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Chapter V

Contents

CHAPTER V

Hospital Plants in the United States

In December 1941 the Army had a total of approximately 74,250 beds in about 200 station hospitals and 14 general hospitals in the United States.1 During the next eighteen months it was to build enough additional hospitals to house more than three times the number provided during the fifteen-month period of peacetime mobilization.2 In addition, it was to have enough hospitals under construction in June 1943 to house over 65,000 more beds.3 Concurrently, improvements would have to be made in the cantonment-type hospitals already in operation.4

Types of Construction

Emphasis on Simplicity

With the country at war, speed in construction and conservation of building materials became factors of paramount consideration. Accordingly the General Staff insisted upon the simplest type of construction. On 29 December 1941 G-4 revoked the authority it had previously granted to construct hospitals on the two-story semipermanent plan,5 and about a month later revised the War Department construction policy. After 6 February 1942 all construction at new stations, except that already in the advanced planning stage, was to be a modified form of the type designed for theaters of operations.6 The Engineers interpreted this policy to mean that in station hospitals all warehouses and utility shops, and all buildings used for housing, feeding, and entertaining male members of the hospital staff would be of theater-of-operations-type construction, while those used in the care, treatment, feeding, and recreation of patients and as quarters, messes, and recreation rooms for nurses were to be of cantonment-type construction.7 General

1Bed Status Rpts, end of last week in Dec 41. Off files, Health Rpts Br Med Statistics Div SGO. A few beds were reported in Darnall General Hospital, but they are not included in the number given above because this hospital did not open until March 1942.

Gen. Hosp.

Sta. Hosp.

Beds Available Sep. 40

4,925

7,391

Beds Added Sep. 40-Dec. 41

10,608

51,345

Beds Added Dec. 41-Jun. 43

38,226

161,279


Source: Bed Status Rpts. Off file, Health Rpts Br Med Statistics Div SGO.
3An Rpt, 1943, Hosp Cons Div SGO. HD.
4The even larger program of construction of all types of housing for the Army, of which the hospital expansion program was a part, is discussed in Jesse A. Remington and Lenore Fine, The Corps of Engineers: Construction in the United States, a forthcoming volume in the series UNITED STATES ARMY IN WORLD WAR II.
5(1) See above, pp. 23-24. (2) Ltr AG 632(12-27- 41), TAG to SG and CofEngrs, 29 Dec 41, sub: Fire-Resistant Type of Cons in Hosps. SG: 632.-1.
6Ltr AG 600.12(2-5-42)MO-D-M, TAG to CGs all Depts, CAs, et al., 6 Feb 42, sub: WD Cons Policy. SG: 600.12.
7Ltr, CofEngrs to TAG, 14 Feb 42, sub: Hosp in T/O Cantonments, with 1st ind AG 600.12 (2-14-42) MO-D, TAG to CofEngrs, 25 Feb 42. CE: 632 Pt 2.


69

hospitals, previously expected to be of semipermanent construction, were now to be entirely of cantonment type. This lowering of standards brought quick protests from The Surgeon General.

The decision to abandon two-story semipermanent construction for general hospitals was modified on 31 December 1941. At The Surgeon General's request, G-4 approved its use if neither a loss of time nor a material increase in costs was involved.8 During the next two months, the Engineers and The Surgeon General's construction officers disagreed on whether semipermanent hospitals could be shown to cost no more than cantonment-type hospitals.9 In some instances dual bids for the erection of a hospital on either plan were called for, and ten hospitals, including those already begun before the war, were constructed on the semipermanent plan.10 Subsequently the Engineers found that the initial cost of semipermanent hospitals was "considerably greater," and on 16 April 1942 G-4 returned to its position that only cantonment-type construction be used for general hospitals.11

The decision to use theater-of-operations-type construction for buildings in station hospitals remained unchanged. Buildings of this type were of the lightest possible frame construction, with exteriors usually of heavy treated paper or fiberboard. Plumbing was omitted from barracks and placed in separate lavatory buildings. Heat was generally furnished by stoves in each building rather than by a central heating plant.12 The Surgeon General based his protests against the use of theater-of-operations-type construction for hospitals in the United States on its lower quality. He stated that barracks and quarters of that type were unsuitable for conversion to wards to meet emergency needs for additional beds, that messes lacked comforts desired for officer-patients, and that kitchens had inadequate refrigeration and dishwashing facilities.13 The Chief of Engineers admitted that it would be difficult to use theater-of-operations-type barracks for emergency wards, but believed it unwise to provide better housing for Medical Department men than for other troops. The General Staff agreed, and on 24 February 1942 reiterated the policy announced earlier that month.14

Later in the year, as the shortage of building materials increased, the General Staff proposed an even lower quality of construction for some hospitals. In May

8Memo, SG for ACofS G-4 WDGS, 31 Dec 41, with 1st ind, ACofS G-4 WDGS to SG, 31 Dec 41. SG: 632.-1.
9(1) Ltr, SG [Col John R. Hall] to TAG 19 Jan 42, sub: Fire-Resistant Type of Hosp Cons. (2) Memo, [Mr] H[arvey] J. H[all] for Col Hall, 5 Feb 42, sub: Comparison Data of the Cantonment-type Cons and the Semipermanent, Fire-Resistant Type, by Bldgs. (3) Ltr, SG (JRH) to CofEngrs, 7 Feb 42, sub: Fire-resistant Type of Hosp. Comparison with Cantonment Types. All in SG: 632-1.
10(1) D/S G-4/33956, ACofS G-4 WDGS to TAG for CofEngrs, 8 Mar 42, sub: Gen Hosp Cons. AG: 322.3 "Gen Hosp." (2) Ltr AG 322.3 Gen Hosp (3-8-42) MO-D, TAG to CofEngrs, 10 Mar 42, same sub. SG: 632-1. General hospitals of this type were Bushnell, McCloskey, Kennedy, Valley Forge, and Schick; there were also five station hospitals of the same type, located at Camps Atterbury (Indiana), Butner (North Carolina), Carson (Colorado), Campbell (Kentucky), and White (Oregon).
11(1) 2nd ind, CofEngrs to TAG, 14 Apr 42, sub: Cons of Hosp, on unknown basic Ltr. CE: 632 Vol.
3. (2) Ltr AG 600.12 (4-15-42) MO-DM, TAG to CGs of AGF, AAF, SOS, et at., 16 Apr 42, sub: WD Cons Policy, ZI. SG: 600.12.
12Engineering Manual, OCE, Oct 43, Ch. IX, Pt I, par 10-03c.
13Memo, SG for CofEngrs, 9 Feb 42, sub: Proposed Hosp at Centerville and Grenada, Miss. SG: 632-1.
14(1) Ltr, CofEngrs to TAG, 14 Feb 42, sub: Hosp in T/O Cantonments, with 1st ind, 25 Feb 42. CE: 632 Pt 2. (2) Ltr AG 600.12 MO-D-M, TAG to CGs, COs, and C of Arms and Servs, 24 Feb 42 sub: WD Cons Policy, ZI. SG: 600.12.


70

1942 the Secretaries of War and Navy and the Chairman of the War Production Board agreed upon a directive which required construction to be reduced to the minimum in both quantity and quality.15 In conformity with this directive the General Staff decided to move units in advanced states of training to field tent camps and to use existing cantonments for the training of new units. They proposed to provide hospitalization for field camps in screened and floored tents.16 The Surgeon General objected and suggested limiting hospitalization in tents to one third of that required for field camps and providing the rest in cantonment-type buildings, erected either in field camps or as additions to near-by station hospitals.17 The General Staff approved the limitation of hospitalization in tentage but directed the use of theater-of-operations-type buildings for the remainder.18 This meant that in some places buildings used for the care and treatment of patients, as well as those for housing personnel and storing supplies, were to be of low quality construction. Again The Surgeon General protested the use of "a hospital of a lower grade than the cantonment type unit."19 While the policy was not changed, the practice of using tentage and theater-of-operations-type construction for entire hospital plants seems to have been limited chiefly to AGF maneuver areas.20

Conversion of Existing Buildings

Another method of achieving speed and conservation was to convert existing civilian buildings into Army hospitals. In mobilization plans this method had had high priority and in the fall of 1940 The Surgeon General had considered its use.21 Soon after war began his construction officers again started looking for civilian buildings suitable for conversion.22 On 19 March 1942, about the time the decision was being made to construct no more semipermanent hospitals, SOS headquarters suggested the acquisition of civilian buildings to house additional general hospital beds.23 A little over a month later the Chief of Staff considered the possibility of abandoning entirely the construction of new general hospitals in favor of the civilian-facilities-conversion method. He gave up that idea after The Surgeon General's Construction Division and SOS headquarters pointed out difficulties involved.24

15Directive for Wartime Cons, 20 May 42, incl to Ltr AG 600.12 (5-20-42) MO-SPAD-M, TAG to CGs AAF, Depts, CAs, and C of Tec Servs, 1 Jun 42, same sub. SG: 632.-1.
16Draft Memo WDGCT 600.12, ACofS G-4 WDGS for CofS, n d, sub: Housing for 1943 Trp Basis. SG: 632-1.
17Memo SG for Col [Lester D.] Flory, Oprs SOS, 17 Jul 42, sub: Comments on Housing for the 1943 Trp Basis. SG: 632-1.
18(1) WD Cir 278, 21 Aug 42. (2) Mil Hosp and Evac Oprs, 15 Sep 42, par 13b (1), incl 1 to Ltr SPOPH 322.15, CG SOS to CGs and COs of SvCs, PEs, and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs. HD: 322 (Hosp and Evac). 
191st ind, SG to CofEngrs thru CG SOS, 8 Sep 42, on Memo CE 354 SPEOT, CofEngrs for SG, 27 Aug 42, sub: Hosp Fac for Fld Cp. SG: 632.-1.
20(1) See below, pp. 104-06. (2) Tynes, Construction Branch, p. 36.
21Memo, Act ACofS G-4 WDGS for CofS, 12 Nov 40, sub: Gen Hosp Program. HRS: G-4/29135-11.
22(1) Ltr, Col John R. Hall, SGO to Dr. Morris Fishbein, AMA, 4 Feb 42. SG: 601.-1. (2) Memo, Maj Achilles L. Tynes, SGO for SG, 26 Feb 42, sub: Rpt of Insp Trip to Monroe and Charlotte, NC. SG: 632.-1.
23Memo SP 632 (3-19-42), CG SOS for CofEngrs, 19 Mar 42, sub: Add Gen Hosps. SG: 632.-1.
24(1) Memo SPEX 632 (5-1-42), [Maj Gen Wilhelm D.] Styer for [Lt Gen Joseph T.] McNarney, 1 May 42, sub: Acquisition of Existing Hosps, . . . in lieu of Cons of New Gen Hosps. (2) Memo, CG SOS for CofSA, 3 May 42. (3) Memo, JTM [cNarney] for CofSA, 5 May 42. (4) D/S 632 (5-3-42), DepCofSA for SG, n d. All in SG: 632.-1. (5) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1.


71

PLAN FOR THEATER-OF-OPERATIONS-TYPE HOSPITAL


72

OLIVER GENERAL HOSPITAL converted from the Forest Hills Hotel

A "Directive for Wartime Construction," issued two weeks later, confirmed as policy the practice of converting existing buildings into hospitals whenever practicable and of constructing new buildings otherwise.25

Difficulties involved in the civilian-facilities-conversion method restricted its use. Of hundreds of buildings which civilians offered to the Medical Department, not over 3 percent were suitable for use as hospitals.26 Many were too small. Some had corridors, stairways, and doors that were too narrow to permit the passage of patients on litters. Others that were several stories high lacked adequate elevator service. Still others were in undesirable locations.27 In some instances, where both the buildings and locations were suitable, local politicians and owners tried to get higher prices than the War Department was willing to pay. In others, local citizens banded together to prevent Army acquisition because they feared a depreciation in neighboring property values.28 Finally, even after suitable buildings were found and all arrangements for acquisition completed, additions and alterations had to be made before the Medical Depart-

25Directive for Wartime Cons, 20 May 42, incl to Ltr AG 600.12 (5-20-42) MO-SPAD-M, TAG to CGs AAF, Depts, CAs, and C of Tec Servs, 1 Jun 42, same sub. SG: 632-1.
26Ltr, Maj Lawrence G. King, SGO to Lt Col Albert Pierson, Off ACofS G-4 WDGS, 18 Jun 42, sub: Util of Existing Bldgs as Hosps. SG: 601.-1.
27(1) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1. (2) Memo, SG for CofSA thru CG SOS, 19 May 42, sub: Preliminary Surv of Atlantic City Hotels for Hosp. HD: Hosp Insp Rpts, p. 680.
28(1) Pers Ltr, Col Harry D. Offutt to Col Don [G.] Hilldrup, 21 Apr 42. SG: 632-2 (3d SvC)AA. (2) Notes on Conf, Hosp Cons Div SGO, 26 Mar 42, sub: Gen Hosp Program. HD: 632.-1.


