p), 10 Aug and 24 Dec 42. (5) Memo, Dir Control Div ASF for CofS ASF, 6 Apr 43, sub: Clarification of Prov of AR 170-10. . . . AG: 600.12(10 Mar 42) (1). (6) AR 170-10, C 2, 14 Apr 43.
25(1) Edward J. Morgan and Donald O. Wagner, The Organization of the Medical Department in the Zone of the Interior (1946), HD, pp. 97-99. (2) Ltr, SG to CG SOS, 9 May 42, sub: Med Activities under WD Cir 59, 1942. SG: 020.-1. (3) Memo, Chief Professional Servs [SGO] for Mr. Corrington Gill, 2 Oct 42, sub: Supervision and Coord of Professional Care in Mil Hosps in Continental US. SG: 701.-1. (4) SOS Orgn Manual, 10 Aug 42, sec 403.02. (5) For a fuller discussion, see Armfield, op. cit.
26WD Cir 248, 4 Dec 41.
27(1) WD Cir 157, 23 May 42. (2) AR 100-80, 9 Jun 42. (3) See below, pp. 94-96.


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latter and of SOS headquarters upon decentralization to the field of as much construction authority and activity as possible, in order to speed construction, resulted by the end of 1942 (as will be seen later) in The Surgeon General's loss of some authority he had previously exercised over the erection and alteration of hospital plants.28

The Wadhams Committee

Late in 1942 responsibilities and organization for hospitalization, along with many other aspects of Medical Department work, were the subject of review and comment by a civilian committee appointed by the Secretary of War. This group, which called itself the "Committee to Study the Medical Department" but which will be referred to hereafter for the sake of brevity as the Wadhams Committee (from the name of its chairman, Col. Sanford Wadhams, a retired medical officer), was constituted to "make a thorough survey of professional, administrative, and supply practices of the Medical Department."29 It probed the relation between the Surgeon General's Office and the SOS Hospitalization and Evacuation Branch, and testimony presented in that connection placed on record information summarized above which might not otherwise have been available.30 While some of the Committee's recommendations dealt with the position of The Surgeon General in the War Department, they appear to have had little influence on the authority and responsibility of either the Surgeon General's Office or major commands for hospitalization. This subject, along with an account of the Committee's background and investigation as a whole, is discussed fully elsewhere.31 Recommendations of the Committee on policies and procedures for hospitalization had significant effects and will be discussed at appropriate places in following chapters.32

Changes in the Surgeon General's Office

During the early war years changes occurred in the organization of the Surgeon General's Office as well as in higher headquarters, but they affected the divisions most concerned with hospitalization less than others.33 On 21 February 1942 the Hospital Construction Subdivision was raised in status to a division, reflecting the rapid expansion of construction activities.34 The next month it was placed, along with the Hospitalization, Planning, and Training Divisions, in a newly formed Operations Service. In August, to describe its functions more accurately, the Hospitalization Division's name was changed to Hospitalization and Evacuation.35

The Hospital Construction Division continued to exercise The Surgeon General's advisory supervision over the construction, leasing, and maintenance of all establishments for the care and treatment of the sick and wounded. Colonel Hall remained at its head. To handle wartime

28(1) Army Hosp Program in Continental US, extract from sec 6, Analysis, Monthly Progress Rpt, data as of 31 Mar 43. SG: 632.-1. (2) See below, pp. 92-93. 
29SecWar Memo, 10 Sep 42. AG: 020 SGO (3-30- 43)(1).
30See above, p. 56, and also Cmtee to Study the MD, 1942, Testimony, pp. 1271-1339, 1690-94, 1869-1964, 1973-2022, 2039-49. HD.
31Armfield, op. cit.
32
See below, pp. 93-94, 99, 118, 122-23, 127, 129, for example.
33Morgan and Wagner, op. cit., pp. 9-25. These changes will be considered in detail in Armfield, op. cit.
34(1) See above, pp. 24-26. (2) Memo, unsigned and unaddressed, 1 Dec 42, sub: Rpt on Admin Devs, SGO. MD: 024.-1.
35An Rpt, 1943, Oprs Serv SGO. HD.


