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Chapter VI

Contents

CHAPTER VI

Early Adjustments in the Zone of Interior Hospital System

As the number of hospitals in the United States increased, changes occurred in the hospital system-that is, the combination of hospitals of different types operating under and serving different major commands. It will be recalled that there were only two types of zone-of-interior hospitals at the beginning of the war-station and general hospitals. As the Army's needs changed with its wartime expansion and combat experience, some of these installations developed characteristics or were given functions which made them differ from the normal. For example, special hospitals were required for prisoners of war and others had to be prepared to receive combat casualties from theaters of operations. Moreover the desirability of establishing a new type of hospital to care for convalescent patients was considered. Expansion of the Army, along with reorganization of the War Department, also raised questions as to which commands should be served by and should operate hospitals of different types. Therefore, before discussing the development of special characteristics and functions of some hospitals, an explanation of the command relationships of station and general hospitals with higher headquarters is in order.

Command Relationships of Hospitals

Station Hospitals

Classified according to major commands under which they operated, station hospitals with few exceptions were either Army Service Forces (called Services of Supply until March 1943) or Army Air Forces hospitals. ASF station hospitals furnished hospitalization not only for men and women of the Service Forces but also for those of the Army Ground Forces. Hence, large camps such as Fort Bragg (North Carolina) and Fort Jackson (South Carolina), with several infantry divisions each, were served by ASF station hospitals. By August 1942 there were 133 ASF station hospitals; by February 1943, 166. In February they ranged in size from 18 to 3,017 beds and had an average capacity of 643 beds each. AAF station hospitals were as numerous as ASF station hospitals, but were generally smaller. Located at AAF bases and fields and normally serving only AAF personnel, they num-


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bered 103 in August 1942 and 169 in February 1943. On the latter date they ranged in size from 19 to 1,471 beds and had an average capacity of 233 beds each.1 Since troops of the Ground Forces and of defense commands were usually hospitalized in ASF hospitals, these commands had no "named" station hospitals under their jurisdiction, but in a few cases they established what amounted to hospitals of that type in the United States.

Defense command troops were generally dispersed over extensive areas to guard the coasts of the United States. Receiving only emergency medical care in their own installations, they were ordinarily treated in ASF hospitals, or in near-by Air Forces, Navy, and civilian hospitals. In general, this system seems to have worked well,2 but in the Western Defense Command where troops were concentrated to ward off a sneak Japanese attack, difficulties arose. Delays in the Defense Command's decision on troop distributions, as well as overlapping jurisdictions of the Defense Command, the Ninth Service Command, and the Army Air Forces, impeded attempts of The Surgeon General, the Service Command, and SOS headquarters to provide adequate facilities.3In April 1942, to meet an immediate need for beds in the Los Angeles area, the Western Defense Command arranged with the Veterans Administration to take over its buildings at Sawtelle, Los Angeles, Calif., from which neuropsychiatric patients were being evacuated inland. The 73d Evacuation Hospital, a Western Defense Command unit, then moved in and established a 750-bed hospital, which became the station hospital for all troops, Service Forces as well as Defense Command, in the area. In the fall of 1942, at the request of the Western Defense Command, the Ninth Service Command took over the operation of this hospital. Although a Defense Command unit, it had actually served as a named station hospital for approximately six months.4

The hospitalization of AGF troops on maneuvers continued to be provided during the early war years essentially as before the war. Ground Forces units, such as evacuation hospitals, furnished immediate care for patients with minor illnesses and injuries, but transferred those requiring major surgery and long-term treatment to near-by ASF hospitals. This sufficed for a situation in which maneuvers shifted from place to place and lasted for a comparatively short time, but The Surgeon General considered different arrangements necessary when in the fall of 1942 the Ground Forces began almost year-round use of two areas, the A. P. Hill Military Reservation in Virginia and the Desert Training Center in California and Arizona.

1Annex B to Memos, SG for CG SOS, 30 Aug 42 and 12 Feb 43, sub: Opr Plan for Hosp and Evac. SG: 705.-1.
2(1) An Rpt, 1943, Surg, Northwestern Sector WDC. HD. (2) An Rpt, 1943, Surg WDC. HD. (3) Incl 1 to Ltr, CG WDC to SG, 21 Dec 43, sub: Opr Plans for Mil Hosp and Evac. HD: Wilson files, "Hosp and Evac Plans." (4) Ltr, CG SDC to SG, 30 Mar 44, sub: Plans for Mil Hosp and Evac. Same file.
3(1) Memo, Chief Misc Br Oprs SOS for Chief Oprs SOS, 14 Apr 42, sub: Add Hosp Cons, WDC. HD: Wilson files, "Book I, 26 Mar 42-26 Sep 42." (2) 1st ind, CG WDC to TAG, 9 Oct 42, on basic Ltr not located. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42." (3) SG: 632,-1(Cp Haan)C and 632.-l(Cp Callan)C. (4) See also Memo SPOPH 632, ACofS for Oprs SOS for ACofS OPD WDGS, 26 Sep 42, sub: Hosp Fac for Eastern and Western Def Comds. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42."
4(1) Ltr, Surg III Corps to SG thru Mil Channels, 3 Feb 43, sub: An Rpt Med Activities III Corps, 1942. Ground Med files: 319.1-2. (2) Ltr, CG WDC to TAG thru CG 9th SvC, 2 Sep 42, sub: Hosp at Sawtelle, Calif, and 4 inds. SG: 632.-1 (Sawtelle, Calif)F. (3) An Rpt, 1942, 73d Evac Hosp. HD.


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Although the Ground Forces operated a numbered evacuation hospital on the A. P. Hill Military Reservation for a short time, the Third Service Command was responsible for providing fixed hospitalization for troops in that area. AGF headquarters maintained that the reservation was being used only temporarily. The Ground Surgeon believed that it was satisfactory to give emergency care in a temporary hospital, operated by personnel of numbered units under service command control, and to evacuate patients with serious illnesses and injuries to the Fort Belvoir Station Hospital fifty miles away. Supporting the Service Command Surgeon, The Surgeon General maintained that adequate hospitals should be provided in the immediate area in which troops were quartered, in order to avoid long ambulance hauls, and that any facilities less than those provided in cantonment-type buildings were unsatisfactory for the hospitalization of troops in the United States. The War Department General Staff supported the position of the Ground Forces, while SOS headquarters gave wavering support to the Medical Department, alternately approving and disapproving recommendations of The Surgeon General. The upshot of the whole matter was that the Third Service Command, failing to secure War Department approval of its plans, continued for a period of almost two years to operate in this area a temporary hospital located in winterized tents and manned by numbered station hospital units without nurses.5

When the War Department decided to operate the Desert Training Center (later called the California-Arizona Maneuver Area) as a simulated theater of operations under the jurisdiction of the Army Ground Forces, the Ground Surgeon agreed with other officers from AGF and ASF headquarters that hospitalization should be provided for it in the same manner as for an actual theater. As a result, engineer units of the communications zone erected theater-of-operations-type buildings for hospitals, and beginning in February 1943, communications zone headquarters moved in numbered station and general hospital units to relieve the Ninth Service Command of all responsibility for hospitalization within the area. By June 1943 the communications zone had either in operation or in the planning stage eight 250-bed and one 150-bed station hospitals and three 1,000-bed general hospitals. Until these were all in operation, the Desert Training Center continued to send large numbers of patients to neighboring ASF hospitals. Later, as communications zone general hospitals began to offer definitive medical care, the number of patients evacuated to ASF hospitals decreased. Supplied with equipment authorized by tables of basic allowances and manned by numbered hospital units which had their own nurses with them, these communications zone hospitals continued to provide station and general hospital types of care until the California-Arizona Maneuver Area closed in the spring of 1944. This plan of hospitalization not only gave participating units invaluable practical experience but also demonstrated the possibility of using num-

5Documents dealing with this extended controversy may be found in the following files: SG: 701.-1 (Cp A. P. Hill)C; SG: 632.-1 (Cp A. P. Hill)C; AG: 632(9-18-42) (1); HRS: MID files 600-659, "Vol. I, Jan 42-Jul 44," and HD: Wilson files, 354.1 "Cp A. P. Hill." See also An Rpts, 1943, 66th, 108th, 222d, and 230th Sta Hosps (HD) and Comment by Brig Gen Frederick A. Blesse, 5 Dec 50. (HD: 314 [Correspondence on MS] III.)