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TABLE 2-ARMY HOSPITALS ESTABLISHED IN CONVERTED CIVILIAN BUILDINGS BY END OF 1943

Hospital

Civilian Buildings

AAF Regional Sta. Hosp.

Miami Biltmore, Floridian, Gulf Stream, King Cole, Nautilus, Pancoast, and Tower Hotels

Army & Navy Gen. Hosp. Annex

Eastman Hotel

Ashford Gen. Hosp.

Greenbrier Hotel

Bronx Area Sta. Hosp.

Lebanon Hosp.

Camp Shanks Sta. Hosp.

Rockland State Hosp.

Charlotte, N.C., Sta. Hosp.

Charlotte Sanatorium

Dante Sta. Hosp., San Francisco, Calif. (Later part of Letterman Gen. Hosp.)

Dante Hosp.

Darnall Gen. Hosp.

Kentucky State Hosp.

Deshon Gen. Hosp.

Butler Hosp.

England Gen. Hosp. (Formerly AAF Sta. Hosp., Atlantic City, N.J.)

Haddon Hall, Cedarcraft, Colton-Manor, Dennis, Keystone, New England, Rydal, Traymore, Warwick, and Chalfone Hotels

Gardiner Gen. Hosp. (Formerly AAF Sta. Hosp., Chicago, Ill.)

Chicago Beach Hotel

Halloran Gen. Hosp.

Willowbrook School

Hoff. Gen. Hosp. Annex.

Jefferson School, Calif.

Los Angeles, Calif., Sta. Hosp.

Villa Riviera Hotel

Mason Gen. Hosp.

Pilgrim State Hosp.

New Haven, Conn., Sta. Hosp.

Wm. Wirt Winchester Hosp.

Oakland Area Sta. Hosp.

Oakland Hotel

Oliver Gen. Hosp.

Forest Hills Hotel

Pasadena Area Sta. Hosp.

Vista Del Arroyo Hotel

Percy Jones Gen. Hosp.

Battle Creek Sanitarium

Percy Jones Gen. Hosp. Annex

Kellogg Estate, Battle Creek, Mich.

Ream Gen. Hosp. (Formerly AAF Sta. Hosp., Palm Beach, Fla.)

Breakers Hotel

Rhodes Gen. Hosp. Annex

Marcy NYA Facility, N.Y.

St. Petersburg, Fla., Sta. Hosp.

Don-Ce-Sar Hotel

Seattle Area Sta. Hosp.

New Richmond Hotel

Staten Island Area Sta. Hosp.

Seaside Hosp.

Torney Gen. Hosp.

El Mirador Hotel

Walter Reed Gen. Hosp. Annex

National Park College


Sources: (1) Ltr, SG to Sec War thru CG ASF, 18 May 43, sub: Gen Hosp Program. Use of converted hotels (Air Forces), with 7 nds. HD: 632.-1 (Hosp Expansion). (2) Incl, Record of Expansion and Contraction, Hosp Z1, and Hosp Ships, to Memo, Chief Cons Br SGO for HD SGO, 1 Nov 46, same sub. Same file. (3) Diary Hosp Cons Br SGO, 15 and 20 Jul 44. HD: 024.7-3. (4) An Rpt, 1943, England Gen Hosp, p. 3. HD. (5) An Rpt, 27 Nov 44, Hq AAF Reg Sta Hosp No. 1, pp. 1-6. HD.

ment could move in and set up functioning hospitals. Despite these difficulties and problems, the Army acquired enough civilian buildings by the end of 1943 to house twenty-three hospitals and expand five others. (Table 2)

Development of One-Story Semipermanent Type Hospital

Concurrently with increasing emphasis on conservation of building materials, forces were at work during 1942 which


74

PLAN FOR TYPE A HOSPITAL

were to cause the War Department to turn again to the construction of semipermanent hospitals. As early as February 1942 the Clay Products Association of the Southwest began a campaign for the use of its materials by the Army, at least in hospital construction.29 In April the Administrator of Veterans Affairs protested against the repetition of a World War I

29(1) Ltrs, Norman W. Kelch, Engr-Mgr, Clay Products Assn of the Southwest to UnderSec War, 13 Feb and 3 Mar 42, sub: Fire-resistive Cons for Cantonment Type Hosps. (2) Ltr, UnderSecWar to Kelch, 19 Mar 42. (3) Ltr, CofEngrs to Kelch, 6 Mar 42. All in CE: 632 Pt 1.


75

BIRMINGHAM GENERAL, A TYPE A HOSPITAL

mistake-the construction of hospitals that could not be converted to postwar use.30 By June shortages of lumber had begun to develop in some areas, while surpluses of brick and tile had begun to accumulate. In some places, therefore, the Engineers began to build cantonment-type hospitals of tile and brick instead of lumber.31 Then, on 10 August 1942, the War Production Board informed The Surgeon General of the availability of tile and brick and urged their use in hospital construction. The Surgeon General replied that he had always preferred noninflammable materials for hospital construction.32 Soon afterward, his representatives joined the Engineers in work on plans for a new type of hospital.

The chief obstacle to development of plans for a one-story semipermanent hospital, which the Chief of Engineers proposed on 26 August 1942, was a difference of opinion between his Office and The Surgeon General's over the internal characteristics of various buildings. Feeling it necessary to hold the cost of construction as near as possible to that of cantonment-type buildings, the Engineers were prone to limit improvements and refinements to the absolute minimum. On the other hand, Colonel Hall of The Surgeon General's Construction Division saw no reason to

30Ltrs, Admin of Vet Affairs to CG SOS and to SecWar, 1 Apr 42. SG: 632.-1.
31(1) Ltr, CofEngrs to SG, 11 Jun 42, sub: Use of Structural-Tile Exterior Walls at Ft Des Moines and Cp Dodge Hosps, with 1st ind, SG to CofEngrs, 15 June 42. SG: 632.-1. (2) Exhibit A to Memo, Col. John R. Hall for SG, 13 Jun 42, sub: Rpt of Fid Trip covering Insp of 1411-bed Hosp at Cp Atterbury and of the French Lick Hotel Property. HD: Hosp Insp Rpts, p. 726.
32(1) Ltr, Chief Bldg Materials Br Oprs WPB to SG, 10 Aug 42. (2) Ltr, SG to WPB, 14 Aug 42, sub: Hosp Cons. Both in SG: 632-1.


76

design a third type of hospital if it was not materially better than the cantonment type and equal, in most respects, to the two-story semipermanent type. For example, he wanted larger and more efficiently arranged clinical buildings, stronger and safer neuropsychiatric wards, increased administrative space, and better-equipped messes. After numerous conferences and what must have seemed to the Engineers an uncompromising attitude on the part of the Surgeon General's Office, they composed their differences and during the winter of 1942-43 a civilian architectural firm employed by the Engineers completed drawings for the new type of hospital.33

The Type A hospital, as plants constructed according to the new design were called, came to be considered by the Surgeon General's Office as the best for emergency construction in the zone of interior. Basically, it was the two-story semipermanent hospital reduced to one-story form. Being only one story high it was safer for patients and did not require expensive and unhandy two-story ramps. Its clinical facilities were more adequate and more efficiently arranged than those of the two-story hospital. It also cost less to build. Because wards were placed on both sides of corridors and were lengthened from 262 to 287 feet, the Type A hospital covered a smaller area than other one-story plants. Its chief disadvantage was that it was designed on the dispersed-pavilion principle. Before the war's end, twelve hospitals were constructed on this plan.34 (Table 3)

Modification of the Type A Hospital for Postwar Use by the Veterans Administration

In the spring of 1943 plans for the Type A hospital were modified as a result of attempts to co-ordinate wartime hospital construction with postwar needs. On 31 March 1943 the President directed the Federal Board of Hospitalization to review plans for hospital construction of all federal agencies, including the War and Navy Departments.35 The next month the Board proposed that the Army build some of its hospitals according to standard plans of the Veterans Administration, for use after the war. SOS headquarters raised no objection, but disclaimed any responsibility for justifying and defending this proposal.36 Anticipating its approval, The Surgeon General's construction officers and the Engineers, in collaboration with the Veterans Administration, prepared layouts for Type A hospitals which substituted five two-story VA-type ward buildings for ordinary wards. In May the President approved the Federal Board's recommendation that two Army general hospitals-McGuire at Richmond, Va., and Vaughan at Hines, Ill.-be constructed on that plan.37

Many factors thus shaped the kinds of hospital plants which the Army acquired

33(1) Ltr, CofEngrs to SG, sub: One-Story Masonry Wall Gen Hosp, 26 Aug 42, with 3 inds. (2) Ltr, SG to CofEngrs, 12 Nov 42, sub: One-Story Masonry Cons Hosp, 1100 Series, Drawings by York and Sawyer, with 4 inds. All in SG: 632.-1.
34(1) Tynes, Construction Branch, pp. 37, 40-41. (2) The Type A hospitals were Battey, Birmingham, Crile, Cushing, DeWitt, Dibble, Glennan, Madigan, Mayo, Baker, and Northington General Hospitals, and Waltham Regional Hospital.
35Ltr, President of US to Sec War, 31 Mar 43. SG: 632.-1.
36Memo, CG SOS for SG 17 Apr 43, sub: Completion of Gen Hosp Program in U.S. SG: 632.-1.
37(1) Memo, SG for CofEngrs, 3 May 43. SG: 632.-1. (2) Ltr, CofEngrs to CG ASF, 10 May 43, sub: VA Type Ward Bldgs, with 1st ind SPRMC 600.12 (5-10-43), CG ASF to CofEngrs, n d. CE: 632 Vol 4. (3) Ltr, Dir Cons VA to Col John R. Hall, SGO, 19 May 43, with 1st ind, SG to CofEngrs, 1 Jun 43, sub: Hosp Cons. SG: 632.-1. (4) Ltr, SG to CofEngrs, 7 Jun 43, sub: 1785-bed Gen Hosp, Richmond, Va., Area. SG: 632.-1 (McGuire Gen Hosp) K.


77

TABLE 3-BUILDING SCHEDULE FOR TYPE-A HOSPITAL

General Hospital Plan

Building

Type

Title

Number Required

For 1727 Beds

For 1515 Beds

ADM

E-H

Administration Building

1

1

ANIM

A-H

Animal House

1

1

BKS

D-H

Med. Det. Adm. & Unit Stores

1

1

BKS

D-H

Med. Det. Barracks

11

10

CHAP

A-H

Chapel

1

1

CLIN

R-H

Clinic, Dental, EEN&T

1

1

CLIN

Q-H

Clinic, Lab. & Prof. Services

1

1

CLIN

X-H

Clinic, X-ray, G. U. & Psysiotherapy

1

1

FIRE 

B-H

Fire Station

1

1

GUAR 

B-H

Guard House

1

1

GUES

A-H

Guest House

1

1

HEAT

G-H

Heating Plant, H.P.

As required

HEAT

E-H

Heating Plant, L.P.

As required

HEAT

F-H

Heating Plant, H.P. Annex to L.P.

As required

INC

A-M

Incinerator-3-ton

1

1

LDY

D-H

Laundry

1

1

LDYSP

A-H

Laundry Steam Plant

1

1

MESS

Z-H

Enl. Patients & Med. Det. Mess

1

1

MESS

AA-H

Officers' & Nurses' Mess

1

1

NQ

A-H

Nurses' Qtrs.

4

3

OQ

E-H

Officers' Qtrs.

2

2

POPX

A-H

Post Office & Post Exchange

1

1

REC

H-H

Med. Det. Recreation

1

1

REC

G-H

Officers' & Nurses' Recreation

1

1

REC

F-H

Patient's Recreation

1

1

RECG

A-H

Receiving & Evacuation Bldg

1

1

SHGA

A-H

Shops & Garage

1

1

SHMO

A-H

Hospital Shop & Morgue

1

1

STOR

I-H

Med. Storehouse

1

1

STOR

H-H

Med. Storehouse & Offices

1

1

STOR

J-H

Storehouse

2

1

SURG

B-H

Clinic, Surgery

1

1

WARD

K-H

Ward, Combination

9

6

WARD

S-H

Ward, Detention

4

3

WARD

J-H

Ward, Standard

15

15


Covered walks and exit ramps are included in the plan. A number of supplementary buildings may also be added to this type of hospital construction. The basic plan is shown on the opposite page.
Source: Tynes, Construction Branch, p. 49. HD:3l4.7-2 (Hosp. Const. Br.).


78

or constructed during World War II. Such forces as necessity for speed in construction, availability of building materials, pressure of civilian groups, and co-ordination of Army wartime construction with postwar needs of other Federal agencies often seemed stronger than medical considerations. The Surgeon General's Office therefore frequently found itself in conflict with higher authorities in attempting to get what it considered to be suitable and satisfactory hospital plants. While undesirable cantonment-type plans drawn before the war were used for most hospitals, better plants were designed and the Army erected 10 two-story and 12 one-story semipermanent hospitals on new plans as well as 2 designed specifically for postwar use by the Veterans Administration.