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workloads the number of officers in this Division was increased between December 1941 and December 1942 from 4 to 8; of civilian architects, from 4 to 7; and of civilian clerks, from 7 to 10. During 1943, 1 officer, 1 civilian, and 2 clerks were dropped from the rolls, but a civilian real estate consultant was added, as the hospital construction program neared completion.36 Changes in the Division's branches reflected shifts in construction policies and problems. In February 1942 there were three branches: Planning and Estimates, Construction and Conversion, and Maintenance and Repairs. In March, when increasing emphasis was placed upon the use of existing buildings, the Construction and Conversion subdivision was separated into two equal branches. Subsequently, the Conversion Branch was likewise subdivided, becoming the Ground Troop Facilities and Air Corps Facilities Branches. This move was perhaps accounted for by the expansion and growing independence of the Air Forces. In the late summer of 1942 the Planning and Estimates Branch was dropped from the Division, foreshadowing the transfer of its activity to the Hospitalization and Evacuation Division. By August, then, the Hospital Construction Division consisted of the Maintenance and Repair, Civilian Facilities Conversion, Ground Troop Facilities, and Air Corps Facilities Branches. This organization continued until July 1943.37

The Hospitalization Division, under Col. Harry D. Offutt, limited its activities largely to the development of hospitalization policies, the control of bed credits in general hospitals, and the maintenance of liaison with other divisions of the Office whose activities affected the functioning of hospitals.38 The names of its subdivisions reflect this fact. In February 1942, they were the following: Hospital Inspection, Bed Credits, and Liaison. In March, the inactive Inspection subdivision was dropped. In August, the two remaining subdivisions became the Bed Credits and Evacuation Branch and the Miscellaneous Branch.39 During 1942 this Division gradually took on another function, the periodic revision required by SOS headquarters of a basic directive for hospitalization and evacuation operations.40 In September 1942 it also took over the job of estimating and planning for general hospital beds that would be required in the future.41 Except for short periods, in December 1942 and again in April 1943, the Division's staff was limited to four officers and four clerks until the latter half of 1943.42 At that time, the Division was enlarged and reorganized, under a new chief, to enable it to carry out the functions and activities which the war placed upon it.43

The Planning and Training Divisions continued to be responsible for numbered hospital units. Col. Howard T. Wickert was chief of the former. It made recommendations for the troop basis, for activation schedules, and for medical support for task forces and overseas theaters. It also prepared and revised tables of organi-

36(1) Tynes, Construction Branch, pp. 11-12. (2) Memo, Lt Col Seth O. Craft for Col R. W. Bliss, 8 Jul 43. HD: 319.1-2.
37Morgan and Wagner, op. cit., Orgn Charts VI, VII, IX, X, and XI.
38An Rpt, FY 1943, Hosp and Evac Div SGO. HD.
39Morgan and Wagner, op. cit., Orgn Charts VI, VII, and IX.
40
An Rpt, FY 1943, Hosp and Evac Div SGO. HD. For this directive, see below, pp. 63-67.
41For example, the Hospitalization and Evacuation Division prepared the following document: Memo, SG for CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps. SG: 632.-2.
42Memo, Col H. D. Offutt for Chief Oprs Serv SGO, 8 Jul 43. HD: 319.1-2.
43See below, pp. 176-78.


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zation, tables of equipment, and equipment lists. After separation of responsibility for nonorganic service units between AGF and SOS headquarters, this Division limited itself primarily to SOS medical units but occasionally extended its activities to others when called upon to participate in conferences with the Operations Division of the General Staff on the formation of task forces or the deployment of additional troops to established theaters. After SOS headquarters was given responsibility for training SOS service units, the Training Division (separated from the Operations Service in August 1942) established a Unit Training Branch to discharge its responsibilities in connection with the training of hospital and other medical units.44