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bered hospital units in the zone of interior medical service.6

General Hospitals

All general hospitals in the United States were operated by the Army Service Forces but were planned to care for patients from the Ground, Air, and Service Forces alike. This arrangement was seriously threatened in the fall of 1942 by an attempt of the Air Forces to establish its own general hospitals. Although unsuccessful at the time, this attempt was a forerunner of others which later in the war had significant effects upon the hospital system. It deserves consideration here not only for that reason but also because it illustrates difficulties created by the War Department reorganization of 1942.

Until the fall of that year only fifteen general hospitals were in operation but beginning in September this number grew until it reached thirty-one by January 1943.7 While new general hospitals were opening, the Air Forces began to establish in effect-though not in name-separate general hospitals for AAF personnel. Having received authority to recruit its own physicians, the Air Forces manned some of its station hospitals with specialists normally assigned only to general hospitals. In the winter of 1942-43 smaller AAF station hospitals began to transfer patients to these instead of general hospitals. The Air Forces also began to transfer to AAF station hospitals patients returned from theaters by airplane. With the development of such practices certain AAF station hospitals requested the Surgeon General's Office to reduce drastically-if not eliminate altogether-the number of beds in general hospitals set aside for AAF patients. Later the Air Surgeon's Office asked for specialized equipment with which to establish fifty-four specialty centers in neurosurgery, orthopedic surgery, thoracic surgery, and deep X-ray therapy in AAF station hospitals.8

The Air Surgeon found legal justification for such actions in the reorganization of the War Department, which in his opinion established the Air Forces as a "command of equal authority" with the Service Forces, as well as in the indefinite terms of current directives governing the transfer of patients to general hospitals. His attempt to set up separate general hospitals for the Air Forces was prompted in part by a desire to establish a separate medical department, but it also sprang from professional considerations. The Air Surgeon contended that Air Forces men, especially combat crew members, required specialized care which only AAF hospitals could give. He believed that fliers were often lost to further combat duty because general hospitals unnecessarily reclassified them for limited service. Furthermore, he insisted that Air Forces hospitals were more efficiently operated

6(1) History of Medical Section, C-AMA. HD. (2) Draft Memo for Record, undated and unsigned. HRS: ASF Planning Div files, 353 DTC 1942-43. (3) Memo, Col William E. Shambora for ACofS G-3 AGF, 11 Mar 43, sub: Insp of La and DTC Maneuvers. Ground Med files: 354.2 "Maneuvers." (4) Interv, MD Historian with Col Shambora, 18 Apr 49. HD: 000.71. (5) An Rpts, 1943, 13th, 22d, 34th, and 297th Gen Hosps, and 37th, 59th, 94th, 107th, 127th, and 181st Sta Hosps. HD. (6) Sidney L. Meller, The Desert Training Center and C-AMA, Study No 15 (1946). AG.
7See below, Table 15, pp. 304-13.
8(1) See Tabs F, G, I, K, and L of Memo SPOPI 020, CG ASF for CofSA, 30 Apr 43, sub: Unification of Med Serv of Army by SG. AG: 020 SGO (3-30-43)(1). (2) Memo, Brig Gen C[harles] C. Hillman for SG, 15 Mar 43, sub: Rpt of Observation Trip. HD: 333. (3) Memo, Chief Professional Serv Br Air Surg Off for Chief Sup Div Air Surg Off, 5 May 43. SG: 323.7-5.


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than Service Forces hospitals and should therefore, in the interest of economy, give the highest type of medical care for which they were equipped and staffed.9

The Surgeon General disapproved the Air Forces' establishment of separate general hospitals under any guise, for he wished to maintain a unified medical service under his direction as chief medical officer of the Army. Stating that men of the Air Forces were not different from those of other arms and services, who also suffered from occupational diseases and hazards, he insisted that general hospitals were adequately staffed and equipped to care for them as well as for the sick and wounded of the rest of the Army. Permitting AAF hospitals to perform the functions of general hospitals would make it more difficult, he stated, to supervise and co-ordinate professional practices and procedures. It would also result in duplication of hospital buildings (since general hospitals were already planned to care for the patients of all major commands) and in an uneconomical use of personnel and equipment. Finally, he argued, having separate sets of hospitals for patients evacuated from theaters of operations would complicate the evacuation process and would cause confusion in the submission of medical reports.10

The question of whether the Air Forces would be permitted to establish separate general hospitals came to a head early in 1943 in connection with a movement initiated by the ASF Chief of Staff to reaffirm The Surgeon General's authority as chief medical officer of the Army.11 It reached the General Staff first, and finally the Secretary of War. G-4 tended to favor the Air Forces, and while conceding that opposing contentions of The Surgeon General and the Air Surgeon were both just, he accepted the latter's view that AAF hospitals were more efficient than those of the Service Forces. He recommended, therefore, that the Air Forces be granted "additional authority" to treat all of their own combat personnel, including evacuees, in AAF hospitals.12 The Office of the Deputy Chief of Staff went a step further, publishing a directive on 20 June 1943 which gave the Air Forces authority not only to treat its own combat personnel but also to operate whatever general hospitals were necessary for that purpose.13 Within a week the Air Surgeon's Office recommended the establishment of five AAF general hospitals: three by the conversion of AAF station hospitals and two

9(1) Memo, Air Surg for CG AAF, n d, sub: [Comments on Gen Somervell's Memo of 30 Apr 43 for CofSA], with 2 incls. Asst SecWar for Air: 632(AAF Hosp). (2) Brief and Discussion, Tab B, to Memo, C of Air Staff for CofSA, 7 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.1 "Rest Ctrs and Conv Homes." (3) Hubert A. Coleman, Organization and Administration, AAF Medical Services in the Zone of the Interior (1948), pp. 93-94. HD.
10(1) Memo SPMCB 701.-1, SG for CG SOS, 13 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.-1 "Rest Ctrs and Conv Homes" (1). (2) 1st ind, SG to CG ASF, 12 Apr 43, on Memo SPOPH 020(3-30-43), CG ASF for SG, 30 Mar 43, sub: Relationship between SG and Air Surg. SG: 024.-1.
11For more details on this movement, see John D. Millett, The Organization and Role of the Army Service Forces (Washington, 1954), pp. 132-37, in UNITED STATES ARMY IN WORLD WAR II; Blanche B. Armfield, Organization and Administration (MS for companion vol. in Medical Dept. series), HD., and Coleman, op. cit., pp. 93-107. Documents concerning it are on file as follows: AG: 020 SGO (3-30-42) (1); HRS: G-4 file, "Hosp and Evac Policy"; SG: 024-1; and HRS: Hq ASF, Gen Styer's files, "Med Dept."
12Memo WDGDS 4440, ACofS G-4 WDGS for CofSA, 15 Jun 43, sub: Med Serv of Army, with incl. HRS: G-4 file, "Hosp and Evac Policy."
13Memo WDCSA/320(5-26-43), DepCofSA for CGs AAF, AGF, ASF, 20 Jun 43, sub: Med Serv of Army. HRS: G-4 file, "Hosp and Evac Policy." The Deputy Chief of Staff, Lt. Gen. Joseph T. McNarney, was an AAF officer.