Estimates of Hospital Capacity Needed

Speed in construction and conservation of materials also affected planning for the expansion of hospitals. During most of 1942 speed was so necessary to keep hospital capacities abreast of the Army's growth that there was little time for reexamining the basis already established for estimating requirements. Hence, conservation of building materials was at first achieved by lowering the quality rather than the quantity of construction. Moreover the need for speed, along with uncertainty about the eventual size of the Army and the rate of its movement overseas, perhaps accounted partially for the fact that until the end of 1942 little attention was given to the co-ordination of station with general hospital requirements, of Army with Navy requirements, and of wartime with postwar requirements. Even disregarding these matters, planning for a rapid and unprecedented expansion was a complicated process. In the first part of 1942 plans had to be made to meet immediate normal requirements. In addition, plans for emergencies were needed because it was feared that sneak attacks, sabotage, or severe epidemics might require hospital beds far in excess of the number normally provided. Later, when emphasis was placed upon reduction in quantity as well as quality of construction, a tendency developed to make long-range plans. All three types of planning-normal, emergency, and long-range-were inevitably interrelated.

Early Plans To Meet Normal Requirements

Plans for station hospitals to house the number of beds authorized by the existing bed ratio were automatically included by the Engineers in general construction plans for each camp, but planning for the expansion of general hospitals was different. Although general hospital beds were authorized for 1 percent of the total strength of the Army, construction of plants to accommodate that number did not automatically follow. Instead The Surgeon General had to request periodically the approval of construction to house specific numbers of general hospital beds. He usually received approval for less than the 1 percent asked for. As a stopgap measure The Surgeon General on 18 December 1941 recommended the construction of four new general hospitals and annexes to two existing hospitals to provide 6,000 additional beds. The next day G-4 approved this recommendation.38

38(1) Ltr, SG to TAG, 18 Dec 41, sub: Location of 6,000 Add Gen Hosp Beds. SG: 632.-1. (2) Memo, ACofS G-4 WDGS for TAG. 19 Dec 41, sub: Gen Hosps. HRS: G-4/29135-11.


79

McGUIRE GENERAL, A VA-TYPE HOSPITAL

The following February, after the troop basis for 1942 was published, The Surgeon General recommended enough additional beds (18,600) to make a total by the end of 1942 of 39,600, 1 percent of the planned strength of the Army.39 Of these, G-4 authorized only 14,000, to be completed by 30 September 1942, advising The Surgeon General informally to include further requirements in longer-range planning.40 By June 1942 it was possible to project requirements to the end of 1943. Informed that the strength of the Army by that time would be 6,600,000 men. The Surgeon General recommended 30,026 beds in addition to those already available or authorized, to make a total of 66,000.41 Although the SOS Hospitalization and Evacuation Branch agreed to this number for planning purposes, the SOS Construction Planning Branch directed the Engineers a few weeks later to construct only 23,500.42

When The Surgeon General estimated total general hospital bed requirements, he planned also their distribution among different hospitals. Before the war all new

39Ltr, SG to CofEngrs, 3 Feb 42, sub: Add Gen Hosp Beds. SG: 632.-1.
40Memo for Record, on Memo, ACofS WDGS G-4 for TAG, 9 Feb 42, sub: Add Gen Hosp Beds. HRS: G-4/29135-11.
41Ltr, SG to CG SOS, 6 Jun 42, sub: Add Gen Hosp Beds. SG: 632.-2.
42Memo SPOPM 632, Dir Oprs Div SOS (init WLW[ilson]) for Dir Reqmts Div SOS, 17 Jun 42, sub: Add Gen Hosp Beds. HD: Wilson files, "Book I, 26 May 42-26 Sep 42." (2) Memos SPRMC 601.1, CG SOS for CofEngrs, 4 and 7 Jul 42, same sub. HD: 632.-1.


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general hospitals had been constructed on a 1,000-bed plan. Larger hospitals could be operated with a lower ratio of personnel to beds, and after Pearl Harbor he began to recommend the construction of 1,500-bed hospitals.43 During 1942 hospitals of this size gradually superseded those of 1,000-bed capacity.44 With this beginning, the tendency to enlarge general hospital capacities was to grow until some of them would reach 6,000 by 1945.

When the Army began to emphasize reductions in quantity as well as quality of construction, attention centered momentarily on the authorized bed ratio. The Inspector General and the director of the SOS Requirements Division believed that it was too high.45 In June 1942 there were 96,291 beds in general and station hospitals, but only about 73,285 were occupied.46 According to the authorized ratio, there should have been 129,640 beds.47 Referring to reports on the occupancy of beds and to directives limiting construction to the essential minimum, SOS headquarters called upon The Surgeon General for an analytical study of bed requirements based on the experience of the previous ten years, rather than World War I, with a view to a possible reduction in authorized ratios.48 Although tables he submitted showed the ratio of occupied beds to Army strength from 1932 to 1941 to have been nearer 3.5 percent than the authorized ratio, The Surgeon General urged that the latter not be reduced. He pointed out that only 80 percent of the beds provided should be considered available, since approximately 20 percent of the total was lost through "dispersion"-the separation of patients into wards according to disease, rank, and sex. He believed that a higher proportion of men would require beds during war than during peacetime, because battle casualties would need extended periods of hospital care, recruits would have higher sick rates than seasoned soldiers, and accidents would occur more frequently under strenuous training programs.49 By the time of this reply higher authorities were considering double bunking in barracks and this was to lead to a temporary increase, rather than a reduction, in the authorized bed ratios.

Planning for Emergencies

Hospital construction for normal use was so urgent in the first hectic months of the war that planning for emergencies was left largely to local commanders. The Surgeon General expected them to meet needs that might arise by setting up beds in the solaria of hospital buildings, by placing more beds in wards than were usually considered desirable, and by using as wards the barracks of enlisted hospital-complements and, if necessary, of other troops. These methods were prescribed in

43(1) Ltr, SG to TAG, 18 Dec 41, sub: Location of 6,000 Add Gen Hosp Beds. SG: 632.-1.
44Ltr, SG to CG SOS, 6 Jun 42, sub: Add Gen Hosp Beds. SG: 632.-2.
45Memo for Record, on Memo SPOPM 323.7 Hosp, CG SOS for SG, 22 Jun 42, sub: Reqmts and Distr of Hosp Beds. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42."
46Bed Status Rpts, end of last week in Jun 42. Off file, Health Rpts Br Med Statistics Div SGO.
47This figure was arrived at by multiplying the strength of the Army in the United States by 4 percent and the total strength of the Army by 1 percent and adding the results. Of a total strength in June 1942 of 3,074,184, there were in the United States 2,472,407 officers and men. Figures furnished by Strength Accounting Branch AGO, 25 Oct 47.
48Memo SPOPM 323.7 Hosp, CG SOS for SG, 22 Jun 42, sub: Reqmts and Distr of Hosp Beds. SG: 632.-2.
491st ind, SG to Dir of Oprs SOS, 25 Jul 42, on Memo 323.7 Hosp, CG SOS for SG, 22 Jun 42, sub: Reqmts and Distr of Hosp Beds. SG: 632-2.


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Army regulations and, upon The Surgeon General's recommendation, the use of barracks to expand hospital capacities was required by the SOS directive on hospitalization and evacuation issued on 18 June 1942. Included in the same directive by the SOS Hospitalization and Evacuation Branch was another provision which The Surgeon General considered unnecessary-the requirement that subordinate commanders plan to double hospital capacities in emergencies by using civilian buildings such as apartments, hotels, schools, and dormitories.50

In the late summer and fall of 1942 a combination of circumstances focused attention upon the question of emergency hospitalization. Plans were being made for the North African invasion and for the reception in the United States of large numbers of casualties. Concurrently, as a means of reducing general construction requirements, the Chief of Staff and the commanding general, Services of Supply, decided to require the double bunking of troops in existing barracks. The Surgeon General warned them that the resultant reduction in per capita air space might lead to severe epidemics of respiratory diseases.51 General Marshall believed that this risk had to be taken, but feared that existing beds might be insufficient if an epidemic should occur at the same time casualties began to flow back from North Africa. On 10 August 1942 he verbally directed The Surgeon General, through the latter's executive officer, to plan to take over hotels in an emergency for use as Army hospitals and to arrange with local physicians for civilian groups to man them. The next day General Marshall's deputy referred to this directive in a meeting of the General Council (a group of representatives of the General Staff, and of AGF, AAF, and SOS headquarters) and the SOS Chief of Staff afterward directed The Surgeon General "to take immediate" steps to enlarge hospital capacities in the event of an emergency.52

The Office of Civilian Defense was making plans for the emergency hospitalization of civilians, earmarking hotels and organizing "affiliated units" of civilian physicians and nurses to staff them if needed.53 Realizing the possibility of conflict between OCD plans and General Marshall's directive, General Magee discussed the problem with General Lutes and with Dr. George Baehr, who was in charge of OCD medical activities. He then presented it to the Office of Defense Health and Welfare Services' Health and Medical Committee, whose function was to co-ordinate all health and medical activities relating to national defense.

Meanwhile, on 27 and 28 August 1942, General Magee transmitted General Marshall's directive to service commands. They were already listing hotels that could

50(1) AR 40-1080, C 2, 16 Mar 40. (2) The Surgeon General's Plan for Hosp (ZI) and Evac, incl to Memo, SG for CG SOS, 31 Mar 42, sub: Basic Plan for Hosp Oprs and Evac of Sick and Wounded. HRS: ASF Hosp and Evac Sec file, "Misc Classified Corresp from Off CG ASF to AGO." (3) 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. Same file. (4) See above, pp. 65-66.
51(1) 1st ind, SG to CG SOS, 11 Jul 42, on Memo, CG SOS for SG, 9 Jul 42, sub: Capacity of Bks. (2) Memo, SG for CG SOS, 25 Aug 42, sub: Double Bunking. All in SG: 632-1.
52(1) Extract from Mins of Gen Council, 11 Aug 42. HD: Wilson files, 600.13 "Hosp Policy and Plans." (2) Memo, CofSA for President of US, 21 Sep 42, sub: Reply to your Memo of Sep 14th Conc Util of Hotels as Mil Hosps. WDCofSA: 632 (14 Aug 42). (3) Memo, Brig Gen Larry B. McAfee for SG, 31 Oct 42. HD: 632.-1 "Hosp Expansion." (4) Statements of SG and his Exec Off, Cmtee to Study the MD, Testimony, pp. 1309ff and 1669ff. HD.
53Cmtee to Study the MD, 1942, Testimony, pp. 984ff. HD.


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be taken over in emergencies, in accordance with the SOS directive of 18 June 1942. To comply with the new directive, they had merely to review those lists, itemize the medical property that would be required, and arrange with a local physician to build up a staff for each emergency hospital.54

The Office of Civilian Defense and the Health and Medical Committee objected to this action because it threatened to interfere with plans for emergency hospitalization for civilians and posed the danger of transferring epidemics from Army camps into cities. The Office of Defense Health and Welfare Services then informed the President of the Army's plan, suggesting that the War Department rescind its directive and plan to provide emergency hospitalization for military personnel entirely within the confines of Army camps and with military professional staffs only.