A Dispute About General Planning for Hospitalization and Evacuation

Closely connected with the War Department reorganization and arising partly from differences of opinion between the Surgeon General's Office and the SOS Hospitalization and Evacuation Branch about their respective responsibilities was a controversy over hospitalization and evacuation planning which developed early in 1942. Within three days after the establishment of the Services of Supply, Colonel Wilson reported to General Lutes on the results of a transcontinental inspection trip which he had undertaken while assigned to G-4 and which he had initiated with a view to having G-4 exercise greater supervision over hospitalization and evacuation. He stated that he had found no definite basic plan for hospitalization and evacuation within the United States, no plan or system of operations for evacuation from theaters, and no basic directive or system for activating, training, equipping, and using numbered hospital units in the United States. He recommended that SOS headquarters give further attention to the problem of numbered hospital units and overseas evacuation and that The Surgeon General be directed to submit basic plans for hospitalization and evacuation operations for the approval of SOS headquarters and subsequent publication "for the guidance of all concerned."45 General Lutes approved the proposal, and on 14 March 1942 directed The Surgeon General to submit such plans.46 The Surgeon General's Hospitalization Division conferred with the Office of the Chief of Transportation and on 31 March 1942 submitted a plan for hospitalization and evacuation operations.47 Considering it unacceptable, Colonel Wilson prepared another which he presented to General Lutes on 18 April 1942 with the statement that its preparation had been necessary "because of the incomplete

44(1) An Rpts, SGO, FY 1942 and 1943, and An Rpt, Oprs Serv SGO, FY 1943. HD. (2) Morgan and Wagner, op. cit., pp. 9-23.
45(1) Memo G-4/24499-178, Col W. M. Goodman, GSC, Chief Planning Br G-4 (init WLW[ilson]) for Gen Somervell, 20 Jan 42, sub: Current Status of Hosp and Evac. MD: Wilson files, "Vol. I, 15 May 41-20 Jan 42." (2) Memo Old G-4/24499-178, Maj W. L. Wilson for Gen [LeRoy] Lutes, 12 Mar 42, sub: Basic Plans for Hosp and Evac. HD: Wilson files, "No 472, Hosp and Evac, 1941-42." (3) For an earlier interim report see: Memo, same for same, 8 Feb 42, sub: Recent Trip for Study of Hosp and Evac. Same file.
46(1) Memo, CG SOS (signed Brig Gen LeRoy Lutes) for SG, 14 Mar 42, sub: Basic Plan for Hosp Oprs. SG: 704.-1. (2) Memo, same for same, 14 Mar 42, sub: Basic Plan for Evac of Sick and Wounded. Same file.
47Memo, SG for CG SOS, 31 Mar 42, sub: Basic Plan for Hosp Oprs and Evac of Sick and Wounded, with incl. SG: 704.-1. The first three drafts of this document, as well as proposals submitted by the Chief of Transportation, are on file HD: 705 (Hosp and Evac Planning).


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nature and less understandable form of various plans submitted by The Surgeon General."48 This draft was discussed with the Surgeon General's Office and then was sent to G-4 on 8 May 1942.49

On the same day General Lutes charged The Surgeon General with having failed to prepare hospitalization and evacuation plans either before or after he was so directed.50 This charge, transmitted to The Surgeon General with a statement by General Somervell that it was "of course inexcusable not to have fully matured basic hospitalization plans,"51 began a controversy which lasted for many months. General Magee defended himself both in writing and in a personal conference with General Somervell. He took the position that all contingencies to be covered by the plan called for, except enemy raids and local disasters, had already arisen and had been actually handled under existing plans. He believed, furthermore, that the document prepared by his Office was not only adequate but also preferable in some respects to the SOS draft.52 Later, when documents of the SOS Hospitalization and Evacuation Branch emphasizing the lack of plans for hospitalization and evacuation were presented to the Wadhams Committee, General Magee again defended his position, stating that if the allegations were true "it would indeed appear that chaotic conditions prevailed, but these assertions are not supported by facts." Although Colonel Wilson insisted that "there wasn't any planning" early in 1942 he now stated that The Surgeon General had not been "any more negligent than all the rest of the Army," including G-4.53 In its final report, the Committee implied approval of The Surgeon General's position, but it made no definite statement clearing him of charges of lack of adequate planning.54