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by the transfer of the Borden (Oklahoma) and Torney (California) General Hospitals to Air Forces' jurisdiction.14 By this time a new Surgeon General, Maj. Gen. Norman T. Kirk, was in office.15 He attacked the problem vigorously, and the entire matter reached the Secretary of War, who called representatives of the General Staff, the commanding generals of the Air and Service Forces, and others into conference. General Kirk then proposed a compromise which the commanders of both the Air and Service Forces accepted.16

General Kirk admitted that Air Forces combat crews needed special treatment and consideration and offered to place flight surgeons in his Office and in general hospitals to serve as advisers in that field. He agreed also to the Air Forces' establishment of convalescent centers. The Air Forces for its part agreed that all general hospitals would continue to operate under The Surgeon General and the commanding general, Army Service Forces, and that patients evacuated from theaters of operations would be sent to general hospitals. The only exception to the latter point was that combat crew members suffering from operational fatigue alone would be sent directly to AAF convalescent centers. These centers were to be equipped and staffed as station hospitals, but one of them, located at Coral Gables, Fla., was authorized to perform a function of general hospitals-the reclassification of officers for limited service and the recommendation for their appearance before retiring boards. These terms of agreement were issued on 9 July 1943, with a statement that they had been personally approved by the Secretary of War.17 On the same day, the authority which had been granted to the Air Forces to establish separate general hospitals was revoked.18

This agreement did not dispose of the question of whether or not AAF station hospitals would give general-hospital-type treatment to zone of interior patients. At the time General Kirk drafted its terms, he had also drafted a statement of policy on the transfer of patients to general hospitals, defining more specifically the types of cases to be transferred. He had intended to have it included in the 9 July 1943 agreement,19 but instead, on 14 July 1943, he requested its publication as a War Department circular.20 While maintaining the traditional responsibility of station hospital commanders for the selection of patients for transfer to general hospitals,

14Memo [Air Surg] (init R[ichard] L. M[eiling]) for CofSA, 26 Jun 43, sub: Med Serv of AAF. Asst SecWar for Air: 632 (AAF).
15Gen Kirk assumed office on 1 June 1943.
16(1) Draft memo, prepared by SG, dated 3 Jul 43, sub: Hosp, with pencil note, "7/3/43 Personally delivered by Gen Kirk to Gen Somervell." SG: 705.-1 and SecWar: SP 632 (3 Jul 43). (2) Memo, CG AAF for DepCofSA, 5 Jul 43, sub: Hosp. Same files. (3) Memo, [Col] F. M. S[mith] for Gen Somervell, 5 Jul 43. HRS: Hq ASF Gen Styer's files, "Med Dept." How the matter reached the Secretary of War is not clear. On 19 November 1950 General Kirk wrote: "A conference was called in his [Secretary of War's] office one morning. I was called in ahead of time and Mr. Stimson told me that Secretary of Air, Mr. Lovett, had been to him that morning and told him about the memorandum. That the Air Force couldn't blame me for bringing it to his attention." Ltr, Maj Gen Norman T. Kirk to Col Roger G. Prentiss, Jr, 19 Nov 50, with incl. HD: 314 (Correspondence on MS) I.
17(1) Memo WDCSA/632 (9 Jul 43), DepCofSA for CGs AAF, ASF, AGF, 9 Jul 43, sub: Hosps. HRS: G-4 file, "Hosp and Evac Policy." (2) Memo, CG AAF for CG ASF, 5 Jul 43, sub: Hosps. AAF: 354.-1 "Rest Ctrs and Conv Homes." (3) Memo, CG ASF for CG AAF, 5 Jul 43. HRS: Hq ASF Gen Styer's files, "Med Dept."
18(1) Memo, DepCofSA for CG AAF, ASF, AGF, 9 Jul 43, sub: Med Serv of the Army. HRS: G-4 file, "Hosp and Evac Policy."
19Draft memo prepared by SG, 3 Jul 43, sub: Hosps, with incl 1, sub: Policy regarding Trf of Pnts to Named Gen Hosps. SG: 705.-1.
20Memo SPMCM 300.5-5, SG for Publications Div AGO, 14 Jul 43. AG: 704.11 (14 Jul 43)(1).


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the revised policy left them less discretion in the matter than they had previously exercised. Its language was directive rather than advisory. The following categories of patients must be transferred to general hospitals: those needing specialized treatment of the types for which general hospitals had been designated; those who would be hospitalized for ninety days or more; those upon whom elective surgery of a formidable type would be performed; those with specific types of fractures, and, with one exception, those evacuated from overseas theaters. Only Air Forces patients on a flying status, evacuated because of operational fatigue alone, were to bypass general hospitals and go direct to Air Forces convalescent centers.21 This directive combined with the agreement already discussed to resolve for a time in The Surgeon General's favor the question of the Air Forces' establishment of separate general hospitals.

Special Types of ASF Station Hospitals

Although all ASF station hospitals were essentially alike in the work they did and the way they operated, a few established in the early war years differed in some respects from the normal. Among them were WAAC hospitals, all-Negro hospitals, and hospitals for civilians and prisoners of war.

Hospitals for Waacs

Formation of the Women's Army Auxiliary Corps in May 1942 emphasized certain problems such as the segregation of women from men in hospitals, the establishment of services not ordinarily found in Army hospitals, and the procurement of nonstandard drugs (that is, those not formally standardized for Army use) for the treatment of women. The law establishing the WAAC directed the Secretary of War to provide hospitalization for its members "to conform as nearly as practicable to similar services rendered to the personnel of the Army" and permitted the use of "facilities and personnel of the Army" for this purpose.22 The Surgeon General approved of this policy. He believed that additional wards should be constructed at established hospitals to supply enough beds to permit the segregation of men from women and of women according to disease and rank. Because he expected women to have a higher sick rate, he recommended the provision of beds for 5 percent of the strength of the WAAC, rather than for 4 percent, as was the case with men. He proposed the procurement of a limited number of female physicians, first as contract surgeons and later as commissioned members of the Medical Corps, to serve in hospitals where the WAAC patient load was high. Otherwise, he planned to give Waacs the same medical care as men. As experience with the hospitalization of Waacs accumulated and statistics showed their noneffective rate to be only slightly higher than that for men, the Army provided hospital beds for them in the same ratio as for men and sent them to the same hospitals, though to segregated wards. Nevertheless, three Army hospitals were occupied chiefly by female patients.23

21WD Cir 165, 19 Jul 43.
22Public Law 554, 77th Cong., 2d sess., sec 10.
23(1) Rpt, SGs Conf with CA and Army Surgs, 25-28 May 42. HD: 337. (2) Memo, SG to CofEngrs, 6 May 43, sub: Med Fac for WAAC. SG: 632.-1. (3) AG Memo W 100-9-43, 3 Jul 43, sub: Housing for WAAC Pers. HD: 322.5-1 (WAC). (4) Memo, Maj Margaret D. Craighill, MC, Liaison Off for WAC for Col [Raymond W.] Bliss, 25 Aug 43, sub: Hosp for WAAC. Same file. (5) Memo, SG for CG SOS, 4 Jan 43, sub: Util of Women Doctors. HRS: Hq ASF Gen Styer's files, "Med Dept 1943."


