more dependent on rail and road communications and access to ports than upon the location of troops. Inasmuch as Great Britain included such a small area, virtually any hospital existing in the country could be used. The reason that four out of five of the general hospitals obtainable were located in the Southern Command was because they were "absolutely all that were available," and not because ground force troops were concentrated there. As for the station hospitals, they had yet to be built, since no existing plants had been obtainable. Based on the premise that the Eighth Air Force would be suffering casualties while the ground forces stationed in Britain would not, station hospitals were being built in the area where the Eighth Air Force, with a strength of 17 percent of the theater, was allotted 25 percent of construction. Finally, General Hawley noted that although the entire hospital program had been delayed, there was less delay in the hospital construction for the Eighth Air Force than for other units. General Hawley put it in this language: 108 You have 25 percent of your new station hospitals; the rest of ETO has exactly none! I know that this is little solace when you need all your hospitals, but I hope you do accept it as evidence that we have tried harder to get you your hospitals-only because you needed them more than we have tried in the program as a whole. It appears in view of this correspondence that the delays in hospital construction could not be attributed to the lack of efforts on the part of the Chief Surgeon, European Theater of Operations. Moreover, an inspection report made to the Air Surgeon after a study of the correspondence relating to the hospital program, led to the conclusion "that the Theater Surgeon was a victim of circumstances beyond his control, and is blameless." " 109 The basic attitude of the theater surgeon was probably expressed in July 1943 in a letter addressed to The Surgeon General, in which he referred to the problem of the Air Force and, presumably, to the policies established in the Zone of Interior with respect to hospitalization policies. While expressing his understanding and concern for special medical problems of the Air Force, he noted: 110 I am so fed up with the ability of the Air Forces to obtain in profusion critical items of medical equipment through their own channels, which I am unable to obtain for other components of the Army, that I am resisting strenuously any move to give the Air Force a separate medical service or separate medical supply. At this time he reaffirmed theater policy which stated that all fixed hospitalization was a function of Services of Supply; both the Air and Ground Forces would provide temporary hospitalization to consist of infirmary cases not exceeding 96 hours duration. Two reports made in the fall of 1943 reflect the trend of thought by both the Army and the Air Forces in the matter of Air Force control of hospitalization. General Grant, the Air Surgeon, was apparently visiting in England at the same time when Col. H. T. Wickert (MC), of The Army Surgeon General's Office visited the United Kingdom, for in his report Colonel Wickert wrote as follows: 111 At the invitation of Major General Lee, I attended his weekly staff conference. Following this, at General Hawley's invitation, I attended a special conference with General Grant (Air Surgeon) and General Hawley with his staff of consultants. The subject of this conference was the old question of fixed hospitals for Air Corps patients being under the control of the Air Force. The conference was lively, friendly, and inconclusive. General Grant had no complaints as to the hospitalization and medical care being received by Air Corps personnel; on the contrary, he was very complimentary, stating that the medical service given Air Corps personnel in England was not only adequate in all respects but was excellent, and that he knew of no way in which it could be improved. However, he did think it desirable, for administrative purposes, to have these hospitals under the control of the Air Forces. General Grant also stated that many of the medical officers with the Air Force units, as attached medical, were individuals of high professional skill and ability, and that if he were given some fixed hospitals under the Air Corps control, full and better use could be made of these medical officers and advantage taken of their professional skills. This latter statement was countered by the thought that probably the best use of these individuals could be made by transferring them from Air Force units to the Theatre Medical Service, where they could be assigned to the larger hospitals where the patient load was adequate to insure full use of their special talents. General Hawley's reaction to the matter was that if he, as Theatre Surgeon, was to be held responsible for the hospitalization and medical service, he was going to try to retain control of the units and installations with which that responsibility was to be discharged. The conference ended without any agreements or plans for any change in the existing status, i. e., no separate hospitalization for Air Forces. This conference apparently took place on 6 September 1943. Two weeks later, Colonel Grow, Eighth Air Force Surgeon, was interviewed at AAF Headquarters by the Assistant Chief of Staff, Intelligence. At that time he stated: 112 In the European Theatre of Operations, the sick and wounded of the Eighth Air Force are first taken care of in the station dispensary. Those requiring other than first aid or very few days of bed rest-in other words, the very slightly ill-are sent to station hospitals which are under the theatre surgeon. Cases may then be returned directly to duty with the air force provided the hospitalization is less than 30 days and their conditions warrant future duty with the air force. Cases which are in the station hospital, or if sent later to a general hospital for over 30 days, are then transferred to the detachment