Meanwhile the plan called for by the Chief of Staff was misinterpreted by the President, who understood that the Army intended to take over hotels and develop them into stand-by hospitals in advance of an emergency. When asked for an explanation, General Marshall assured him that this was not so, but assumed full responsibility for having directed the earmarking of hotels and the organization of civilian staffs for emergency use. The President apparently considered this explanation satisfactory, for he passed General Marshall's letter on to the Office of Defense Health and Welfare Services with the single comment, "for your information."55

After General Marshall's explanation to the President it was still necessary to solve the problem of simultaneous planning by the Army and the Office of Civilian Defense to use civilian staffs in emergency hospitals. At first SOS headquarters took the position that "any plan to utilize civilian medical personnel for military hospitalization is entirely a planning matter to establish a potential means to meet major emergencies. . ."56 When this assurance failed to satisfy the Office of Civilian Defense, SOS headquarters changed its position and, strangely enough, required The Surgeon General to inform the Health and Medical Committee that it had never been War Department policy to use civilian staffs to care for military patients.57 Meanwhile General Magee had conferred with General Marshall and with Dr. Baehr. He then proposed a compro-

54(1) Memo, SG for Brig Gen LeRoy Lutes, 21 Aug 42, sub: Over-All Plan for Emergency Med Care, Civ and Mil. HD: 632.-1 "Hosp Expansion." (2) Statements by Baehr and Magee, Cmtee to Study the MD, 1942, Testimony, pp. 984ff and 1669ff. HD. (3) Ltrs, CG SOS per SG to CGs of SvCs, 27 and 28 Aug 42, sub: Hosp Expansion. HD: 632.-1.
55(1) Ltr, Exec Sec, Health and Med Cmtee to Dir Off of Def Health and Welfare Servs, 5 Sep 42. HD: 632.-1 "Hosp Expansion." (2) Ltr, Dir Off of Civ Def to same, 12 Sep 42. Same file. (3) Ltr, Dir Off of Def Health and Welfare Servs to the President, 10 Sep 42. Natl Archives: Record Group 215, Off of Community War Servs, 922.3. (4) Memo, FDR[oosevelt] for Gen Marshall, 14 Sep 42. WDCofSA: 632 (14 Aug 42). (5) Memo, CofSA for the President, 21 Sep 42, sub: Reply to your Memo. . . . Same file. (6) Memo, FDR[oosevelt] for Hon Paul McNutt, [Dir Off of Def Health and Welfare Servs], 3 Oct 42. Natl Archives: Record Group 215, Off of Community War Servs, 922.3.
56(1) Memo SPOPH 701, Lt Col W. L. Wilson, Chief Hosp and Evac Br SOS for Gen Lutes, 17 Sep 42, sub: Current Program for Mil Hosp, with 2 incls. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42." (2) Ltr SPAAC 601, Chief Admin Serv SOS for Dir OCD, 9 Oct 42. Natl Archives: Record Group 215, Off of Community War Servs, 922.3.
57(1) Memo, SG for CG SOS, 8 Oct 42, sub: Planning for Expansion, Army Med Fac. HD: 632.-1 "Hosp Expansion." (2) Ltr, Dir OCD to Maj Gen George Grunert, Chief Admin Serv SOS, 23 Oct 42. Natl Archives: Record Group 215, Off of Community War Servs, 922.3. (3) Memo SPAAC 632 (10-20-42), CG SOS for SG, 26 Oct 42, same sub, with 4 inds. SG: 632.-1. (4) Memo SPOPH 632 (10-10-42), Dep for ACofS for Oprs SOS (init WLW[ilson]) for Chief Admin Serv SOS, 20 Oct 42, same sub. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42." (5) Memo SPOPH 632 (11-17-42), ACofS for Oprs SOS (init WLW[ilson]) for same, 22 Nov 42, same sub. Same file. (6) Ltr, Act SG to Exec Sec, Health and Med Cmtee, 14 Dec 42. SG: 632.-1.


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mise which in his opinion embodied the wishes of General Marshall and met the approval of Dr. Baehr. According to its terms the Army would plan to use in an emergency only those hotels which it could reasonably expect to staff with military personnel. If civilian doctors and nurses should be needed temporarily the Army would borrow staffs organized by the Office of Civilian Defense and the United States Public Health Service. Although SOS headquarters had disavowed the use of civilian staffs shortly before, it now approved a letter to service commands on 11 January 1943 explaining the compromise just mentioned.58 On 22 February Dr. Baehr sent a similar explanation to regional medical officers of OCD.59 Since the contemplated emergency never developed, the Army had no occasion either to take over the hotels earmarked or to call upon the Office of Civilian Defense for emergency staffs.

SOS planning for the emergency expansion of Army hospitals went on concurrently with that directed by General Marshall. On 25 August 1942 the Chief of the Hospitalization and Evacuation Branch informed General Lutes that no plan existed for assuring the availability of beds in case of an epidemic and requested authority to prepare one.60 Given the go-ahead signal, he proposed on 9 September 1942 that the station hospital bed ratio be raised from 4 percent to 5 percent for the winter of 1942-43 and that housing for additional beds thus authorized should be provided either by converting cantonment-type hospital barracks into wards and constructing theater-of-operations-type barracks for the displaced enlisted personnel or by constructing additional cantonment-type wards wherever a medical detachment already lived in theater-of-operations-type barracks.61 This plan was approved, and on 19 September 1942 the commanding general, Services of Supply, ordered the Chief of Engineers to put it into effect.62 As further provision for an emergency, the SOS Hospitalization and Evacuation Branch inserted in the revised version of the hospitalization and evacuation directive dated 15 September 1942 a requirement that each hospital plan to provide additional beds in barracks for 10 percent of the troops served.63 Thus each hospital would be prepared to care for 15 percent of its station's strength. The 5 percent authorization proved sufficient for the winter's needs.

In the course of the Army's controversy with the Office of Civilian-Defense, General Marshall directed General Snyder, the medical officer on The Inspector General's staff, to investigate means of meeting requirements that might develop in an emergency. General Snyder reported that enough beds existed, on the 4 percent

58(1) 3d ind, Act SG to Chief of Admin Serv SOS, 14 Dec 42, on Memo SPAAC 632 (10-20-42), CG SOS for SG, 26 Oct 42, sub: Planning for Expansion, Army Med Fac. SG: 632.-1. (2) Ltr SPX 632 (1-8-43) OB-S-SPOPH-M, CG SOS to CGs all SvCs, 11 Jan 43, same sub. HD: 632.-1.
59
Ltr, Chief Med Off OCD to Regional Med Offs OCD, 22 Feb 43, sub: Cooperation with the Army in the Care of Mil Casualties. HD: 632.-1.
60Memo SPOPH 620 (7-4-42) Bks, Col Wilson for Gen Lutes, 25 Aug 42, sub: Capacity of Bks. HD: Wilson files, "Book I, 26 Mar-26 Sep 42."
61Memo SPOPH 322.15, ACofS for Oprs SOS (init WLW[ilson]) for Cons Br Reqmts Div SOS, 9 Sep 42, sub: Opr Plans for Hosp and Evac. HD: Wilson files, "Book I, 26 Mar-26 Sep 42."
62Memo SPRMC 632 (9-9-42), CG SOS for CofEngrs, 19 Sep 42, sub: Add Hosps. SG: 632.-1.
63Mil Hosp and Evac Oprs, sec I, par 3b (3), incl 1 to Ltr SPOPH 322.15, CG SOS to CGs of SvCs and PEs and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs. HD: 322.


84

basis, to meet ordinary requirements plus those of a minor epidemic. He estimated that 7,500 additional beds could be made available by treating minor cases in quarters; 6,000, by treating uncomplicated cases of venereal disease on a duty status; 97,000, by caring for convalescent patients in barracks; 25,000, by reducing the floor area per bed in existing wards; and a substantial number, by improving administrative procedures and limiting the performance of elective operations. In case of an unusually severe epidemic, all barracks, he believed, could be converted into hospitals and troops could be moved into warehouses, regimental recreation buildings, and chapels.64 Under an SOS directive, The Surgeon General attempted later to carry out some of General Snyder's recommendations for more effective bed utilization.65 His recommendations for meeting the needs of an epidemic never had to be put into effect.

Long-Range Planning

Late in 1942 the Army began to try to co-ordinate hospital construction with other requirements and with postwar needs. To this end SOS headquarters insisted that each service forecast its normal needs as far ahead as possible.66 The Surgeon General found it difficult to anticipate station hospital requirements because they depended, as always, upon troop distributions unknown by him. In addition, records of existing station hospitals were unreliable, those of the divisions of the Surgeon General's Office differing among themselves and with records of the Engineers.67 But projection into the future of general hospital bed requirements was less difficult.

In forecasting the need for general hospital beds in the fall of 1942, The Surgeon General adopted a new basis for estimates. Plans for the invasion of North Africa were being made and it was expected that large numbers of combat casualties would be returned to the United States. From World War I experience it appeared that beds would be needed in general hospitals in the United States for 1.7 percent of all overseas forces if patients requiring 120 or more days of hospitalization were evacuated from theaters of operations.68 The Surgeon General therefore added .7 percent of the strength of overseas forces to the 1 percent of the total strength of the Army already established as the basis for estimating general hospital bed requirements. On 26 September 1942 he recommended that a total of 96,000 general hospital beds be provided by the end of 1943 and of 124,800 by the middle of 1944. About two months later, when the projected Army strength was changed, he proposed that the mid-1944 figure be cut to 103,500. SOS headquarters approved his recommendations, and until the early part of 1943 this figure stood as the number of beds authorized for planning purposes, but not for construction.69(Chart 4)

64Ltr, IG per Brig Gen Howard McC. Snyder to CofSA, 10 Nov 42, sub: Surv of Hosp Fac and their Util. HRS: WDCSA 632.
65See below, pp. 127, 130-31.
66(1) Memo, CofEngrs for SG, 10 Oct 42, sub: Prep of Sec V of Army Sup Program. SG: 632.-1. (2) Memo for Record, on 3d ind SPOPH 632 (9-26-42), CG SOS to SG, 29 Oct 42, on Memo, SG for CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42."
67(1) Cmtee to Study the MD, 1942, Rpt, p. 8. HD. (2) Memo, Dir Control Div SGO for SG, 8 Feb 43, sub: Statistics on Hosp Beds. SG: 632.-2.
68Statistics of World War I were analyzed in Army Medical Bulletin, No. 24 (1931).
69(1) Memo, SG for CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps, with 4 inds. SG: 632-2. (2) Memo, Chief Hosp Cons Div SGO for Asst Dir Fiscal Div SGO, 19 Jan 43, sub: Bed Reqmts for FY 1944. Same file. (3) Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5.


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CHART 4-THE SURGEON GENERAL'S ESTIMATES IN 1941-42 OF BED REQUIREMENTS IN GENERAL HOSPITALS IN CONTINENTAL UNITED STATES AND ACTUAL BEDS REPORTED JANUARY 1942-JULY 1944

Early in 1943 a combination of circumstances pointed toward intensified efforts by the General Staff and SOS headquarters to limit construction. In January a study of hospital bed occupancy, prepared by the Surgeon General's Office for inclusion in the SOS Monthly Progress Report, showed that estimated requirements had been higher than actual needs. While there was a close correlation between estimated requirements and occupied beds in station hospitals, a discrepancy between estimated requirements and occupied beds in general hospitals had grown from 11,000 to 45,000 during 1942. The Surgeon General explained that this resulted from better health and fewer combat casualties than anticipated.70 In March 1943 certain members of Congress threatened to investigate the use of all hospital beds, both civilian and military, in the United States.71 Soon afterward the Secretary of the Navy proposed that the Army and Navy consider the possibility of making joint use of their hospitals.72 Furthermore, the Surgeon General of the

70(1) SOS Monthly Progress Rpt, Sec 5, Pt IV, Health, pp. 44-45, 31 Jan 43.
71Establishing a Select Committee to Investigate Hospital Facilities Within the United States of America, 78th Cong, 1st sess on H. Res. 146, 3 March 1943.
72Memo WDGDS 2857, ACofS G-4 WDGS for CofSA, 15 Mar 43, sub: Joint Army-Navy Use of Available Hosp Accommodations. HRS: G-4 files, "Hosp and Evac Policy."


86

United States Public Health Service, calling attention to the interest of Congress and of the War Production Board in the matter, suggested to Brig. Gen. Frank T. Hines, Administrator of Veterans Affairs and Chairman of the Federal Board of Hospitalization, the desirability of co-ordinating the hospital construction planning of all Government agencies.73 As a result, the President on 31 March 1943 ordered the War and Navy Departments, the Federal Security Administration, and the Veterans Administration to submit all plans for additional hospital construction to the Federal Board of Hospitalization for co-ordination and submission to him, through the Bureau of the Budget, for approval.74

Meanwhile, despite a discrepancy between estimated and actual requirements in 1942 and in the face of growing interest in limiting hospital construction, The Surgeon General again raised his estimates. On the basis of new troop strength figures from the Bureau of the Budget, he asked SOS headquarters on 11 March 1943 to approve an increase in authorized general hospital beds from 96,000 to 102,882 for December 1943 and from 103,500 to 110,693 for July 1944. He also asked approval of the higher bed ratio which he had been using since September 1942.75 Apparently the Services of Supply, renamed Army Service Forces on 12 March 1943, was in no mood to approve either additional beds or a higher ratio. Instead, its Requirements Division directed The Surgeon General to review the proposed ratio in the light of recent war experience and to consider a reduction of construction requirements by the joint use of Army and Navy facilities, the expansion of existing general hospitals, and the conversion of station to general hospitals.76

Methods which ASF headquarters suggested for reducing hospital construction proved practicable only in part. A study of the possibilities of joint Army-Navy hospitalization promised little in the way of additional beds for Army use.77 The proposal to reduce the bed ratio got nowhere. The director of the ASF Control Division agreed with The Surgeon General that information on World War II casualty rates was insufficient to warrant a reduction, and the ASF Hospitalization and Evacuation Branch interpreted the 15 September 1942 directive on hospitalization and evacuation as giving The Surgeon General alone the authority to estimate bed requirements for overseas casualties.78 Hence, the ASF Requirements Division accepted The Surgeon General's estimate of requirements and turned to the remaining means of reducing general hospital construction-the use of station hospital beds and the expansion of existing general hospitals.