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At the WAAC training centers-Fort Des Moines (Iowa), Daytona Beach (Florida), and Fort Oglethorpe (Georgia)-the station hospitals became predominantly WAAC hospitals, staffed largely by women and caring mainly for women. This was especially true at Daytona Beach. By the end of 1943 its 601-bed hospital had an enlisted complement made up almost entirely of women, only fifty men being assigned for duty in and around the hospital. At Fort Des Moines, female doctors engaged as contract surgeons were assigned for duty with the Waacs. At first the development and supervision of special professional services for women were left largely to local hospital commanders. Station hospitals at training centers developed gynecologic and obstetric services and procured locally special drugs required for the medical care of women. In May 1943, approximately a year after the WAAC was established and a month after Congress authorized the commissioning of women physicians in the Army, The Surgeon General assigned a female Medical Corps officer to his Office to supervise the handling of medical problems peculiar to female personnel.24

All-Negro Hospitals

The establishment of two all-Negro station hospitals in the United States came not as a result of any policy of The Surgeon General to segregate patients racially for medical care and treatment, but rather as a result of The Surgeon General's opposition to the integration of Negro doctors and nurses with white professional personnel in the operation of hospitals caring for white patients.25 This consideration had already resulted in the establishment in May 1941 of groups of all-Negro wards in the hospitals at Fort Bragg (North Carolina) and Camp Livingston (Louisiana). Perhaps because of unencouraging reports from these experiments, the Army had not extended the practice to other hospitals. After war started, The Surgeon General revived a recommendation, previously disapproved by the General Staff, that all-Negro hospitals be established to employ additional Negro doctors and nurses. The Staff reversed its earlier decision, and during 1942 an all-Negro station hospital was organized at Fort Huachuca (Arizona), a post at which Negro troops were being trained. A separate hospital, manned by white doctors and nurses, continued in operation to care for white patients. The year before, the Army Air Forces had established an all-Negro hospital at Tuskegee, Ala.

Establishment of all-Negro hospitals and wards did not signify a general abandonment of the Army's long-established policy of nonsegregated treatment. Other hospitals manned by white doctors and nurses continued to treat patients of both races on a nonsegregated basis throughout the war.26 Nor did it mean that the Medical

24(1) An Rpts, 1943, Sta Hosps, Daytona Beach and Ft Oglethorpe. HD. (2) Memos, Dr Paul Titus, Consultant, to SG, [27 Sep 43] and 1 Nov 43, sub: Rpts on Surg (Obstetrics-Gynecology) as an Army Serv. HD: 210.01. (3) Memo, SG for CG SOS, 4 Jan 43, sub: Util of Women Doctors. HRS: Hq ASF Gen Styer's files, "Med Dept 1943." (4) Mattie E. Treadwell, The Women's Army Corps (Washington, 1954), Ch. XXXI, in UNITED STATES ARMY IN WORLD WAR II. (5) Margaret D. Craighill, History of Women's Medical Unit (1946). HD.
25For a full discussion of the question of the use of Negro professional personnel by the Medical Department, see John H. McMinn and Max Levin, Personnel (MS for companion Vol. in Medical Department series). HD. Also see Ulysses Lee, The Employment of Negro Troops, a forthcoming volume in the series UNITED STATES ARMY IN WORLD WAR II.
26(1) Ltr, SG to TAG, 25 Oct 40, sub: Plan for Util of Negro Offs, Nurses, and EM in MD, and 3 inds. (2) Memo, SG for ACofS G-1 WDGS, 7 Jul 41, sub: Rpts on Util of Negro Med Pers. (3) Memo, Maj Arthur B. Welsh for [Brig] Gen [Larry B.] McAfee, 17 Jan 42. (4) Memo, SG for ACofS G-3 WDGS, 30 Jan 42. (5) Memo, SG for TAG, 16 Mar 42, sub: SecWar's Press Conf on Use of Negro Doctors. All in HD: 291.2. (6) Memo, ACofS G-l WDGS for CofSA, 4 Aug 41, sub: Almt of Negro MD Res Offs and Female Nurses. HRS: G-l/15640-46. (7) Memo, P. W. Clarkson, Off ACofS G-1 WDGS for Record, 8 Aug 41. Same file. (8) An Rpt, 1942, Post Surg Ft Huachuca. HD.


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Department would fail to use Negro enlisted personnel and civilians in other hospitals. As early as December 1941, for example, Negro enlisted men were assigned to the medical detachment of at least one station hospital-that at Chanute Field (Illinois).27 Later Negro enlisted men and women were assigned to other Army hospitals. While many were employed in housekeeping and maintenance operations, some were assigned to technical and administrative duties.28

Before leaving this subject one needs to look ahead to the later war years. At that time the practice of using Negro doctors and nurses on a segregated basis was modified. Such civilian groups as the National Association of Colored Graduate Nurses, certain segments of the press, some members of Congress, the Negro civilian aide to the Secretary of War, and the President's wife (Mrs. Franklin D. Roosevelt) urged The Surgeon General, ASF headquarters, and the Secretary of War to use more Negro nurses and to use them on a nonsegregated basis.29 In December 1943 and again in May 1944 ASF headquarters directed The Surgeon General to procure and use additional Negro nurses.30 Accordingly, Negro nurses on duty with the Army increased from 218 in December 1943 to 512 by July 1945. Although some continued to serve with all-Negro hospitals in this country and in theaters of operations, others were used on a nonsegregated basis in 4 general hospitals, 3 regional hospitals, and at least 9 station hospitals in the United States.31 During 1945 nonsegregated use of Negro doctors occurred in at least one instance. When the troop strength of Fort Huachuca declined, the patient load decreased and professional staffs of the two station hospitals at that post were reduced accordingly. Services of the two then gradually merged and both doctors and nurses of the two races served together to care for white as well as Negro personnel.32 Thus the primary reason for the establishment of separate all-Negro wards and hospi-

27An Rpt, 1941, Sta Hosp, Chanute Field. HD.
28(1) An Rpts, 1942, Sta Hosps, Cps Shelby and Forrest, and An Rpts, 1942, 702d, 720th, 721st, and 730th Med Sanitary Cos. HD. (2) McMinn and Levin, op. cit.
29Letters to this effect may be found in the following files: SG: 211 "Nurses, Negro"; OSW: Civ Aide to SecWar, "Nurses"; and AG: 211 "Nurses, Negro." See also Florence A. Blanchfield and Mary W. Standlee, The Army Nurse Corps in World War II (1950), pp. 161-205. HD.
30(1) Memo, CG ASF for SG, 14 Dec 43, sub: Utilization of Negro Nurses. SG: 291.2-1. (2) Memo, CofS ASF for SG, 6 May 44, same sub. ASF: 210.31.
31(1) Memo, Col Florence A. Blanchfield (SGO) for Col Arthur B. Welsh (SGO), 17 Dec 43, sub: Distr of Colored Nurses. SG: 291.2-1. (2) Memo, SG for Civ Aide to SecWar, 26 Jul 45. SG: 211 "Nurses, Negro." (3) Facts about Negro Nurses and the War, prepared jointly by the National Association of Colored Graduate Nurses and the National Nursing Council for War Service, ca. Jan 45. OSW: Civ Aide to SecWar, "Nurses."
32(1) Memo, Asst Aide to SecWar for SG, 29 Mar 45, sub: Staff of Sta Hosp No 1, Ft Huachuca, Ariz. (2) Memo, Dep Chief [of Oprs Serv] for Hosp and Domestic Oprs [SGO] for SG, 8 Jun 45, sub: Rpt of Visit to Sta Hosp, Ft Huachuca, Ariz. (3) Ltr, CO Sta Hosp Ft Huachuca to Maj Gen G[eorge] F. Lull, SGO, 16 Aug 45. All in OSW: Civ Aide to SecWar, "Huachuca." There was some question during the war whether the two hospitals at Huachuca were ever in fact two separate hospitals or merely two sections of one hospital. This arose apparently from the fact that the post surgeon, a white Medical Corps officer, served in addition as commander of the white hospital and exercised at the same time considerable authority over the commanding officer of the all-Negro hospital. Failure to settle this question resulted in dissatisfaction on the part of the latter. See letters in the file just cited and in SG: 323.3 (Ft Huachuca)N.


