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Introduction - Part I

Contents

PART ONE

HOSPITALIZATION
DURING THE EMERGENCY PERIOD
8 SEPTEMBER 1939-7 DECEMBER 1941


Introduction

The State of Army Hospitalization, 1939

When President Roosevelt proclaimed a "limited national emergency" on 8 September 1939, just one week after Germany invaded Poland, the Medical Department of the United States Army was operating 7 general hospitals and 119 station hospitals. Five of the general hospitals were located in the United States-Walter Reed at Washington, D. C.; Army and Navy at Hot Springs, Ark.; Fitzsimons at Denver, Colo.; Letterman at San Francisco, Calif.; and William Beaumont at El Paso, Tex. The other two were in overseas possessions-Tripler in the Hawaiian Islands and Sternberg in the Philippines. Of the station hospitals 104 were on Army posts in the United States and Alaska, while the remainder were divided among the Philippine Islands, the Hawaiian Islands, and the Panama Canal Zone. Each station hospital was designated by the name of the post on which it was located and each general hospital, except one, was named for a deceased medical officer. Hence, station and general hospitals in the United States in both peace and war, as well as those in overseas possessions in peacetime, were called "named hospitals."

Station hospitals and general hospitals had different functions. The former served local and ordinary needs, usually receiving patients from stations where located and treating those with minor ills and injuries only. General hospitals, on the other hand, were designed to serve general and special needs. By transfer from station hospitals they received patients who suffered from severe or obscure diseases as well as those who needed complicated surgery.

Capacities of named hospitals depended largely upon troop populations served. Other factors also influenced their capacities, such as climate, prevalence of disease, general physical condition of troops, and types of activities in which the latter were engaged. Hospital capacities and hospital requirements were expressed in terms of beds, which in the Army meant not only beds themselves but also shelter, equipment, utilities, and personnel that went with them. For an Army strength of 135,749 in the United States and Alaska in June 1939 there were 4,136 general hospital beds and 8,234 station hospital beds. This represented a bed ratio to strength of approximately 3 percent for general hospitals and 6 percent for station hospitals. For a strength of 10,993 in the Philippines there were 317 general hospital beds and 360 station hospital beds. In the Hawaiian Islands, the most healthful of overseas possessions, there were 350 general hospital beds and 360 station hospital beds for a strength of 20,601. The Panama Canal Zone, with next to the highest sick rate in the Army, had only 269 station hospital beds for a strength of 13,533, a ratio of 1.98 percent. This unusual situation resulted from the fact that civilian Canal Zone hospitals-Gorgas, Colon, and Corozal-staffed with Army Medical Corps officers but under the control of the Governor of the Canal Zone,


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cared for a considerable portion of the Army's patients in that area.1

The Surgeon General believed that the Army's hospitals were inadequate, even for peacetime needs. He had begun a long-range program in 1934 to improve and expand them but funds appropriated by Congress for Medical Department construction had been sufficient for little more than essential maintenance of existing buildings. As a result, the Army's hospitals in 1939 were poorly suited to any increase in its strength. In Panama only fifty beds were located in a hospital building. The remainder were crowded into buildings erected for other purposes. Hospital plants in the Hawaiian and Philippine Islands needed repairs and alterations. In the United States hospital buildings were small and widely scattered among a number of permanent Army posts. Erected twenty-five to thirty years before, many lacked facilities for the separation of patients according to grade, sex, and disease, and for such modern diagnostic and treatment procedures as basal metabolism, X-ray, and oxygen and physical therapy. Of the entire number, The Surgeon General considered only twenty-five as modern, fire-resistant buildings and only fifty of the remainder as worth modernization. The others, he believed, should be replaced with new buildings.2

For the care of patients in theaters of operations in wartime the Medical Department had a doctrine of hospitalization and evacuation that dated from the Civil War and had been successfully applied during both the Spanish-American War and World War I. Casualties were given emergency treatment at a series of medical stations established in the forward areas of combat zones. To provide such treatment as well as the transportation of patients, when necessary, from one station to another farther to the rear, every regiment and separate battalion of all arms and services, except medical, had a medical detachment, and every division had a medical regiment, medical battalion, or medical squadron. To furnish as near the front as possible a higher type of treatment than first aid or emergency medical care, hospitals designed for easy movement and hence called "mobile hospitals" were assigned to field armies. They were of three types: surgical hospitals, evacuation hospitals, and convalescent hospitals. Surgical hospitals were planned for use in either division or army areas of combat zones. In division areas they were to carry out emergency procedures, such as treatment of shock, control of stubborn hemorrhage, reconstitution of blood following hemorrhage, and fixation of complex fractures, in order to prepare men with serious injuries for further removal to the rear. In army areas they performed much the same function as evacuation hospitals. Evacuation hospitals normally served only in the rear areas of combat zones. They provided definitive treatment for evacuees from forward areas and for the sick and