In a conference attended by representatives of the Surgeon General's Office on 8 April 1943, the ASF Requirements Divi-

73Ltr, SG USPHS to Brig Gen Frank T. Hines, 18 Mar 43. SG: 632.-1.
74(1) Ltrs, Franklin D. Roosevelt to SecWar and to Dir Bu of Budget, 31 Mar 43. SG: 632.-1. (2) Ltr, Dir Bu of Budget to Chm Fed Board of Hosp, 2 Apr 43. Same file.
75Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5.
761st ind, CG ASF to SG, n d, on Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5.
77(1) 2d ind, SG to CG ASF, 31 Mar 43, on Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5. (2) 1st ind, SG to CG ASF, 12 Jun 43, on Memo, CG ASF for SG, 19 Mar 43, sub: Joint Army-Navy Use of Available Hosp Accommodations. SG: 705.-1.
78(1) Memo SPOPH 632 (5 Apr 43), ACofS for Oprs ASF (init WLW[ilson]) for ACofS for Mat ASF, 7 Apr 43, sub: Hosp, Gen Hosps. HD: Wilson files, "Book IV, 16 Mar 43-17 Jun 43." (2) Memo, Dir Control Div ASF for CG ASF, 2 Apr 43, sub: Situation with Respect to Army Hosps. SG: 322.15.


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sion pointed out that the construction or acquisition of general hospitals to provide a total of 83,000 beds had already been approved. To provide approximately 103,500 beds by December 1943, about 20,500 additional beds would be required. On the basis of projected overseas movements, 5,400 station hospital beds would be surplus by that time. If they should be converted to general hospital use, housing for only 15,100 additional general hospital beds would need to be constructed. Additional general hospital requirements during 1944 could be met by using increasingly large numbers of surplus station hospitals for that purpose. ASF headquarters therefore approved the expansion of thirteen existing general hospitals by 250 beds each, the construction of seven new general hospitals, and the acquisition of Pilgrim State Hospital, Brentwood (Long Island), New York, in order to provide the total number of beds required by December 1943.79

Reviewing this plan as the President had directed, the Federal Board approved the construction of the thirteen 250-bed annexes, the acquisition of Pilgrim State Hospital, and the construction of two new general hospitals.80 Before it acted on the five other general hospitals, the Air Forces gave up certain buildings it had been using, including the Chicago Beach Hotel at Chicago and the Haddon Hall Hotel at Atlantic City. Furthermore, ASF headquarters decided that adjustments in the military program would make possible a reduction in authorized beds by approximately 7,000. Accordingly on 22 June 1943 the commanding general, Army Service Forces, directed The Surgeon General to withdraw from the Federal Board requests for approval of 8,750 additional beds and to provide, instead, 1,810 beds in the two hotels being vacated by the Air Forces. In the opinion of ASF, this would complete the general hospital building program in the United States.81

The events just described reveal a pattern that was to be repeated later in the war-increases in estimated bed requirements by The Surgeon General, publication of statistics showing relatively low occupancy of beds already provided, and subsequent efforts by higher headquarters to limit or reduce the number authorized. In this instance, such efforts resulted from attempts to reduce construction costs and save building materials but later from a need to conserve personnel. Earlier, as already noted, the urgent necessity for additional hospitals precluded doubts about estimated requirements as well as co-ordination of hospital construction programs of various federal agencies, both military and civilian. When such co-ordination was finally undertaken, the Army program had been virtually completed. Experiences encountered in planning for emergency hospitalization revealed the difficulties involved in co-ordinating plans of the Army with those of other agencies and in permitting several War Department agencies to work independently on a single problem.

79(1) Memo, "Basis used by Gen Wood at Conf on Hosp, ZI, SOS, 8 Apr 43, attended by Hall, Offutt, Wickert, Welsh," undated and unsigned. HD: SGO Oprs Div files. (2) Memo, CG ASF for SG, 9 Apr 43, sub: Completion of Gen Hosp Program in US. HRS: Hq ASF Somervell files, "SG 1943." (3) Memo, CG ASF for SG, 10 Apr 43, same sub. SG: 632.-1.
80Photostat copy, Res adopted by Fed Bd Hosp, 21 May 43. SG: 632.-1 (McGuire Gen Hosp)K. See also pp. 000, above.
81(1) Ltr, SG to SecWar thru CG ASF, 18 May 43, sub: Gen Hosp Program, Use of Converted Hotels (AF), and 6 inds. SG: 632.-1. (2) Memo, CG ASF for SG, 22 Jun 43, sub: Completion of Gen Hosp Program. Same file.


88

Location, Siting, and Internal Arrangement of Hospital Plants

In the hospital construction program attention had to be given not only to types of construction and estimates of the capacity needed but also to the location, siting, and internal arrangements of hospital buildings. After war was declared the selection of locations and sites, especially for general hospitals, became more complicated, while the need for speed in construction raised again the question of control over the internal arrangements of hospitals.

Selection of Locations and Sites

Station hospitals had to be located at camps whose situation was chosen by higher authority than the Surgeon General's Office, but selection of sites within those camps was a joint enterprise of The Surgeon General and the Chief of Engineers. In selecting locations for general hospitals The Surgeon General had more authority but not a free hand. He set up criteria of his own but was also subject to policies established by higher authority, to review of ASF headquarters, and to the Engineers' opinion of the suitability of available sites within general areas.

After war began The Surgeon General continued to regard as important such factors as climate, terrain, utilities connections, transportation systems, and communications networks. Moreover the growth of war industries and military installations necessitated more careful investigation than before of available labor, housing, and commodity markets. Furthermore there was the well-established policy of locating general hospitals in areas near large training camps, in order to simplify the transfer of patients from station to general hospitals. Occasionally these factors conflicted with each other. For example, cities with adequate housing, labor, and commodity markets were scarce in the South and Southwest, where most troops were concentrated.82 A policy of hospitalizing war casualties near their homes was not established until the general hospital construction program had been virtually completed.83 It therefore had little effect upon hospital locations. If it had been established earlier, more general hospitals might have been located in centers of population rather than in centers of troop density and the problem of finding areas with adequate markets might have been less difficult.

Early in 1942 G-4 ordered all new general hospitals to be located between the Atlantic and Pacific coast ranges as a safety masure.84 It was immediately evident that this policy conflicted with the necessity of placing hospitals near ports of debarkation where they could readily receive patients returning from overseas theaters.85 In June 1942, therefore, SOS headquarters permitted the construction of some general hospitals near the coasts to support ports of debarkation, but it made even more restrictive the area for the location of others by moving its boundaries inland to a line running from

82The above information was taken from numerous reports of inspection of areas for hospital locations. They are filed in SG: 632.-1 and in HD: Hosp Insp Rpts.
83
See below, pp. 116-17.
84(1) Rpt on SGO Staff Conf, 17 Feb 42, in Diary of SGO Hist Subdiv. HD. (2) Info furnished by Col John R. Hall (Ret), 2 Dec 50. HD: 314 (Correspondence on MS) III.
85Ltr, SG to TAG, 14 Feb 42, sub: Add Gen Hosp Beds. SG: 632.-1.


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LOCATION OF GENERAL, CONVALESCENT, AND REGIONAL HOSPITALS DURING WORLD WAR II


90

Spokane to Phoenix to El Paso to Temple (Texas) to Atlanta to Cleveland.86 This limitation was not strictly observed and toward the end of 1942 General Marshall in a conference with General Magee verbally abrogated both the G-4 and SOS restrictions.87 Of the 51 general hospitals authorized, acquired, or constructed between the beginning and end of the war, 28 were outside the area prescribed by SOS headquarters, 4 were on its edge and 19 were within it.88 Of the 28 outside the area, 9 were in the populous northeastern section of the country and 7 were in the Pacific Coast area.

Increasing emphasis during 1942 upon the use of existing civilian buildings for Army hospitals complicated the process of site selection and sometimes interfered with proper location. In some instances several buildings, such as hotels or civilian hospitals, had to be surveyed for engineering features and potential bed capacities before a decision could be made either to use one of them or to erect a new Army plant in the same general area. In the latter case a satisfactory site still had to be selected. Existing buildings were sometimes chosen simply because they were suitable for conversion into Army hospitals, even though they were in towns that were smaller than The Surgeon General considered desirable or were outside the area prescribed by SOS headquarters.89

The Surgeon General's selection of locations for general hospitals had to be reviewed by SOS headquarters before the Engineers could investigate specific sites for their construction. Of eighteen locations which The Surgeon General proposed in June 1942, the SOS Hospitalization and Evacuation Branch changed almost a third because its chief considered them too near the coast or other general hospitals and too far from adequate rail facilities and large towns.90 During the winter of 1942 that Branch urged The Surgeon General rather unsuccessfully to locate more hospitals in the West, to care for possible increases in troop concentrations and evacuee loads in that area.91 About the same time, the SOS Requirements Division became involved, insisting upon the speedy selection of locations for all hospitals to be constructed by June 1944. This made selection more difficult, according to both The Surgeon General and the Chief of Engineers, and in some instances The Surgeon General found it expedient to agree to sites which, although

86Opr Plans for Hosp and Evac, sec I, par 5 c, incl 1 to Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs and Gen Hosps, and to SG, 18 Jun 42, same sub. HD: 705.-1.
871st ind, SG to CG SOS, 15 Jan 43, on Memo SPRMC 632, CG SOS for SG, 18 Dec 42, sub: Hosp, Gen Hosps. SG: 632.-1.
88General Hospitals established outside the area were: Ashford, Newton D. Baker, Birmingham, Brooke, Butner, Cushing, Dibble, Deshon, DeWitt, Edwards, England, Finney, Fletcher, Foster, Hammond, Halloran, Madigan, Mason, McCaw, McGuire, Moore, Oliver, Pickett, Ream, Rhoads, Torney, Valley Forge, and Woodrow Wilson; those inside the area were: Ashburn, Battey, Borden, Bruns, Bushnell, Carson, Gardiner, Glennan, Harmon, Kennedy, Mayo, Nichols, Percy Jones, Prisoner-of-War General Hospital No. 2, Schick, Thayer, Vaughan, Wakeman, and Winter; those on the edge were Baxter, Crile, McCloskey, and Northington.
89(1) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1. (2) Memo CE 632 (Hosps) SPEOT, CofEngrs for CG SOS, 19 Dec 42, sub: Adv Planning for Add Gen Hosp Fac. SG: 632-1.
90Memo SPOPM 632, ACofS for Oprs SOS (init WLW[ilson]) for Dir Reqmts Div SOS, 17 Jun 42, sub: Add Gen Hosps. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42."
91(1) 3d ind SPOPH 632 (9-26-42), CG SOS (Oprs SOS) to SG, 29 Oct 42, with n. for record, on Memo, SG for CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42." (2) 5th ind SPOPH 632 (9-26-42), ACofS Oprs SOS for ACofS Mat SOS, 5 Dec 42, on same memo. Same file.