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tals-opposition to the integrated use of Negro and white professional personnel in the care of both white and Negro patients-had begun to lose some of its force by the end of the war.

Army Hospitals for Civilians

By the end of 1942 a situation developed which required the establishment in the United States of several hospitals for civilian employees and their families. During 1941 the Army had initiated industrial hygiene programs in Army-owned plants and depots. Under Medical Department supervision, these programs expanded rapidly during 1942 to keep pace with wartime industrial growth. Designed to give only emergency medical care, industrial hygiene facilities were adequate in areas where civilian hospitals were available. Toward the end of 1942, when the Ordnance Department established storage depots for explosives in isolated regions, lack of hospitals retarded employee procurement and increased absenteeism. Workers were reluctant to move with their families to such areas and failure to receive prompt medical care often resulted in prolonged illnesses. To help maintain depot production levels, The Surgeon General proposed in December 1942 that the Army construct and operate hospitals in remote areas which lacked adequate medical facilities. In February 1943 the Secretary of War authorized the construction of hospitals at the Sierra (California), Umatilla (Oregon), Black Hills (South Dakota), Tooele (Utah), Sioux (Nebraska), and Navajo (Arizona) Ordnance Depots. Constructed during 1943, these hospitals operated under service command supervision until after the end of the war. They differed from other Army station hospitals in having a minimum of military personnel assigned to them, in providing family medical care, including gynecologic and obstetric services, and in requiring payment for services rendered. Despite recommendations of The Surgeon General, similar hospitals were not established in other places. In one instance, permission was granted to establish an Army hospital but was withdrawn partly on account of political pressure and partly because the community itself, after an extended period of time, provided additional hospital accommodations. In another, authority was granted to hospitalize civilian employees and their families in a near-by Army station hospital.33

Hospitals for Prisoners of War

Early in 1942, when prospective combat operations demanded preparation for the internment of prisoners of war, The Provost Marshal General and The Surgeon General agreed upon basic policies for their hospitalization. In compliance with the Geneva Convention,34 hospital accommodations and medical care for prisoners of war were to be equal to those for United States troops, and prisoners

33(1) Ltr, SG to SecWar thru CG SOS, 11 Dec 42, sub: Med Care for Civ Employees of Army-Operated Plants, and their Families, with 4 inds. (2) Ltr, SG to CofS SOS, 21 Jan 43, same sub. (3) Memo WDGDS-2172, SecWar for CG SOS, 9 Feb 43, same sub. All in AG: 701(9-17-41)(1). (4) W. L. Cooke, Jr, Organization and Administration of Preventive Medicine Program, pp. 53-59. HD. (5) An Rpts, 1943, Sta Hosp Black Hills and Tooele Ord Depots. HD. (6) An Rpts, 1942 and 43, Surg, 1st thru 9th SvC. HD. (7) Memo, Capt J[ames] J. Souder for Col J[ohn] R. Hall, 8 Apr 43, sub: Conf on Prov of Hosp Fac for Instis in Ogden, Utah, Area. SG: 632.-1.
34Article I, Chapter I, Conventions of 1906 and 1929. See Army Medical Bulletin, No. 62 (1942), pp. 88 and 105.


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were to assist in the care of their compatriots. Promulgated in tentative regulations published in April 1942 and reiterated in September 1943, these policies governed the hospitalization of prisoners throughout the war. For separate prisoner-of-war camps, the Army constructed hospitals with beds for 4 percent of the inmates. For prisoners at Army posts, wards surrounded by wire fences were added to existing station hospitals. Whether in separate camps or on Army posts, such hospitals operated under service command supervision and, except for the use of captured enemy personnel and civilian registered nurses, were similar to other service command hospitals. Prisoners requiring more specialized care than offered in station hospitals were transferred to general hospitals.35

Port and Debarkation Hospitals

Hospitals were needed near ports for large numbers of transients-troops awaiting shipment overseas as well as patients being returned to general hospitals in the United States. In accord with SOS directives, hospitals for ports and staging areas were exempt from service command jurisdiction and operated directly under port commanders who in turn were subject to control by the Chief of Transportation.36 For most of 1942, many ports lacked adequate staging area hospitals and therefore sent patients to others located near by. At Los Angeles, for example, patients from the port were cared for in the Western Defense Command's 73d Evacuation Hospital at Sawtelle. The ports at Charleston, New Orleans, and San Francisco used Stark, LaGarde, and Letterman General Hospitals, respectively, while those at Boston and Hampton Roads sent patients to near-by service command station hospitals. During 1942 and 1943 special port and staging area hospitals were constructed and opened to care for port personnel and transient troops. They differed from other station hospitals primarily in that their surgical services were considerably smaller and less important than their medical services, because they normally performed only emergency surgery for the thousands of troops who passed through ports.37

The kind of hospitals that would be used to receive transient patients returning from theaters of operations remained uncertain until the latter part of 1942. Special debarkation hospitals under port control might be established in existing buildings with only the personnel and equipment needed to "process" returning patients-that is, replace their missing records, make partial payments of the

35(1) Memo, Capt Charles M. Huey, Mil Intel Aliens Div OPMG for Chief Aliens Div OPMG, 26 Dec 41, sub: Conf Regarding the Estab of Hosp  . . . in PW Cps. SG: 255.-1. (2) Tentative Regulations: Interned Alien Enemies and Prisoners of War. AG: 383.6(8-9-42)(1). (3) PW Cir 1, 24 Sep 43. PW Off OPMG. (4) Memo, CofS ASF for SG and QMG, 26 May 43, sub: Hosp Fac for PW Cps, and 1st ind. SG: 632-1. (5) An Rpts, 1943, Surg, 7th and 8th SvCs. HD. (6) An Rpts, 1943, Sta Hosp PW Cps at Florence, Ariz; Cp Clark, Mo; and Como, Miss. HD. (7) See also: Rene H. Juchli, Record of Events in the Treatment of Prisoners of War, World War II (1945). HD.
36Mil Hosp and Evac Oprs, incl 1 to Ltr SPOPH 322.15, CG SOS to CGs and COs of SvCs and PEs and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs. HD: 322(Hosp and Evac).
37(1) An Rpts, 1942 and 43, Surg, Boston, New York, Hampton Roads, Charleston, New Orleans, Seattle, and Portland PEs, and An Rpts, 1943, Surg, Cps Myles Standish, Kilmer, and Plauche. HD. (2) Opr Plan for Mil Hosp and Evac, Boston, 30 Nov 42; New York, 10 Dec 42; Hampton Roads, 15 Dec 42; Charleston, 24 Nov 42; New Orleans, 12 Dec 42; San Francisco, 9 Jul and 1 Dec 42; and Seattle, 27 Nov 42. HD: Wilson files. (3) SG: 632.-2, 1942 and 43, (LaGarde GH)K, (Letterman GH)K, and (Stark GH)K.


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money due them, classify them according to disease or injury, and prepare them for further travel to general hospitals. Such hospitals had been used during World War I,38 and for a while in 1942 it seemed as if SOS headquarters and certain port commanders expected their revival. One SOS directive implied that ports might establish special debarkation hospitals,39 and Charleston, Seattle, and San Francisco expressed a desire for them.40

The Surgeon General had other plans. During the emergency period he had used general hospitals near ports-Tilton for New York, Stark for Charleston, LaGarde for New Orleans, and Letterman for San Francisco-to receive and care for patients brought in on ships. After war began he continued this system, granting unlimited bed credits in near-by general hospitals to ports receiving overseas casualties.41 He also located some of the general hospitals planned early in 1942 in coastal areas, though not in close proximity to ports,42 with the expectation that they would process patients arriving from theaters.