of patients. If at the end of their hospitalization it is determined that they are fit for duty, they are returned to the 12th Replacement Control Depot of the Eighth Air Force and from there to duty. On the other hand, if they are not fit for duty in the future in the European Theatre, they are evacuated with the S. O. S. From the time they are transferred to the detachment of patients, they become lost to the Eighth Air Force. It would probably facilitate the evacuation of these cases to air force installations in the zone of the interior if the Eighth Air Force had three or four general hospitals to receive these cases. The chain of evacuation back to the U. S. would probably have to be further reinforced by some air corps agency at the port of embarkation, somewhat similar to the "in transit" set-up at Newark. If then the Air Forces had general hospitals in the U. S. where these patients could be received on arrival, the chain of evacuation would be complete and possibly through or because of this control, cases could reach the rehabilitation expeditiously. Despite the administrative difficulties encountered, General Grow did not desire at this time to control fixed installations in the European Theater. He advised the Air Surgeon, General Grant, on 25 January 1944, that he had made no effort to secure station or general hospitals for the exclusive use of the, Air Forces. He commented on the good relationship existing between him and the Chief Surgeon, ETO, stating that in his opinion it would be unwise to disturb this relationship. General Grow believed that the Chief Surgeon, ETO, was doing everything that this situation would permit to make possible an efficient medical service for the Air Forces, although he advised General Grant that, should a situation arise in which the Air Forces would be stationed where no SOS hospitals were available, such as had occurred in Italy, it might be necessary to request hospital facilities. At this time, it was not anticipated that such would be the case in ETO.113 The availability of hospital facilities was, however, but one part of the total picture emerging in connection with the medical service. From the theater point of view it must be remembered that General Grow was a staff officer with command responsibility to General Eaker; at the same time in medical matters involving hospitalization and evacuation policies at the theater level except at air bases he was responsible to the theater surgeon who reported to the Commanding General, SOS. In the theater during this period the Eighth Air Force was engaged in a running jurisdictional battle with the SOS to obtain a supply pipeline to the United States for supply items "peculiar to the Air Forces." The Eighth Air Force had been to a large degree successful, having established an Air Service Command in the European Theater and the so-called "in transit" Depot at Newark, New Jersey, from where supplies were furnished to the theater without recourse to normal SOS channels. This procedure involved, of course, medical supplies as well as other types. And while Eighth Air Force line officers had not urged a comparable battle to obtain medical service excepting to urge that the SOS complete the construc tion of hospital facilities as promised, the storm signals were beginning to emerge as early as the summer of 1943. It was during this period that, in the Zone of Interior, The Surgeon General had reduced Air Force station hospitals to the level of dispensaries by circumscribing the type of surgery that could be undertaken. Since, in the theater, the Air Force controlled no fixed hospital facilities, the pattern was to take a slightly different form. The fundamental question emerging in both the Zone of Interior and the theater, however, was in essence that of command control. Should or should not the Air Force control its hospital facilities as it did its repair and maintenance depots? When that question was answered there would also be answered the correlative question of whether the major force-having as it did, a potential combat mission in war and peace-would maintain administrative control of its human resources, or if it would have major responsibility for maintaining the effectiveness of its fighting machine without control of its human resources. 115 As previously described," informal complaints about the medical care rendered Air Force combat personnel in the British Isles had flowed with such persistence that in early March 1944 they reached the President. It was his personal decision to send a Board including Dr. Edward Strecker, General Kirk, and General Grant to the ETO to study the situation. On the question of policy concerning hospitalization, it will be further recalled, the board concluded: "In view of the long-established system of hospitalization in the ETO and contemplated new operations, it is felt that any change in the general principle of hospitalization in the ETO at this time should not be recommended." 116 General Grant accepted this majority decision with reluctance and only because D Day was such a short distance away.' 117 One agreement which apparently came out of the meeting, however, was along the lines of the recommendation made the previous summer by General Hawley, namely, that flight surgeons be attached to general hospitals to aid in disposition of Air Force personnel. Generals Hawley and Grow agreed specifically that "a flight surgeon be assigned to act in a consultant capacity and be a voting member of the Disposition Board in general hospitals having the number of Air Corps patients which in the judgment of the Air Forces warrants such assignment." As a result of this agreement, flight surgeon advisers were placed on detached service at six general hospitals. A plan had to be devised to remove them from the Table of Organization of their units, otherwise no replacements could be secured. A new unit, designated Medical at Large, ASC, USSTAF, was activated for these advisers.119 "" 118 |