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less desirable in his opinion, were superior for construction purposes.92

Throughout the early war years, local pressure on the War Department sometimes complicated the process of selecting hospital locations and sites but apparently did not often sway the judgment of those responsible for making the choice. In their attempts to lure additional wartime activities, many communities and cities made attractive offers, including the presentation of lands for general hospitals and the extension of utilities lines to the edges of those areas. In some instances there seemed to be a buyers' market. For example, after The Surgeon General planned to establish a general hospital in the Fort Worth-Waco (Texas) area, six cities offered valuable inducements. From the sites offered, The Surgeon General selected the one which, in the opinion of his representative and that of the Chief of Engineers, seemed best suited for hospital purposes.93 In other instances local authorities banded together to prevent the establishment of hospitals in their areas.94 Sometimes United States Senators and Representatives also attempted to influence the selection of certain locations. Generally they seem to have met with little success. For example, Sens. Charles L. McNary and Rufus C. Holman and Rep. Walter M. Pierce were particularly insistent upon the establishment of hospitals near LeGrande and Hot Lake, Oreg., rather than at Spokane and Walla Walla, Wash., but after appropriate investigations the latter locations were approved.95 Likewise, Sen. John H. Bankhead and Rep. Carter Manasco sought a hospital for Jaspar, Ala., a mining town suffering from a lack of war projects, but The Surgeon General's representative recommended that Jaspar not be selected, and the place finally chosen for the one hospital in Alabama was Tuscaloosa.96 On the other hand, a hospital was located at Martinsburg, W. Va., a city commended for that purpose by Rep. Jennings Randolph;97 and, as a rule, after The Surgeon General's Construction Division made tentative selections of locations and sites, it discussed them with appropriate Senators and Representatives and secured their co-operation and help in dealing with local authorities.98

In view of the many factors involved, it is not surprising that the process of site selection was slow and gave rise to considerable criticism later in the war. Much of this criticism sprang from the fact that there were too few hospitals in densely populated areas to enable all patients

92(1) Memo, CG SOS (Dir Reqmts Div) for SG, 18 Dec 42, sub: Hosp, Gen Hosps, with 1st ind, SG to CG SOS, 15 Jan 43. SG: 632.-1. (2) Memo CE 632 (Hospitals) SPEOT, CofEngrs for CG SOS, 19 Dec 42, sub: Adv Planning for Add Gen Hosp Fac. Same file. (3) Ltr, Col John R. Hall to Lt Col Don J. Leehey, Off Div Engr, Portland, Oreg, 23 Mar 42. SG: 601.-1.
93(1) Memo, Col John R. Hall for SG, 31 Dec 41, sub: Rpt of Insp Trip Made for the Purpose of Locating Add Gen Hosp . . . in North Texas Area, with 12 incls. SG: 632.-1. (2) D/S, ACofS G-4 WDGS to TAG, SG, and CG 8th CA, 19 Jan 42, sub: Site for Gen Hosp, Temple, Tex. HRS: G-4/29135-11.
94Notes on Conf, 26 Mar 42, Hosp Cons Div SGO, atchd to Ltr, SG to TAG, 14 Feb 42, sub: Add Gen Hosp Beds. HD: 632.-1.
95(1) Ltr, SG to Hon Rufus C. Holman, US Sen, 21 Apr 42. SG: 601.-1. (2) Memo, Col John R. Hall for SG, 3 Jun 42, sub: Insp Trip to Oreg, Wash, and Calif. Same file.
96(1) Memo, Maj Lee C. Gammill for Col John R. Hall, 6 Jul 42, sub: Jaspar, Ala, Hosp Sites. HD: Hosp Insp Rpts. (2) Memo, Lt Col Achilles L. Tynes for SG, 22 Aug 42, sub: Rpt on Site Bd Surv for Location of Gen Hosp at Greeneville (sic), SC and Jaspar, Ala. SG: 601.-1.
97Memo, Col John R. Hall for SG, 15 Jun 42, sub: Insp of Proposed Sites Offered by City of Martinsburg, W. Va. HD: Hosp Insp Rpts.
98Info furnished by Col Hall (Ret), 2 Dec 50. HD: 314 (Correspondence on MS) III.


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evacuated from overseas theaters to be cared for near their homes. It was generally forgotten-or ignored-that most of the general hospitals were located to facilitate the transfer of patients from station hospitals in training camps and that the War Department did not establish a policy of hospitalizing overseas evacuees near their homes until most of the general hospitals had been established.

Control over Internal Arrangement of Hospitals

The Surgeon General continued to insist that building schedules, hospital layouts, and floor plans of all new hospitals, plans for all "major" alterations to existing buildings, and all subsequent changes in such plans should be referred to his Office for approval.99 On the other hand, the Chief of Engineers attempted, as did The Quartermaster General before him, to decentralize as much authority as possible in order to save time. Beginning in February 1942, he again raised the question of having The Surgeon General approve standard building schedules and layouts for use in the field, without further reference to the latter's Office, but apparently neither the Chief of Engineers nor SOS headquarters wished to challenge The Surgeon General's position. While official construction policy letters did not require the reference of layouts and plans to his Office, the Engineers generally followed that practice.100

The extent of The Surgeon General's authority over hospital construction was discussed but not defined after reorganization of the Services of Supply in the late summer of 1942. On 5 August General Magee requested that certain functions be "retained" in his Office, not decentralized to the field. Among them were the approval of hospital floor plans and layouts, plans for the conversion of civilian buildings into Army hospitals, and all major alterations to existing hospital buildings.101 General Somervell's reply was inconclusive. He stated that the approval of floor plans and layouts had been and was at that time a responsibility of the Chief of Engineers, but that it was the practice to secure concurrence of the Surgeon General's Office in them. Plans for the conversion of civilian buildings, he stated, fell in a "twilight zone" that was not well defined either before or after the reorganization. As for alterations to existing hospitals, General Somervell stated that there was no clear definition of the word "major." He implied that The Surgeon General should agree with the Chief of Engineers to decentralize authority for alterations to service commands. If The Surgeon General could not trust service command surgeons to supervise alterations properly, General Somervell concluded, he should replace the surgeons.102

99(1) Ltr, SG to CofEngrs, 9 Feb 42, sub: Hosp Bldg Schedules. (2) 1st ind, SG to CofEngrs, 1 May 43, on Ltr 600.92 (Gen) SPEEG, CofEngrs to SG, 25 Apr 42, sub: Typical Hosp Layouts. (3) 1st ind, SG to CofEngrs, 2 Aug 42, on Synopsis Ltr, CofEngrs to SG, 28 Jul 42, sub: Auth of Div Engr to Auth Cons. All in SG: 632.-1.
100(1) Ltr, SG to CofEngrs, 9 Feb 42, sub: Hosp Bldg Schedules. SG: 632.-1. (2) Ltr 600.92 (Gen) SPEEG, CofEngrs to SG, 25 Apr 42, sub: Typical Hosp Layouts. Same file. (3) Ltr AG 600.12 (2-19-42) MO-D-M, TAG to CGs of all Depts and CAs, COs of Exempted Stas, and C of Arms and Servs, 24 Feb 42, sub: WD Cons Policy, ZI. HRS: G-4/31751. (4) 1st ind, CofEngrs to CG AAF, 25 Aug 42, on Ltr, CG AAF to CofEngrs, 19 Aug 42, sub: Hosp Cons. AAF: 632 "B Hosp and Infirmaries."
101Ltr, SG to CG SOS, 5 Aug 42, sub: Liaison in Reorgn of SvCs. SG: 020.-1.
1021st ind, CG SOS to SG, 15 Aug 42, on Ltr, SG to CG SOS, 5 Aug 42, sub: Liaison in Reorgn of SvCs. SG: 020.-1.


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Within the same month it became apparent that local changes in approved plans for converting civilian buildings into hospitals needed to be more strictly controlled. Aware of the difficulties of such conversions, The Surgeon General asked authority on 2 August 1942 to commission five civilian architects to serve as advisers on the spot in the alterations required. The commanding general, Services of Supply, disapproved this request because the Chief of Engineers considered it an encroachment upon his responsibility.103 Meanwhile word reached Washington that local engineer and medical officers had made unnecessary and expensive changes in plans for one of the conversions. After a conference on this problem on 14 August 1942 among representatives of the Services of Supply, the Chief of Engineers, The Surgeon General, and the War Production Board, General Somervell directed that no changes should be made in approved plans for altering hotels or other buildings without the written consent of both The Surgeon General and the Chief of Engineers.104

In following months The Surgeon General and the Chief of Engineers agreed upon a partial decentralization of authority to approve alterations of existing hospitals. On 5 October 1942 the War Department delegated to service commanders the authority to approve alterations costing up to $10,000 on any building, at any one time and place.105 On 13 November 1942 The Surgeon General suggested, as he had before, that all "major" alterations to hospital buildings, regardless of cost, be sent to his Office for approval. He defined "major" alterations as those requiring structural changes to convert sections of buildings or entire buildings from one use to another, to convert ward to office space or vice versa, or to extend buildings into areas expected to be kept vacant. The Chief of Engineers insisted that the term "major" changes would be misleading and suggested that the phrase "changes involving more than $10,000" be used instead. Undoubtedly aware of the War Department's action of 5 October 1942, The Surgeon General reluctantly agreed and on 3 December 1942 the Chief of Engineers issued a letter authorizing local alterations costing up to $10,000 on hospital buildings, without prior approval of The Surgeon General.106 

In November 1942 the Wadhams Committee attributed what it considered to be shortcomings in hospital construction partially to the limited extent of The Surgeon General's authority but also to the inadequacy of his own construction staff. Stating that the division of responsibility between the Chief of Engineers and The Surgeon General had permitted "passing the buck," it recommended that the latter be given more authority over construction. At the same time the committee proposed that The Surgeon General strengthen his construction staff by adding to it outstanding civilian hospital architects and by placing at its head a nonmedical man

103(1) Memo for Record, on DF, CG SOS to SG, 17 Sep 42, sub: Increase in Procurement Objective, AUS. AG: SPGA 210.1 Med 1-20.
104(1) Memo 323.7 Hosp SPPDX, Mr. L. G. Woodford for Gen Harrison, 14 Aug 42, sub: Conversion of Hotels to Army Hosps. SG: 632-2. (2) SOS Memo S100-2-42, 27 Aug 42, sub: Limitation on Alterations to Hosps. CE: 632, Pt 2.
105AR 100-80 C 3, 5 Oct 42.
106(1) Memo, SG for CofEngrs, 13 Nov 42, sub: Routing of Project Ests Affecting Hosp Bldgs, with 1st ind CE 600.94 (Surg Gen) SPEUU, CofEngrs to SG, n d; 2d ind, SG to CofEngrs, 25 Nov 42, and 3d ind CE 600.94 (Surg Gen) SPEUU, CofEngrs to SG, 7 Dec 42. SG: 632.-1. (2) Ltr, CofEngrs to CGs of SvCs, 3 Dec 42, sub: Nonrecurrent Project Ests Involving Hosp Bldgs. CE: 632, Pt 2.


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experienced in hospital planning. The Surgeon General naturally agreed that he should have more authority, but he concurred with the chief of his Hospital Construction Division in defending the practice of placing a doctor at its head and ascribed the division's shortage of trained architects to the disapproval of his request to commission five to assist in the conversion program.107

Maintenance of Hospital Plants

Responsibility for Maintenance

Even before The Surgeon General lost control over hospital alterations costing less than $10,000, he had also lost authority over the expenditure of funds for hospital repair and maintenance. At the beginning of 1942 funds from three appropriations were used for hospital maintenance. Two of them, the Barracks and Quarters (B&Q) appropriation and the Construction and Repair of Hospitals (C&RofH) appropriation, were Engineer appropriations; the third, the Medical and Hospital Department (M&HD) appropriation, was made to the Medical Department. Funds from the B&Q appropriation and from the M&HD appropriation were controlled exclusively by the Engineers and the Medical Department respectively. Those from the C&RofH appropriation were controlled jointly by the Chief of Engineers and The Surgeon General. B&Q funds paid for such things as firing boiler plants of hospitals and repairing certain buildings occupied and used by operational personnel. C&RofH funds provided for the maintenance of buildings occupied and used by patients and for the upkeep of installed equipment. M&HD funds were used to maintain noninstalled Medical Department equipment and to meet expenses connected with the purchase of medical supplies.108

The use of three funds for hospital maintenance produced complications. One was confusion about the fund to which various expenditures should be charged. In January and February 1942 questions arose over whether repairs to hospital barracks should be charged to B&Q or to C&RofH funds.109 Fine distinctions sometimes had to be made in applying the C&RofH fund rather than the M&HD fund and vice versa. For example, carpenters were employed from both. Those paid with M&HD funds could repair hospital furniture and non-installed equipment, but not buildings and installed equipment; those paid with C&RofH funds had to do that.110 Another problem arose in the joint administration of C&RofH funds. Although they were Engineer funds, their appropriation was based on estimates prepared by The Surgeon General and they were allotted to hospitals on his recommendation. Corps area and post surgeons controlled their expenditure and reported on it to The Surgeon General, but post engineer officers performed the work.111

107(1) Cmtee to Study the MD, 1942, Rpt. HD. (2) Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 31. HD. (3) Memo, Col John R. Hall for Exec Off SGO, 3 Dec 42. SG: 632.-1.
108Tynes, Construction Branch, p. 54. Also see the language of the appropriations acts.
109(1) Ltr CE 121.2 (Funds) CU, CofEngrs to SG, 7 Jan 42, sub: Policy for Div of B&QA Funds and C&RofHA Funds, with 1st ind, SG to CofEngrs, 1 Mar 42. (2) Ltr CE 121.2 (Funds) CUC, CofEngrs to SG, 25 Feb 42, sub: Policy for Div of B&QA, C&RofHA and Air Corps Tec Funds, and 1st ind, SG to CofEngrs, 1 Mar 42. Both in SG: 632.-1.
110Memo, Col F[rancis] C. Tyng for Budget Off WD, 22 Mar 42, sub: Trf of Approp C&RofH from a Sep Approp to M&HD, A. SG: 632.-1.
111(1) Memo, Col F. C. Tyng for Budget Off WD, 22 Mar 42, sub: Trf of Approp C&RofH from a Sep Approp to M&HD, A. SG: 632.-1. (2) AR 40-585, par 3 and 4, 16 Jul 31.