A final decision to this effect came in the fall of 1942 in connection with plans for the reception of casualties from the North African invasion. At that time whole trainloads of patients with a variety of ills could be sent to a single general hospital, because hospitals had not yet been designated for the specialized treatment of certain types of cases nor had the policy of hospitalizing casualties near their homes been established.43 Two alternatives therefore presented themselves, namely, ship-to-train movements, in which patients would be transferred directly from ships to trains for transfer to distant general hospitals, and ship-to-hospital movements, in which they would be moved from ships to near-by hospitals before undertaking further travel.44 The possibility of using ship-to-train movements exclusively, thereby eliminating the need for a debarkation hospital at or near the port, arose at Hampton Roads. Piers at that port had ample trackage to accommodate hospital trains, making it possible to move patients under cover directly from ships to trains. The port commander preferred this procedure, his surgeon explaining that it would maintain the port as an agency of movement, its primary purpose.45 While The Surgeon General and the chief of the SOS Hospitalization and Evacuation Branch recognized the merits of this position, both felt that some ship-to-hospital movement would be unavoidable. Some patients would require immediate hospital care before further travel; in some instances ship-to-train evacuation might

38The Medical Department . . . in the World War (1923), vol. V, pp. 426-33, 786, 791, 800.
39Mil Hosp and Evac Oprs, par 5 d (3) (d), incl 1, to Ltr SPOPM 322.15, CG SOS to CGs and COs, CAs, PEs, GHs and SG, 18 Jun 42, sub: Opr Plans for Mil Hosp and Evac. HD: 705.-1.
40Opr Plans for Mil Hosp and Evac, Jul 42, Charleston, Seattle, San Francisco, New Orleans, and Boston. HD: Wilson files.
41For example, see: (1) Ltr, SG to CG NYPE, 18 Feb 42, sub: Bed Almts in Gen Hosps. Same file. (2) Ltr, SG to CG 9th CA, 5 Jan 42, sub: Bed Almts in Barnes Gen Hosp. SG: 632.2 (Barnes GH)K. (3) 2d ind, SG to CG NYPE, 9 Mar 42, on Ltr, Port Surg Sub-Port of Boston to Port Surg NYPE, 5 Mar 42, sub: Bed Credits. SG: 632.-2 (NYPE)N. (4) 1st ind, CG SOS (SG) to CO CPE, 29 Aug 42, on Ltr, CO CPE to CG SOS, 21 Aug 42, sub: Bed Credits. SG: 632.-2 (Stark GH)K.
42For example, Valley Forge, Woodrow Wilson, Moore, Torney, Hammond, Baxter, and McCaw General Hospitals. Also see above, pp. 88-90.
43See below, pp. 116-17.
44Rpt, Conf, CofT, SG, SOS, NYPE, and HRPE, 23 Oct 42. TC: 370.05 (Plans, Policies, Procedures).
45(1) Ltr, CG HRPE to SG, 10 Nov 42. SG: 705.-1 (HRPE)N. (2) Ltr, Port Surg HRPE to SG, 15 Dec 42, sub: Opr Plans for Mil Hosp and Evac. HD: Wilson files.


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interfere with troop movements; in others, casualties might arrive unexpectedly when trains were unavailable.46 For these reasons they overruled the port commander. Since the housing shortage in Norfolk made impracticable a proposal to take over a hotel for hospital use, arrangements were made to use the station hospital at Fort Monroe and five hundred beds in the Veterans Administration hospital at Kecoughtan, Va., for debarkation purposes.47 This action made it clear that some hospital, whatever its kind, would be established to receive casualties at every port of debarkation.

Unlike his counterpart at Hampton Roads, the port commander at New York wanted Halloran General Hospital, being opened on Staten Island, to serve solely as a debarkation hospital under port control.48 The Chief of Transportation, on the other hand, wished to keep ports free of the burden of administering large hospitals and on 9 November 1942 announced that SOS directives authorized ports to operate hospitals for assigned personnel and transient troops only, not for patients being returned from theaters.49 Concurrence of the SOS Hospitalization and Evacuation Branch in this interpretation placed an official stamp of approval on The Surgeon General's plan to use general hospitals under service command control, rather than special hospitals under port control, for debarkation activities.

Most general hospitals located near ports performed dual functions-providing definitive treatment for some patients and processing others for further travel-until late in the war. This created complications. Ports were granted unlimited bed credits in such hospitals, but near-by station hospitals also continued to receive bed credits in them. This overlapping caused some concern in SOS headquarters.50 Investigation showed that Halloran General Hospital kept a list of patients earmarked for transfer to other general hospitals when the evacuation load required it.51 Stark, LaGarde, and Barnes General Hospitals simply waited until the necessity arose and then transferred patients receiving definitive care to other general hospitals located farther away from ports. Others, notably Letterman and Lovell, kept beds vacant while awaiting the arrival of evacuated casualties. This system occasionally caused the transfer of patients needing general hospital care to station hospitals. In the opinion of some hospital commanders, it was also wasteful of both professional personnel and highly specialized equipment.52 Later, when the evacuation load reached its peak, The Surgeon General partially shared their view, for in 1945, as will be seen later, he proposed the conversion of

46(1) 1st ind, Chief Hosp and Evac Br SOS to CofT, 18 Nov 42, sub: Evac, on unknown basic Ltr. TC: 370.05(Plans, Policies, Procedures). (2) Ltr, CG HRPE to SG, 10 Nov 42. SG: 705.-1 (HRPE)N.
47(1) Off memo, signed by Col H. D. Offutt, 9 Nov 42. HD: 370.05 "Spec Oprs." (2) Ltr, Act SG to CG HRPE, 14 Nov 42. SG: 705.-1 (HRPE)N.
48(1) Diary, Chief Hosp and Evac Br SOS, 2 Nov 42. HD: Wilson files, "Diary." (2) Ltr, Port Surg NYPE to Col H. D. Offutt, 12 Nov 42. SG: 705(NYPE)N. (3) An Rpt, 1942, Halloran Gen Hosp. HD.
49(1) Diary, Chief Hosp and Evac Br SOS, 3 Nov 42. HD: Wilson files, "Diary." (2) Ltr, CofT to CGs of PEs, 9 Nov 42, sub: Mil Hosp and Evac. TC: 370.05 (Plans, Policies, Procedures).
50Diary, Chief Hosp and Evac Br SOS, 14 Dec 42. HD: Wilson files, "Diary."
51Memo SPOPH 701, Chief Hosp and Evac Br SOS for ACofS for Oprs SOS, 27 Dec 42, sub: Availability of Hosp Beds for Port of NY. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec 42."
52An Rpts, 1942 and 43, Halloran, Stark, LaGarde, Barnes, Letterman, and Lovell Gen Hosps. HD.