1Annual Report of The Surgeon General, U.S. Army, 1939 (Washington, 1940), pp. 170, 250; 1940 (Washington, 1941), p. 1 (cited hereafter as Annual Report. . .Surgeon General). Only Puerto Rico, with a mean annual strength of 1,312, had a slightly higher admission rate than Panama. Puerto Rico had no Army hospital in the middle of 1939.
2(1) Annual Report. . .Surgeon General, 1937 (1937), pp. 167-68; 1939 (1940), p. 253; 1940 (1941), p. 265. (2) Hearings before the Subcommittee of the Committee on Appropriations, House of Representatives, 76th Cong, 1st session [H. R. 6791] Supplemental Military Appropriation Bill for 1940 (Washington, 1939), pp. 157-58. (3) Statement of MD Activities by Maj Gen James C. Magee, SG, USA, for the Subcmtee of the House Cmtee on Mil Approps (1939). HD: 321.6-1. (4) Preliminary Estimates, QMC, FY 1941 (25 May 39). Off file, Hosp Cons Div, SGO. (5) An Rpts, CA Surgs. SG: 319.1-2. (6) C. M. Walson, "Observations at Army Hospitals," Army Medical Bulletin, No. 42 (1937), pp. 65-72.


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injured of surrounding areas. They returned some patients to duty after short periods of treatment, transferred others with prospect of early recovery to convalescent hospitals, and prepared still others for transportation to general hospitals for continuation of treatment. Convalescent hospitals were not staffed and equipped to perform major surgery. Their chief function was to restore to physical fitness patients received from evacuation hospitals, to treat cases of venereal disease, and to care for patients from units located near by.

For service in communications zones there were station and general hospitals. The latter received patients not only from station hospitals but mainly from evacuation and surgical hospitals. They returned some to duty in theaters of operations and transferred others for further treatment to general hospitals in the zone of interior. Since it was expected that hospitals in communications zones would rarely need to be moved, station and general hospitals were called "fixed hospitals." When several were grouped in one location they might be combined into a hospital center with a 1,000-bed convalescent camp. All hospitals in theaters of operations, whether fixed or mobile, were designated by numbers rather than by names and locations, and hence were called "numbered hospitals."3

Unlike named hospitals in the United States, numbered hospitals had standard capacities, staffs, and equipment that were established by tables of organization, tables of basic allowances, and equipment lists. Tables of organization for hospitals showed the capacities of installations which different units were designed to operate. While tables of basic allowances listed equipment authorized for units and their members, they did not itemize such articles as drugs and biologicals, surgical gauzes, surgical instruments, dental supplies and equipment, laboratory supplies and equipment, X-ray supplies and equipment, and operating-room equipment. These were included under one heading as an "assemblage." Items for hospital assemblages were listed individually and by amounts in Medical Department equipment lists.

For use in theaters of operations in June 1939 the Medical Department had little more than doctrine. Only five Medical Department field units were in existence-four medical regiments (two of which were overseas) and one medical squadron. According to The Surgeon General, failure to have other units in training resulted from a shortage of Medical Department enlisted men. Congress limited their number to 5 percent of the strength of the Army, and use of more than 4 percent in named hospitals and other peacetime installations left few for field units. Early in 1939 The Surgeon General had sought an increase in the Medical Department's allowance of enlisted men, but without success.4

To provide officers for wartime hospitals-physicians, dentists, and nurses-The Surgeon General had proposed in March 1939 the revival of "affiliated units." These were reserve units sponsored by civilian hospitals and medical schools. Such units had been organized by the American Red Cross during World War I and had contributed substantially to Army hospital service in France. "I am convinced," wrote Surgeon General Charles R. Reynolds, "that the Medical Department can have reserve hospital

3AR 40-580, MD, Hosps-Gen Provisions, 29 Jun 29.
4(1) Cmtee to Study the MD, 1942, Testimony of Col Albert G. Love, p. 2. HD. (2) Annual Report. . .Surgeon General, 1939 (1940), pp. 179-82.


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units ready to function as required . . . only by civil institutions sponsoring these units, especially those needed within the early periods of mobilization. . . ."5 In August 1939 the Secretary of War approved in principle The Surgeon General's plan to organize affiliated units to staff 32 general, 17 evacuation, and 13 surgical hospitals. Full approval was given several months later.6

The only reserve equipment which the Medical Department had on hand was that stored after World War I. It was "of 1918 vintage, incomplete in modern operating-room equipment, wholly deficient in essential laboratory equipment, totally lacking in X-ray, physical therapy and hydrotherapy equipment, and stocked with scientific items now obsolete and rapidly becoming obsolescent."7 Moreover, with few exceptions, tables of organization and tables of basic allowances for field medical units, including hospitals, had not been changed since 1929, and the preparation of new equipment lists for them had just been begun in January 1939.8 To prepare for war the Medical Department had to start almost from scratch.