The real picture was neither as black as SOS headquarters painted it nor as white as the Surgeon General's Office maintained. Plans for meeting normal hospital requirements for the zone of interior and theaters of operations were being made continuously by the Surgeon General's Office. In view of the generous basis on which normal beds were authorized in the United States, together with the possibilities of expansion by setting up wards in barracks (a method that was almost traditional with the Medical Department), it would seem that emergency needs also were being sufficiently provided for. Since

48Memo, Maj W. L. Wilson for Gen Lutes, 18 Apr 42, sub: Hosp and Evac Oprs, SOS. HD: Wilson files, "No 472, Hosp and Evac, 1941-42."
49(1) Memo, Col H. T. Wickert, SGO for Col [W. L.] Wilson, SOS, 30 Apr 42, with incl Memo, SG for Dir Oprs SOS, 30 Apr 42. HRS: ASF Hosp and Evac Sec file, "Misc Classified Corresp from Off CG ASF to AGO." (2) Memo, CG SOS for ACofS G-4 WDGS, 8 May 42, sub: Hosp and Evac Oprs SOS. HRS: G-4 files, "Hosp and Evac Policy."
50Memo, Brig Gen LeRoy Lutes for Gen Somervell, 8 May 42, sub: Activities of SG. SG: 704.-1.
51Memo, Gen Somervell for Gen Magee, 8 May 42. SG: 704.-1.
521st ind, SG to CG SOS, 12 May 42, on Memo, Gen Somervell for Gen Magee, 8 May 42. SG: 704.-1. The following note appears on this indorsement: "Personally delivered by Gen Magee, 12 May 42." General Lutes prepared a reply to General Magee, pointing out errors in the latter's defense and contending that there were no plans. ([2d ind SPOPG 370.05 (Policy), CG ASF (init LL[utes]) to SG, 19 May 42, on Memo, Gen Somervell for Gen Magee, 8 May 42. HRS: ASF Hosp and Evac Sec file, "Misc Classified Corresp from Off CG ASF to AGO."]) Whether or not this reply was sent to General Magee is uncertain. No copy of it has been found in SGO files. An ink note attached to the copy cited states: "This is in reply to a formal indorsement written by Surg. Gen. in which he took exception to criticism of his lack of a suitable plan. He visited Gen Somervell on the subject. Gen S may want to know of this reply. Lutes." In pencil on this copy is the following notation: "Suspend for Jun 3."
53Cmtee to Study the MD, Testimony, pp. 1988-89, 1995-98, 1919-23. HD.
54Cmtee to Study the MD, Rpt, p. 15, HD.


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no enemy attack or severe epidemic occurred, the latter statement can be made with less certainty than the former. Moreover, the Surgeon General's Office was collaborating with the Chief of Transportation in planning facilities, personnel, and equipment for the evacuation of patients from theaters of operations. But the Medical Department had not prepared a basic directive for hospitalization and evacuation such as SOS headquarters required, nor was any one division in the Surgeon General's Office charged with the preparation of comprehensive Army-wide plans for hospitalization and evacuation. Certainly confusion existed as to responsibilities under the new War Department organization, but one may question whether, under the circumstances, it was any more incumbent on The Surgeon General than on higher headquarters to define those responsibilities and to require subordinate commanders to submit plans for hospitalization and evacuation.

The "plan" which Colonel Wilson drafted differed considerably from the one prepared by The Surgeon General's Hospitalization Division.55 Perhaps this was caused as much by ambiguity of the SOS directive requiring the preparation of a "plan" as by The Surgeon General's lack of officers trained in planning, which SOS headquarters charged. A comparison of the two drafts shows that Colonel Wilson accepted and incorporated most of the information, pertaining chiefly to established policies and procedures, which The Surgeon General's draft contained. Greatest change was the addition of statements outlining the responsibilities of various commanders for hospitalization and evacuation and requiring them to submit plans, in specified forms at specific times, to The Surgeon General, who in turn was to review and co-ordinate them and then submit them along with his own "plan" to SOS headquarters. Reviewing the SOS draft, G-4 called it "an 'omnibus document' which undertakes to do a number of things," and suggested that two documents should be issued in its place: one, a statement of basic policies and procedures for hospitalization and evacuation; the other, a directive calling for "data and sub-plans from the field."56 Subsequently, after collaboration between G-4 and SOS headquarters, two documents were issued on 18 June 1942. One was a General Staff directive stating in general terms the responsibilities of major commanders for hospitalization and evacuation. This remained unchanged for the balance of the war. The other, revised later on, was an SOS letter with the SOS "plan" as an inclosure.57 Only the plans which these documents required of subordinate agencies need to be considered here. Responsibilities which they delineated and policies and procedures which the SOS "plan" announced will be discussed elsewhere in this volume.58