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staging area station hospitals into debarkation hospitals.53

Designation of General Hospitals for Specialized Treatment

Early in 1943 The Surgeon General initiated a formal program of specialization in general hospitals. During World War I the Medical Department had manned and equipped certain hospitals for the care of particular types of cases.54 In the interval between wars specialization had continued on a limited scale. By January 1942, for example, deep X-ray therapy had been established as a specialty in the Army and Navy, Fitzsimons, Lawson, Letterman, Walter Reed, and William Beaumont General Hospitals.55 In March 1942 Darnall General Hospital opened to receive psychotic patients who needed closed ward treatment.56 Other specialty centers gradually developed at hospitals where eminent specialists were assigned,57 and toward the end of 1942 The Surgeon General made it known that he intended to formalize and extend existing specialization. Apparently he awaited only the development of circumstances warranting such action.58

In the winter of 1942 that development occurred. Beginning in September new general hospitals opened in increasing numbers.59 It was soon evident that a limited supply of specialists would prohibit the staffing of each one for all kinds of surgical and medical work. Referring to this problem, the surgeon of the Fourth Service Command suggested in January 1943 that certain general hospitals in his area be equipped and manned to give specialized care in different branches of surgery.60 Simultaneously with the opening of the new general hospitals, a transition from defensive to offensive warfare presaged the arrival of large numbers of combat casualties requiring complicated surgery. Moreover, public insistence upon hospitalization of casualties near their homes grew until The Adjutant General in December 1942 proposed establishment of a policy to conform with the demand.61 If adopted and applied too rigidly, such a policy would conflict with The Surgeon General's unpublished plan to transfer casualties to hospitals specializing in particular diseases or injuries. He therefore made a counterproposal: patients needing specialized treatment would be sent to general hospitals designated for such, while those requiring prolonged but not specialized treatment would be transferred to hospitals in the vicinity of their homes.62

53See below, p. 192.
54The Medical Department . . . in the World War (1923), vol. V, pp. 171-73.
55SG Ltr 44, 15 May 41, and SG Ltr 1, 2 Jan 42.
56An Rpt, 1942, Darnall Gen Hosp. HD.
57An example of this development was found in Tilton General Hospital which established a special neurosurgical section during 1942 and was designated a neurosurgical center in March 1943. An Rpts, 1942 and 43, Tilton Gen Hosp. HD.
58(1) Memo, SG for Dir Control Div SOS, 1 Aug 42. SG: 020.-1. (2) Memo, Chief Pers Serv SGO for Dir Mil Pers SOS, 2 Dec 42. SG: 323.7-5.
59

Month

Number of General Hospitals Reporting Patients Weekly

August 1942

15

September 1942

17

October 1942

19

November 1942

22

December 1942

26

January 1943

31

60Ltr, CG 4th SvC (Chief Med Br) to SG, 23 Jan 43, sub: Surg Serv, Gen Hosps, with 1st ind, CG SOS (SG) to CG 4th SvC attn Chief Med Br, 8 Feb 43. SG: 323.7-5 (4th SvC)AA.
61(1) Draft memo, TAG for CofS SOS, 29 Dec 42, sub: Hosp of Casuals Returned to the US as Battle Casualties. AG: 701(12-29-42)(1). (2) IAS, TAG to SG, 29 Dec 42, same sub. Same file.
62(1) 1st memo ind, SG to TAG, 7 Jan 43, on IAS, TAG to SG, 29 Dec 42, sub: Hosp of Casualties. AG: 701(12-29-42)(1). (2) Memo SPOPH 701(1-16-43), ACofS for Oprs SOS for TAG, 19 Jan 43, same sub. Same file.


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Approval and publication of this policy on 1 February 194363 required the formal designation of specialty centers. For several weeks afterward The Surgeon General's Hospitalization and Evacuation Division worked on this problem,64 and on 6 March 1943 the War Department designated nineteen general hospitals for the following specialties: chest surgery, maxillofacial and plastic surgery, ophthalmic surgery and the treatment of the blind, neurosurgery, and the performance of amputations.65 About two months later, two additional specialties-vascular surgery and the treatment of the deaf-were announced and another general hospital was placed on the list.66 Further extension of specialization occurred during the later war years.

The Question of Establishing Convalescent Hospitals

During the latter part of 1942 the opinion gained favor both in civilian and military circles that special accommodations for convalescent patients should be provided either as separate hospitals or as annexes to existing hospitals. Among civilians it developed apparently from a desire either to "do something for the boys" or, in some instances, to dispose of large estates with questionable market values.67 In the Army it arose from the need to save both manpower and hospital beds. The idea was not new, for during World War I the Medical Department had conducted "reconstruction" programs in general hospitals and convalescent centers both in the United States and France.68 In the latter half of 1942 several widely separated hospitals-the Fort Bliss Station Hospital in Texas, the Jefferson Barracks Station Hospital in Missouri, and the Lovell General Hospital in Massachusetts-established programs to harden patients for return to duty, to reduce the period of their convalescence, and to salvage for full field duty those who might otherwise be either discharged from the Army or placed in the limited service category.69 In January 1943 the surgeon of the Eighth Service Command recommended the organization of casual detachments to recondition convalescent patients and salvage psychoneurotic soldiers for full duty.70 The surgeon of the Ninth Service Command proposed the establishment of "overflow installations" to free hospital beds of patients no longer needing hospital care but not yet ready for full military duty.71 In this connection, General Snyder, a medical officer on the staff of The Inspector General, found in a survey in November 1942 that approximately 67 percent of the patients

63WD Cir 34, 1 Feb 43.
64(1) Memo, SG for TAG, 24 Feb 43, sub: Cir Ltr 50, Spec Hosps. AG: 705(2-24-43)(1). (2) Ltr, Col Arden Freer, SGO to Col S[anford] W. French, Hq 4th SvC, 8 Feb 43. SG: 323.7-5 (4th SvC)AA.
65WD Memo W40-9-43, 6 Mar 43, sub: Gen Hosps for Spec Surg Treatment. AG: 705(2-24-43)(1).
66WD Memo W40-14-43, 28 May 43, sub: Gen Hosp, Specialized Treatment. AG: 323.7-5(W40-9-43) (3-6-43).
67The Surgeon General received numerous offers. For some of the replies he made, see: (1) Ltr SPMCC, SG to Mr. W. K. Kellogg, 4 Aug 42. (2) Ltr, Act SG to Hon Joseph F. Guffey, US Sen, 20 Nov 42. (3) Ltr, Act SG to Hon Lex Green, H. R., 12 Dec 42. All in HD: 601.-1.
68(1) The Medical Department . . . in the World War (1927), vol. XIII, pp. 79-222. (2) Charles E. Remy, The History of a Convalescent Camp of the American Expeditionary Forces in France (1942). HD.
69An Rpts, 1942, Sta Hosps at Ft Bliss and Jefferson Bks, and Lovell Gen Hosp. HD. Similar action was being taken in the European Theater of Operations at the same time. See Memo, Consultant in Surg ETO to Dir Professional Serv ETO, 28 Sep 42, sub: Rpt on Visit to Med Instls in Northern Ireland. HD: ETO file, "Col Elliott C. Cutler, Rpts Jul 42-Dec 42." 
70An Rpt, 1942, Chief Med Br 8th SvC. HD.
71An Rpt, 1942, Chief Med Br 9th SvC. HD.


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in Army hospitals were convalescent and could be cared for in barracks, if necessary, to release hospital beds for patients requiring close medical supervision.72

While medical officers in the field were becoming aware of the convalescent problem, it was also receiving attention in Washington. In September 1942 it came up in the hearings of the Wadhams Committee.73 A month later the Air Forces requested authority "to establish and operate specialized hospital and recuperative centers for individualized treatment, rehabilitation, and classification of Air Forces personnel."74 The Air Surgeon believed that special hospitals should be established under Air Forces' control to treat and rehabilitate Air Forces patients suffering from such conditions as staleness, anoxia, operational fatigue, aeroneurosis, and aero-embolism.75 Surgeon General Magee, on the other hand, strongly disapproved the establishment by the Air Forces not only of general hospitals, as discussed earlier, but also of any hospitals other than the station hospitals which they already operated. Moreover, he preferred to carry on reconditioning programs in existing hospitals. He argued that convalescent patients often needed observation and sometimes "active therapeutic management" by doctors fully acquainted with their cases and should therefore not be moved far from hospitals where they received definitive care. He contended furthermore that the establishment of convalescent hospitals would lead to duplication of buildings and a waste of personnel and equipment. Hence, he refused to concur in the Air Forces' proposal, but gave his approval instead to the establishment of nonmedical AAF rest camps. To the Wadhams Committee's recommendation for the establishment of separate convalescent accommodations free of the hospital atmosphere, The Surgeon General replied on 15 December 1942: "It is the opinion of this office that convalescent sections may be more advantageously operated as integral parts of military hospitals. . . "76