Effect of the War in Europe

The period of the emergency in the United States was for the Medical Department a time of partial preparation for war through the provision of the hospitalization actually required for an expanding Army. Its steps in this direction were sometimes painful and often halting. Several factors accounted for this. Formal mobilization planning of the Medical Department, like that of the rest of the Army, was based upon a belief that the anticipated force of 1,000,000 to 1,200,000 men would be called up only if the United States or its possessions were attacked. It was therefore essentially defensive in nature. Moreover, there was uncertainty about the nature of increases of the Army-whether rises in the authorized strength of the Regular Army were temporary or permanent and whether or not the mobilization that finally occurred was for a year of training only, as it purported to be. Furthermore, funds which the General Staff could secure for the entire Army, let alone the Medical Department, were limited by the caution of the President and the sentiment of Congress. Finally, The Surgeon General and his associates, like many others in the Army and the Government at large, found it difficult to break peacetime habits of thought and action in order to plan imaginatively for a second World War.9

5(1) Ltr, SG to TAG, 17 Mar 39, sub: Affiliation of MD Units with Civ Insts. HD: 326.01-1 (Affiliated Units). (2) The Medical Department of the United States Army in the World War (Washington, 1923), vol. I, p. 102 (cited hereafter as The Medical Department . . . in the World War).
6(1) Cmtee to Study the MD, 1942, Testimony, pp. 8-10. HD. (2) Annual Report . . . Surgeon General, 1940 (1941). pp. 177-78. (3) For a full discussion of the revival of affiliated units see John H. McMinn and Max Levin, Personnel (manuscript for a companion volume in this series). HD.
7Ltr, SG to TAG, 6 Apr 40, sub: Status of MD for War. AG: 381 (4-6-40) (1).
8(1) Tables of organization and tables of basic allowances that were available in June 1939 are on file in HD. (2) Incl 2, Ltr, Brig Gen Harry D. Offutt to Col H. W. Doan, 10 Jun 48. HD: 322. (3) Interv, MD Historians with Gen Offutt, 10 Nov 49. HD: 000.71.
9Mark S. Watson, Chief of Staff: Prewar Plans and Preparations (Washington, 1950), pp. 15-56, 126-71, in UNITED STATES ARMY IN WORLD WAR II, discusses plans and preparations of the General Staff, along with limiting factors and influences, in considerable detail. Robert E. Sherwood, Roosevelt and Hopkins: An Intimate History (New York, 1950), pp. 157-62, discusses the difficulty Government Departments displayed in adjusting to planning for a global war.


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The war in Europe had almost immediate effects upon the Army and the Medical Department. In September 1939 the authorized enlisted strength of the Regular Army was increased from 210,000 to 227,000. The next spring, as the Nazi war machine rolled toward the English Channel, it was again raised-to 280,000 in May and to 375,000 in June. Then, in the latter part of 1940, after the fall of France, Congress approved a peacetime mobilization. From September of that year until December 1941, the Army's strength grew from 438,254 officers and enlisted men to 1,686,403. The Medical Department had to expand its operations accordingly. This involved mainly building up facilities in the United States, where 85 to 90 percent of the troops were stationed, but hospitals in overseas possessions also had to be expanded and additional ones provided for new Atlantic defense bases. While a regular system of field hospitalization and evacuation was as yet unnecessary, medical units had to be organized and prepared for such service.10

The expansion of hospital facilities in the United States involved many considerations. Decisions had to be made as to the types of housing to be used and the number of beds that would be needed. Means had to be found for providing suitable hospital plants in as short a time as possible. New hospitals had to be manned and the staffs of old ones augmented. "Green" officers had to organize hospitals and establish procedures for their administration. Supplies and equipment had to be placed in hospital plants at appropriate times. Finally, it was necessary to develop procedures for the operation of the greatly expanded hospital system.

The preparation of hospital units for field service sometimes conflicted with these activities, for such units also demanded personnel and equipment. The amount they should be given while in training was a moot question. The number of such units to be activated had to be determined. After they were organized they needed to be trained. Before most of these steps could be taken, tables and lists governing their organization, manning, and equipment had to be revised and modernized.

The challenge of an expanding Regular Army and a peacetime mobilization affected only slightly the organizational structure of the Army for hospitalization. Yet this structure and its changes must be understood before the actions of various agencies in providing hospitalization are discussed.

10Biennial Report of the Chief of Staff of the United States Army, July 1, 1939 to June 30, 1941, to the Secretary of War (Washington, 1941) (cited hereafter as Biennial Report . . . Chief of Staff, 1939-41). Figures on strength of the Army were supplied by the Strength Accounting Branch, AGO.

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