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Early in 1942 the Chief of Engineers began to simplify the administration of the C&RofH fund. In order to reduce bookkeeping, he proposed on 31 January 1942 the abandonment of a practice of subdividing the fund into several smaller project-funds.112 He also began to make allotments directly to district engineers, without securing The Surgeon General's and corps area surgeons' recommendations.113 Then he directed district engineers to prepare estimates of C&RofH funds in the same way they did those of B&Q funds.114 The Surgeon General went along with these changes, but insisted that corps area surgeons be informed of allotments made to hospitals and that they continue to report to him on all expenditures made from such allotments.115

The next month the merger of the C&RofH appropriation with either the B&Q or the M&HD appropriation came up for consideration. The Chief of Engineers wanted the C&RofH fund merged with the B&Q fund under his control. Hearing of pending legislation to that effect, The Surgeon General recommended to the Budget Officer of the War Department on 22 March 1942 that the C&RofH and the M&HD appropriations be combined into one, under Medical Department control. In support of this recommendation he pointed out unsatisfactory features of having a fund controlled jointly by the Engineers and the Medical Department.116 This action came too late, because the merger of C&RofH with B&Q funds under a single appropriation called Engineer Service, Army, had already occurred on 5 March 1942.117 The Surgeon General protested against this "radical departure" from accepted practices, maintaining now that joint control of the C&RofH fund had been satisfactory, that only doctors could determine the maintenance required for hospitals, and that Congress had always been, and might be expected to continue to be, more liberal in appropriating funds for hospital maintenance than for the routine maintenance of Army posts.118 He failed, however, to keep control over funds expended for hospital maintenance, for on 23 May 1942 the War Department charged the Chief of Engineers with responsibility for repairs and utilities at general hospitals and on 9 June 1942 rescinded the Army regulation which had outlined The Surgeon General's former authority over hospital maintenance.119 With the reorganization of the Services of Supply, the Chief of Engineers requested The Surgeon General on 17 August 1942 to close out all fiscal transactions pertaining to hospital

112Memo CE 121.2 (Projects) CUC, CofEngrs for SG, 31 Jan 42, sub: Project Revision. SG: 632.-1.
113Ltr, Surg 4th CA to SG, 19 Jan 42, sub: C&RofH Funds, with 2d ind, CofEngrs to SG, 13 Feb 42. SG: 632.-1 (4th CA) AA.
114Ltr CE 315 (Forms) CUC, CofEngrs to SG, 27 Jan 42, sub: Application of OCE Forms No 395 and 395-A to An Est of Funds Req of C&RofH, A. SG: 632.-1.
115(1) 1st ind, SG to CofEngrs, 23 Jan 42, on Ltr, Surg 4th CA to SG, 19 Jan 42, sub: C&RofH Funds. SG: 632.-1 (4th CA)AA. (2) Ltr, Maj Seth [O.] Craft to Surg 2d CA, 7 Mar 42. SG: 632.-1 (2d CA)AA. (3) Ltr, same to Capt Joe [E.] McKnight, MAC, Off of Surg 1st CA, 4 Feb 42. SG: 632.-1 (1st CA)AA.
116(1) Ltr, SG to CofEngrs, 25 Feb 42, sub: C&RofH Funds, as Affected by Pending Legislation, H. Res. 6611. SG: 632.-1. (2) Memo, SG for Budget Off WD, 22 Mar 42, sub: Trf of Approp C&RofH . . . to M&HD, A, for FY 1943. SG: 632.-1.
117(1) 5th Supp Nat Def Approp Act, 1942, Public Law 474, apvd 5 Mar 42. (2) GAO Acts and Procedures Ltr 4236, 7 Mar 42. HD: 121.2.
118(1) Ltr CE 121.2 (Funds) CUC, CofEngrs to SG, 24 Mar 42, sub: Maintenance of Hosp Structures. (2) Memo, SG for Maj Gen T[homas] M. Robins, Asst CofEngrs, 26 Mar 42, sub: Maintenance and Repair of Hosps. (3) Memo CE 600.3 (Gen)-CU, CofEngrs for SG, 10 Apr 42, sub: Repairs and Util Functions at MD Fac, with 1st ind, SG to CofEngrs, 23 Apr 42. All in SG: 632.-1.
119(1) WD Cir 157, 23 May 42. (2) AR 100-80, 9 Jun 42.


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maintenance and to plan to transfer the funds, personnel, and equipment used in that work to the Engineers as of the close of business on 31 August 1942.120

After responsibility was concentrated in the Chief of Engineers, the maintenance and repair of hospitals failed to suffer as the Surgeon General's Office had anticipated. The surgeons of several service commands reported favorably on the performance of maintenance work under the new system.121 As late as 1945, Col. Achilles L. Tynes, of the Hospital Construction Division, pointed out that hospitals had experienced no difficulty in getting repairs during the war and that it could not be proved that retention of control of funds by the Medical Department would have been more satisfactory than control by the Engineers.122

Reflooring and Reroofing

Throughout the war, maintenance programs of magnitude had to be carried on concurrently with new construction programs, largely as the result of the use of cantonment-type construction in the majority of hospitals built both before and after the war began. Green pine lumber, the only type available in many cases, was frequently used for both flooring and roofing. As it dried and warped, it pulled the nails through tar-paper roofing, tearing it and producing leaks, and caused floors to shrink and splinter, leaving them unsightly, insanitary, and dangerous. Beginning late in 1941 and continuing through 1942, The Surgeon General and the Chief of Engineers initiated and carried through extensive programs of reroofing and reflooring. Asphalt strip shingles gradually replaced tar-paper roofs, and old floors were covered with layers, first of plywood and then of linoleum or similar material. In corridors, imitation-rubber strip-runners were laid to protect floors, to reduce noise, and to increase patients' safety. These costly programs might have been avoided had better materials been available and authorized for initial hospital construction.123

Efforts to Increase the Safety and Comfort of Patients

Despite the War Department's policy of "Spartan simplicity" in construction and maintenance during 1942 and 1943, the Engineers and the Medical Department tried to increase the safety and comfort of patients in hospitals. The practice of installing automatic sprinkler systems as protection against fire in cantonment-type wards was continued and extended to include recreation, mess, post exchange, and clinic buildings as well.124 Numerous requests from separate hospitals for heat in corridors, to protect patients as well as the pipes of sprinkler systems from extreme cold, had prompted The Surgeon General

120Ltr, Asst CofEngrs to SG, 17 Aug 42, sub: Trf of Repairs and Util Functions. SG: 632.-1.
121An Rpts, 1942, Surg 5th, 7th, and 9th SvCs. HD. 
122Tynes, Construction Branch, p. 64.
123Correspondence among The Surgeon General, The Quartermaster General, and the Chief of Engineers on these programs is on file in SG: 632.-1; SG: 632.-1 (1st thru 9th CAs)AA; and CE: 632 Vol. 3. Also see Speech, Lessons Learned from Planning and Constructing Army Hospitals, by Col Hall, 16 Sep 43 (HD: 632.-1), and Tynes, Construction Branch, pp. 65-67.
124(1) 2d ind, SG to TAG, 19 Jan 42, and 3d ind AG 671.7 (31 Dec 42) MO-D, TAG to CofEngrs, 26 Jan 42, on Synopsis Ltr, Div Engr Carib Div to CofEngrs, 31 Dec 41, sub: Automatic Sprinkler Systs. SG: 671.-2. (2) OCE Cir Ltr 1665, 2 Jun 42, sub: Automatic Sprinkler and Fire Alarm Systs in Small Hosps. CE: 671.3, Pt 1. (3) SOS Memo S30-2-42, sub: Policy Governing Instl of Automatic Sprinkler Systs and Fire Alarm Systs. SG: 671.2.


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in October 1941 to reverse an earlier decision and request the installation of heating facilities.125  On 4 February 1942 the Secretary of War authorized their installation in the corridors of all cantonment-type hospitals then under construction or planned.126 Getting approval for the installation of air-cooling systems in hospitals in hot southern areas was considerably more complicated.

During the first summer that the Army began to use cantonment-type hospitals on a wide scale, hospital commanders and corps area surgeons, especially in areas with high temperatures, had complained that patients suffered from heat in wards and that the temperature in operating rooms and clinics was frequently unbearable.127 The attic space above the low-ceilinged cantonment-type buildings collected and held heated air, raising the temperature in the buildings higher than on the outside. Dust in new camps often made it necessary to close all windows, and use of sterilizers and developing tanks in clinics and dark rooms increased humidity in those sections of hospitals.128 Colonel Offutt, Chief of The Surgeon General's Hospitalization Division, promised in September 1941 that attempts would be made to correct this situation by the summer of 1942.129

During the next spring the Surgeon General's Office collaborated with local surgeons and representatives from manufacturing concerns in working out systems employing mechanical air conditioners, evaporative coolers, and forced-air ventilation. The mechanical air conditioners were self-contained package-type coolers, like those used in restaurants and offices. Outside air was drawn into buildings over coils containing a refrigerating gas, and air-duct installation was not required. Evaporative coolers were useful in dry areas of the Southwest, where the humidity was extremely low. These devices drew hot outside air into buildings through wet, porous substances; as the moisture evaporated, the air cooled. In the hot and humid climate of the South and Southeast, where evaporative cooling was not practicable, forced ventilation was used. Exhaust fans in attics blew out hot air, producing a condition in the wards below similar to that found outside in the shade with a light breeze.130 Using C&RofH funds allocated by The Surgeon General, local hospital commanders and utilities officers began to install such systems during the spring of 1942.131

Before this program had gotten very far it encountered a directive, on 20 May

125Ltr, SG to QMG, 29 Oct 41, sub: Heating of Enclosed Corridors. CE: 632, Pt I.
126Ltr SGO 674.-1, SG to CofEngrs, 7 Jan 42, sub: Instl of Heating Fac in Corridors of Cantonment-type Hosps, with 1st ind, CofEngrs to TAG, 27 Jan 42, and 2d ind, TAG to CofEngrs, 4 Feb 42. CE: 632, Pt I.
127For example, see: (1) Synopsis Ltr, AF Combat Comd Hq to CofAC, 5 Jul 41. SG: 632.-1. (2) 1st wrapper ind, Surg 9th CA to SG, 3 Jul 41. SG: 673.-4 (9th CA)AA. (3) Ltr, Surg 4th CA to SG, 6 Sep 41, sub: Comfort and Welfare of Pnts in Cantonment Hosps. SG: 632.-1 (4th CA)AA.
128Speech, Lessons Learned from Planning and Constructing Army Hospitals, by Col Hall, 16 Sep 43. HD: 632.-1.
129Ltr, SG (per Col H. D. Offutt) to Surg 4th CA, 10 Sep 41, sub: Comfort and Welfare of Pnts in Cantonment Hosps. SG: 632.-1 (4th CA)AA.
130(1) Speech, Lessons Learned from Planning and Constructing Army Hospitals, by Col Hall, 16 Sep 43. HD: 632.-1. (2) Memo, Col John R. Hall for SG, 16 Jun 43, sub: Résumé of Procurement of Air-Conditioning and Ventilative Equip for Cantonment-Type Hosps. SG: 673.-4.
131(1) 1st ind, SG to CofEngrs, 14 Feb 42, on Ltr, Carrier Corp to SG, 12 Feb 42. (2) Ltr, SG to CofEngrs, 6 Apr 42, sub: Special Features for Ventilation of Hosps. (3) Ltr, SG to Various Sta and Gen Hosps, 3d, 4th, 5th, 6th, 7th, and 8th CAs, 6 May 42, sub: Air Conditioning of Operating Rms, X-ray Rms, and Recovery Rms. All in SG: 673-4.


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1942, severely restricting the use of mechanical and electrical equipment in Army construction.132 The Chief of Engineers, who by now controlled funds for the purchase of cooling equipment and was responsible for its installation, sought approval of the War Production Board for installing the apparatus recommended by The Surgeon General.133 The Board approved the use of air conditioners in operating rooms, X-ray clinics, and recovery wards, but failed to deal with The Surgeon General's proposal to install exhaust fans or evaporative coolers in other hospital buildings.134 The supply of fans and coolers already on hand was believed to be limited, but no Government agency actually knew its extent.135 Consequently the SOS Resources Division wanted to limit installation to cases of greatest need and in August 1942 approved only a limited program.136 Early in 1943 a practice of transferring equipment from nonessential to military uses developed and the War Production Board ascertained that dealers had considerable stocks of air-conditioning and mechanical-ventilating equipment on hand.137 When The Surgeon General resubmitted his proposal in January and February,138 therefore, the War Department issued a policy letter on the subject.