Before final action was taken on the Air Forces' request, both the Air Surgeon and The Surgeon General began to initiate reconditioning programs in existing hospitals. In November 1942 the Wadhams Committee recommended this step as well as the establishment of convalescent hospitals.77 The next month, the commanding general, Army Air Forces, published a directive, prepared by the Air Surgeon, requiring all Air Forces hospitals "to institute recreation and reconditioning programs for convalescent patients."78 In January 1943 The Surgeon General pro-

72Ltr, Asst to IG (Brig Gen Howard McC. Snyder) to IG, 10 Nov 42, sub: Surv of Hosp Fac and their Util. IG: 705-Hosp(A).
73Cmtee to Study the MD, 1942, Testimony, pp. 205, 383-84, 441-42, and 460. HD.
74Memo, C of Air Staff for CofSA, 7 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.1 "Rest Ctrs and Conv Homes."
75(1) Cmtee to Study the MD, 1942, Testimony of Brig Gen David N. W. Grant, pp. 383-84. HD. (2) Brief and Consideration of Non-Concurrence [of SG], Tab B and par IV of Memo, C of Air Staff for CofSA, 7 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.1 "Rest Ctrs and Conv Homes."
76(1) Cmtee to Study the MD, 1942, Testimony of Offs of SGO, pp. 163-66, 441-42, 460, HD. (2) Memo SPMCB 701.-1, SG for CG SOS, 13 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.1 "Rest Ctrs and Conv Homes" (1). (3) 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 No 24. HD.
77Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 14. HD.
78(1) AAF Memo 25-9, 14 Dec 42, sub: Recreation and Reconditioning for Conv Pnts in AAF Hosps. AAF: 300.6. (2) Howard A. Rusk, "Convalescence and Rehabilitation," Doctors at War, Morris Fishbein, ed. (New York, 1945), pp. 303-04.


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posed a War Department circular to require all fixed hospitals, overseas as well as in the United States, to inaugurate reconditioning programs. Fearing that such programs would require additional personnel and construction and doubting its own authority to order their establishment, SOS headquarters delayed publication of this directive until 11 February 1943.79 Both the Air Forces and War Department directives provided for programs of recreation, graded exercises, and drills; the former, for a program of education as well. Until late 1943 only a few hospitals, among them the station hospitals at Camp Crowder (Missouri), Fort Benning (Georgia), Jefferson Barracks (Missouri), and the O'Reilly General Hospital, developed effective programs.80

Meanwhile the Air Forces' persistence in demanding separate convalescent facilities led the General Staff to consider that problem. At first G-4 was reluctant to permit the Air Forces to establish even rest centers, proposing instead that they "farm out" convalescents in civilian resort hotels. G-4 felt that the convalescent problem was one for the future, since the immediate needs of combat zones could be met by the organization of rest camps in theaters and patients returned to the United States either would be ready for sick leaves at home or would need definitive care in general hospitals.81 Both the Ground and Service Forces agreed with this viewpoint82 but the Air Surgeon was striving for authority to establish "specialized hospital and recuperative centers."83 Tending to agree with the Air Forces on the need, G-1 on 16 March 1943 recommended the provision of such facilities not only for the Air Forces but for the Ground and Service Forces as well.84 Because of conflicting opinions, G-4 called the commanding generals of the Ground, Service, and Air Forces into conference with the General Staff on 7 May 1943.85 The viewpoint of G-1 prevailed and on 14 June 1943 G-4 directed ASF headquarters to investigate the proposal to establish convalescent facilities, to determine the requirements of the Army as a whole, and to take whatever action appeared desirable.86

Two days before this directive was issued Surgeon General Kirk had instructed his Hospital Construction Division to prepare a program for the establishment of convalescent annexes at general hospitals. On

79(1) Ltr SPMCB 300.5-1, SG to TAG, 7 Jan 43, sub: WD Cir, with atchd corresp from various offs in SOS. AG: 701(l-7-43)(1). (2) AG Memo W40-6-43, 11 Feb 43, sub: Conv and Reconditioning in Hosps. Same file.
80An Rpts, 1942 and 43, Sta Hosps at Jefferson Bks, and 1943-44, Reconditioning Div SGO. HD.
81Memo WDGDS 2317, ACofS G-4 WDGS for ACofS G-l WDGS, 6 Feb 43, sub: Rest and Recuperation of Mil Pers. AAF: 354.1 "Rest Ctrs and Conv Homes."
82(1) Memo 720 GNGAP-A, CG AGF for ACofS G-l WDGS, 25 Feb 43, sub: Rest Cps for AGF Pers. AAF: 354.1 "Rest Ctrs and Conv Homes." (2) DF SPGAM/720/Gen(2-8-43)-16, CG SOS for ACofS G-1 WDGS, 27 Feb 43, sub: Rest and Recuperation of Mil Pers. HRS: G-1/354.7(2-8-43).
83(1) Comment No 2, Air Surg to Dir Base Serv AAF, 10 Feb 43, on R&R Sheet, Dir Base Serv AAF to Air Surg, 2 Feb 43, sub: Renaming of Pers Rest Ctr Projects. AAF: 354.1 "Rest Ctrs and Conv Homes." (2) R&R Sheet, Dep C of Air Staff to Air Surg, 18 Feb 43, sub: Specialized Hosp and Recuperative Fac for AAF Pers, with atchd draft Memo, CG AAF for AsstSec War for Air, 10 Feb 43, and draft Memo, AsstSec War for Air for SecWar, 15 Feb 43. Same file.
84Memo, ACofS G-1 WDGS for CofSA, 24 May 43, sub: Specialized Treatment for Aircraft Combat Crew Pers. HRS: G-l/354.7(2-8-43).
85Coleman, op. cit., pp. 384-86, citing Memo, ACofS G-4 WDGS for ACofS G-1, G-3, OPD WDGS, and CGs AGF, AAF, ASF, n d, and Memo WDGAP/354.7(3-8-43), ACofS G-1 WDGS for CofSA, 25 May 43.
86Memo WDGDS 4588, ACofS G-4 WDGS for CG ASF, 14 Jun 43, sub: Recuperation Ctrs for Conv Pnts. Filed as incl to ind dated 29 Jul 43. HD: Wilson files, "Day File, Jul 43."


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21 June 1943 ASF headquarters approved the program The Surgeon General presented.87 Neither mentioned separate facilities for the Air Forces, hoping apparently to keep the convalescent care of all patients under their own control. The day before, however, a short-lived memorandum (already discussed) had granted the Air Forces authority to hospitalize combat crew members returned from theaters of operations and to operate whatever general hospitals were necessary for that purpose.88 As a part of the compromise settlement of this question, it will be recalled, Surgeon General Kirk agreed to the Air Forces' establishment of convalescent centers for the care of both combat crew members suffering solely from operational fatigue and other Air Forces patients whose medical care had been completed in general hospitals, while the Air Surgeon agreed to the continued operation of all general hospitals by the Service Forces. The Air Forces therefore activated eight convalescent centers in the latter half of 1943,89 while the Service Forces established convalescent annexes at each general hospital. Convalescent hospitals as such were not authorized until the spring of 1944.90

87(1) Memo, Col John R. Hall for SG, 12 Jun 43. (2) 1st ind SPRMC 322 (18 Jun 43), CG SOS to SG, 22 Jun 43, on unknown basic Ltr. Both in SG: 632.-1.
88See above, pp. 107-08.
89AAF Memo 20-12, 18 Sep 43.
90See below, pp. 188-90.

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