Subordinate agencies had to include in hospitalization plans tabulations of beds for normal use, along with statements of

55(1) Memo, SG for CG SOS, 31 Mar 42, sub: Basic Plan for Hosp Oprs and Evac of Sick and Wounded, with incl 1. SG: 704-1. (2) Memo, Maj W. L. Wilson for Gen Lutes, 18 Apr 42, sub: Hosp and Evac Oprs SOS, with Tab A, same sub. HD: Wilson files, "No 472, Hosp and Evac, 1941-42."
56Memo, ACofS G-4 WDGS for CG SOS attn Oprs Div, 11 May 42, sub: Hosp and Evac Oprs, SOS. HRS: G-4 files, "Hosp and Evac Policy."
57(1) Ltr AG 704 (6-17-42) MB-D-TS-M, Sec War to CGs AGF, AAF, SOS, et al., 18 Jun 42, sub: WD Hosp and Evac Policy. HD: 705.-1. (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. Same file.
58See below, pp. 57-58, 81, 88-90, 114, 319-20, for example.


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shortages; reports of provisions made to double hospital capacities in emergencies by the use of existing buildings such as apartments, hotels, schools, and dormitories; and reports of relations established with other agencies, such as the Office of Civilian Defense, "under which unilateral or mutual hospitalization support may be planned." Evacuation plans were to include estimates of persons of all types to be evacuated, both normally and in emergencies, along with statements about the status of personnel and equipment required for the transportation and care en route of patients being evacuated.

Hospital, port, and corps area commanders complied with this directive, and on 30 August 1942 The Surgeon General transmitted their plans, along with his own "comprehensive plan," to SOS headquarters.59 The Surgeon General's "plan" was twofold. It contained a consolidation of the tables presented by corps areas and a draft of a "plan" based largely upon the SOS directive issued on 18 June 1942. The SOS Hospitalization and Evacuation Branch considered this draft acceptable, but revised it before publication, adding statements to bring the compilation of policies and procedures governing hospitalization and evacuation up to date and changing the wording to require The Surgeon General to submit a directive, rather than a "plan," thus making the terminology conform more closely with the fact. The revised edition of the hospitalization-and-evacuation-operations-planning directive was issued by SOS headquarters in November 1942, although it was dated 15 September 1942.60 To make subsequent revisions as required, The Surgeon General on 7 November 1942 appointed a board of officers, with Colonel Offutt as chairman.61 Although it submitted a revised version on 12 February 1943, none was published until the end of 1943.62 That version appeared in the form of a War Department circular.

An evaluation of the importance of the "plan" or directive, as issued in its various versions, is difficult because of the controversial atmosphere in which it was prepared. In April 1943 the director of the ASF Planning Division stated that the 15 September 1942 version was "the first world-wide system for operations in the history of the War Department, under which the sick and wounded might be received from overseas commands and cared for and transported ultimately to a general hospital in the United States."63 Considered objectively this was undoubtedly an overstatement, but the directive did have certain values which stand out with considerable clarity.

In its initial form the directive helped, at a time when other efforts were being made to achieve the same end, to clarify hospitalization and evacuation responsibilities. It was not strictly applicable to Ground and Air Forces commanders, however, for it was issued in the first two versions as an SOS directive only. When published in later versions as a War Department circular, it became binding upon Ground, Air, and Service Forces alike. In

59Memo, SC for CG SOS, 30 Aug 42, sub: Opr Plans for Hosp and Evac. SG: 704.-1.
60(1) Memo SPOPH 322.15, CG SOS for CGs and COs of SvCs and PEs and for SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs, with incl 1, same sub. SG: 704.-1. (2) Memo, SG for Chief Oprs SOS, 27 Jan 43. SG: 705.-1.
61SG 00 456, 7 Nov 42.
62(1) Memo, SG for CG SOS, 12 Feb 43, sub: Opr Plans for Hosp and Evac. SG: 705.-1. (2) WD Cir 316, 6 Dec 43.
63Memo SPOPI 370.05, Dir Planning Div ASF for ACofS for Oprs ASF, 23 Apr 43, sub: Hosp and Evac Plans. HD: Wilson files, "Book IV, 16 Mar 43-17 Jan 43."