Under the new policy the installation of cooling equipment from existing inventories or from recaptured stocks was permitted in areas where the average July temperature exceeded 75° Fahrenheit. Depending upon humidity of the area in which a hospital was located, either evaporative coolers or exhaust fans were permitted in operating rooms, wards, X-ray rooms, clinics, dispensaries where minor operations were performed, and patients' mess halls. Where neither of these types served the purpose, air conditioners might be installed in operating rooms, X-ray rooms, flight surgeons' clinics, and recovery wards. In desert areas, evaporative coolers might also be used in quarters occupied by personnel on night duty.139

Installation of the long-desired equipment now began. Since authority to approve jobs amounting to $10,000 or less had been decentralized to service commands, the installation of air-conditioning and mechanical-ventilating systems was a responsibility of local engineers. The Chief of Engineers and The Surgeon General developed guides for their use, and on 15 April 1943 the Chief of Engineers informed service command engineers of procedures to follow in processing requests

132Directive for Wartime Cons, 20 May 42, incl to Ltr AG 600.12 (5-20-42) MO-SPAD-M, TAG to CGs of AAF, Depts, and CAs and to C of Tec Servs, 1 Jun 42, same sub. SG: 632.-1.
133(1) Ltr, CofEngrs to Refrigeration Sec and Fan and Blower Sec WPB, 20 Jun 42. CE: 673, Pt 3. (2) Ltr, SG to CofEngrs, sub: Ventilation and Air Conditioning for Cantonment-type Hosp Bldgs, 13 Jun 42. SG: 673-4.
134Ltr, WPB to CofEngrs, 23 Jun 42. CE: 673, Pt 3.
135(1) Memo, 1st Lt James J. Souder for Col John R. Hall, 2 Aug 42, sub: Conf on Evaporative Cooling for Hosp Bldgs. SG: 673.-4. (2) Notes on tel conv between Lt Col Norris G. Kenny and Col John R. Hall, 29 Jun 42. Same file.
136(1) Memo, Dir Resources Div SOS for SG, 30 Jun 42, sub: Exception from 'List of Prohibited Items for Cons Work' of Ventilation Fans for Hosps. SG: 673.-4. (2) Memo SPRMC 674.4(8-11-42), CG SOS for CofEngrs, 16 Aug 42, sub: Policy Determining Instl of Humidifying Coolers. CE: 673, Pt 3.
137Memo, Capt James J. Souder for Col John R. Hall, 15 Feb 43, sub: Conf on Air Conditioning and Ventilation for Hosps. SG: 673.-4.
138(1) Memo, SG for Maj Frank Seeter, Resources Div SOS, 23 Jan 42, sub: Ventilative Treatment in Cantonment-Type Hosps. SG: 673.-4. (2) Memo, SG for Production Div SOS, 22 Feb 43, same sub. Same file.
139WD Memo W100-4-43, 24 Mar 43, sub: Policy for Air-Conditioning, Cooling, and Ventilation of Army Insls, Continental US. SG: 673.-4.


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for that work.140 Although delivery of units was delayed in some cases until the fall of 1943, many hospitals had air-cooling systems in time for both patients and operational personnel to benefit from reduced temperatures during the summer of that year.141

Correction of Errors  in Cantonment-Type Hospitals

While improvements already mentioned were being made, the Engineers and the Medical Department worked to correct inadequacies of space for various functions, especially in cantonment-type hospitals. The prewar practice of providing more room for administrative and service activities, X-ray work, storage, and recreation was continued.142 Action was also taken to furnish ear, eye, nose, and throat (EENT) clinics with more space than that originally planned. This occurred after the War Department established a policy of giving eye examinations and spectacles to all soldiers who required them. Existing EENT clinics were enlarged or were abandoned in favor of new ones set up in ward buildings.143

In the fall of 1942 the Wadhams Committee found fault particularly with shortage of occupational therapy facilities, inadequacy of space for post exchange and recreational activities, and lack of safety features in neuropsychiatric wards.144 The chief of The Surgeon General's Hospital Construction Division, Colonel Hall, agreed that post exchanges and recreational facilities were too small but stated that War Department construction policies were responsible for that fault. He believed that it was unnecessary and impractical to have occupational therapy facilities in station hospitals, because in his opinion all patients needing occupational therapy should be sent to general hospitals.145 Nevertheless, in compliance with an SOS directive, The Surgeon General submitted a comprehensive program on 17 January 1943 for the construction of additional occupational therapy buildings, recreation buildings, detachment dayrooms, post exchanges, libraries, chapels, officers' and nurses' recreation buildings, and theaters in all hospitals of two hundred or more beds.146 SOS headquarters apparently considered this program as one going beyond the bounds of War Department construction policies, and returned it for reconsideration. After

140(1) Memo, SG for CofEngrs, 27 Apr 43, sub: Instl Plans for Air Conditioning, Evaporative Cooling, and Mechanical Ventilation. SG: 673.-4. (2) Ltr, CofEngrs to CG 2d SvC attn Dir of Real Estate, Repairs, and Utils, 15 Apr 43, same sub. Same file.
141For example, see: An Rpts, 1943, of Kennedy and Ashburn Gen Hosps and of Sta Hosps at Scott Fld and Cps Bowie, Beale, and Maxey. HD.
142(1) Ltr, SG to CofEngrs, 27 Jan 42, sub: Request for Urgent Emergency Cons. SG: 632.-1. (2) Ltr, SG to CofEngrs, 6 Jul 42, sub: Request for Working Drawings for Admin Bldg, Type HA-1 and HA-2, with 4 inds. Same file. (3) An Rpts, 1942, Sta Hosps at Cps Dodge and Forrest and 1943, Sta Hosps at Cps Beale, Hale, and Hood. HD.
143(1) Memo, Col John R. Hall for Chief Professional Serv SGO, 30 Jul 42, sub: Conversion of Ward Bldg into an Enlarged EENT Clinic. SG: 632.-1. (2) Ltr, SG to CofEngrs, 7 Aug 42, sub: Plans for Conversion of a Ward Bldg into an EENT Clinic. Same file. (3) An Rpt, 1942, Sta Hosp at Cp Forrest and 1943, Sta Hosps at Cps Beale, Ellis, Hale, and Hood. HD.
144(1) Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd Nos 10, 15, and 47. HD. (2) Cmtee to Study the MD, 1942, Rpt, pp. 6, 7, 12, and 24. HD.
145(1) Memo, Col John R. Hall for Exec Off SGO, 3 Dec 42. SG: 632.-1. (2) Extract from 1st ind, SG to CG SOS, 15 Dec 42, on extract from Memo, CG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd Nos 10 and 15. HD.
146Extracts from Ltr, SG to CG SOS, 17 Jan 43, sub: Recreational Fac in Army Hosps, in Cmtee to Study the MD, 1942-43, Actions an Recomd, Recomd No 10. HD.


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that, it seems to have passed for some months among the offices of The Surgeon General, the Chief of Engineers, and the SOS Requirements Division,147 and improvements of the kind asked for were not approved until the latter half of the war.

With regard to neuropsychiatric wards, Colonel Hall pointed out that plans for their construction had been completely revised during 1941. Faults that continued to exist, he said, resulted either from failure of construction officers to follow specifications closely or from the difficulty of constructing wards in wooden buildings so that patients could not escape or commit suicide yet at the same time could be easily removed in case of fire.148 On his advice, The Surgeon General recommended on 31 December 1942 that the Engineers be instructed to provide all neuropsychiatric wards, including those already constructed, with the features called for in revised plans.149 During the first half of 1943 the Engineers undertook a program of improving neuropsychiatric wards in compliance with this recommendation.150

In the spring of 1943, in order to eliminate the need for alterations and additions to hospitals after completion, plans for some cantonment-type buildings were redrawn. This may have resulted from a report made by the Seventh Service Command's Inspector General. Investigating construction projects at hospitals in his area, he concluded on 9 March 1943 that similar alterations could be avoided in the future by a revision of construction plans.151 Soon after his report reached Washington, the Engineers began to collaborate with the Surgeon General's Office in revising plans for cantonment-type administration buildings, clinics, and messes. By the middle of 1943 this project had apparently been completed,152 but this was too late to effect significant savings in hospital alterations, for the major portion of the hospital construction program had already been completed.

Conformity of Hospital Construction to Needs

As hospitals were constructed to meet wartime needs experiences encountered in the period of peacetime mobilization were repeated in individual instances. With the Army growing by leaps and bounds troops sometimes moved into new camps before hospitals were completed, and old camps were expanded before existing hospitals could be enlarged. In some areas there were unexpected delays in construction. For these there were numerous causes. Among them were unfavorable weather conditions; shortages of equipment such as electric cables, pumps, motors, and especially high pressure boilers; and labor troubles, including scarcity of laborers and disputes between employers and em-

147Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 10. HD.
148(1) Memo, Col John R. Hall for Exec Off SGO, 3 Dec 42. SG: 632.-1. (2) Extract from 1st ind SG to CG SOS, 14 Dec 42, on Memo, CG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 47. HD.
149Ltr SPMCC 632.-1, SG (init JRH[all]) to CG SOS, 31 Dec 42, sub: NP Wards. CE: 632, Vol. 3.
150Ink note, "All items referred to have been taken care of by revised drawings and specifications and by circular letter and informal conference with SGO, 7/29/43," on Ltr, SG to CG SOS, 31 Dec 42, sub: NP Wards. CE: 632, Vol. 3.
151Ltr, IG 7th SvC to IG, 9 Mar 43, sub: Cons Plans, Gen Hosps, with 2 inds. SG: 333.1-1 (7th SvC)AA.
152(1) Memo, CofEngrs for SG, 24 Mar 43, sub: Hosp Bldg Plans, with 1st ind, SG to CofEngrs, 2 Apr 43. SG: 632.-1. (2) Ltr CE 600.13 (Hosp) SPEEW, CofEngrs to SG, 31 Mar 43, sub: Proposed Hosp Messes, with 3 inds. Same file.


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ployees. For posts where actual needs outstripped hospital construction, The Surgeon General set aside additional beds in general hospitals and local medical officers resorted to expedients used before the war to provide adequate hospital care.153 

As a whole, construction kept up with actual needs even though it lagged considerably behind estimated requirements. During the first year and a half of the war the number of station hospitals increased from about 200 to more than 425; and the number of normal beds (that is, those for which 100 square feet of space each was provided in ward buildings) rose from about 58,725 to over 220,000. During the entire period the total number of station hospital beds that were occupied throughout the United States was continuously lower than the total number of normal beds provided. From December 1942 to March 1943, when the incidence of respiratory diseases increased and the transfer of patients from station to general hospitals was restricted to save places for anticipated casualties, the number of patients in station hospitals exceeded the number of normal beds available but not of normal beds provided. (Only 80 percent of the beds provided were considered available, because the necessity of segregating patients into separate wards according to disease, sex, and grade meant that empty beds in "wrong" wards, amounting as a rule to 20 percent of the total, could not be used.) During the entire period, however, emergency and expansion beds (that is, those set up on the basis of 72 square feet each not only in wards but also in porches, solaria, halls, etc.) made the number of all beds available greater than the number of beds occupied.154

The number of general hospitals in operation increased from 14 in December 1941 to 40 by June 1943; of beds in them, from about 15,500 to more than 53,750. The total number of occupied beds never reached the total of normal beds provided, but from April through September 1942 in general hospitals the number of occupied beds exceeded the number of normal beds available. This overcrowding resulted largely from the policy of giving the station hospital program priority over that for general hospitals because of the more immediate need for station hospital beds. General hospitals, as did station hospitals, set up emergency and expansion beds when they were needed. Older and better-established hospitals, such as Walter Reed and the Army and Navy General Hospital, tended to be more crowded than newer ones, because the latter had to await the presence of supplies and equipment as well as full complements of personnel before patients could be transferred to them in large numbers. By June 1943, as more new general hospitals opened, the number of available normal beds outnumbered by a comfortable margin the number of occupied beds.155 (Chart 5)

153(1) An Rpts, 1942, Surg 1st, 3d, and 4th SvCs. HD. (2) An Rpts, 1942, Sta Hosps at Cps McCoy and Adair and Borden Gen Hosp. HD. (3) Memo CE 600.914 (WWGH) SPEOT, CofEngrs for SG, 15 Dec 42, sub: Progress at Woodrow Wilson Gen Hosp. SG: 632.-1 (WWGH)K. (4) Ltr, CO Valley Forge Gen. Hosp to SG, 17 Oct 42, sub: Completion Date. SG: 632.-1 (VFGH)K. (5) Ltr, Col E[rnest] R. Gentry to Col H. D. Offutt, 24 Oct 42. SG: 323.7-5 (Borden GH)K. (6) Rpts on Status of Hosp in US, 1 and 6 Feb 43.SG: 632.-1. (7) Memo, SG for CG ASF, 31 Mar 43. HD: 632-2.
154The above is based on: (1) Bed Status Rpts. Off file, Health Rpts Br Med Statistics Div SGO. (2) ASF Monthly Progress Rpt, Sec 7, Health, pp. 13-16, 28 Feb 43.
155The above is based on: (1) Bed Status Rpts. Off file, Health Rpts Br Med Statistics Div SGO. (2) ASF Monthly Progress Rpts, Sec 7, Health, 28 Feb and 31 May 43.


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CHART 5-STATUS OF STATION AND GENERAL HOSPITAL BEDS IN CONTINENTAL UNITED STATES: DECEMBER 1941-JUNE 1943

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