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each version, the directive served as a valuable reference document, for it assembled in one place statements of several policies and procedures that existed only in separate letters, circulars, and regulations. It was not comprehensive in this respect, nor was it always up to date, for many additional policies and procedures had to be established and old ones changed during the periods between revisions. In September 1942 Colonel Offutt stated that his Division could operate effectively under the current version.64 The following February, when Colonel Wilson visited field installations to evaluate operations under the directive, he found that each headquarters visited, with one exception, thought it clear, understandable, practicable, and of definite benefit.65

The value of the subordinate plans submitted in compliance with the basic directive is less clear. Each came to be what The Surgeon General's executive officer, Col. John A. Rogers, called one of them in September 1942-"just a plan to be tucked away."66 Each was reviewed by the hospitalization and evacuation sections of both the Surgeon General's Office and SOS headquarters. They were then filed for future reference.67 That no emergency developed to require their use need not detract from the foresightedness of having emergency expansion plans on hand, but whether those on file would have been adequate for a major disaster seems to have been doubted in the fall of 1942.68 Tabulations of shortages of personnel, equipment, hospital beds, and transportation usually arrived too late to have any appreciable effect upon the supply of those elements, for problems of shortages were handled when they appeared and could not await the submission at periodic intervals of subordinate plans for hospitalization and evacuation. This requirement was dropped from subsequent versions of the directive early in 1944.69

In conclusion, one may question whether the benefits derived from the directive counterbalanced the friction and bad feeling which its issuance engendered between SOS headquarters and the Surgeon General's Office. Similar results might have been achieved more harmoniously if the principals in both agencies had been more considerate and understanding in dealing with each other or if relationships and responsibilities of the SOS Hospitalization and Evacuation Branch and the Surgeon General's Office had been more clearly delineated. Such was not the case, however, and the controversy that developed in this instance illustrated dangers and difficulties inherent in the new structure of the War Department and the new position of The Surgeon General.

64Diary, Hosp and Evac Br SOS, 22 Sep 42. HD: Wilson files, "Diary."
65(1) Résumé of Conf, SvCs and Ports, Feb-Mar 43, incl 1 to Memo SPOPI 337, CG ASF for SC and CofT, 30 Apr 43, same sub. HD: Wilson files, "Book IV, 16 Mar 43-17 Jun 43." (2) Memo, Col W. L. Wilson for Chief Hosp and Evac Br ASF, 17 Feb 43, sub: Visit to 8th SvC and Southern Def Comd. MD: Wilson files, "Book III, 1 Jan 43-15 Mar 43." (Col Robert C. McDonald succeeded Colonel Wilson as Chief, Hospital and Evacuation Branch on 6 February 1943.)
66Notes on tel conv between Col E. C. Jones, Surg 5th SvC and Col Rogers, 1 Sep 42. HD: Oprs Div files.
67(1) Memo SPOPH 322.15, Chief Hosp and Evac Br SOS for Chief Oprs SOS, 16 Nov 42, sub: SvC and Port Plans for Hosp and Evac Oprs. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42." (2) Memo, SG for CG SOS, 30 Aug 42, sub: Oprs Plans for Hosp and Evac. SG: 704-1. (3) Copies of the subordinate plans are in Wilson files, HD.
68See below, pp. 80-84.
69(1) For example, see 1st ind SPOPH 322.15 (8-30-42), CG SOS to SG, 26 Sep 42, on Memo, SG for CG SOS, 30 Aug 42, sub: Oprs Plans for Hosp and Evac. CE: 632. (2) WD Cir 140, 11 Apr 44.

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