MEDICAL HISTORY OF UNIT - OCTOBER 27, 1944

1.. Development of Organization and Administration of Unit.
a. This unit arrived in Oran, Algeria, on 25 January, 1943 an spent 23 days in a staging area before moving to our hospital location in the interesting summer resort city of Tlemcen, Algeria, located approximately 100 miles southwest of Oran on the slopes of a great plateau which stretched for miles south, east and west of the city.
b, The hospital buildings themselves were formerly schools which, when renovated, made excellent facilities for hospitalization, the worst feature was the fact that the hospital was split into two sections, one school building being located on the outskirts of the city while the other was located about five city blocks away in the center of the city.
c. Laundry service was unsatisfactory for about six months inasmuch as it was done under local contract by a civilian hotel. Facilities were not adequate to care for the large quantities such as a hospital consumes. Utilizing the service of QM laundries in the city of Oran would have required a truck solely for that purpose and would have entailed a special trip each day, or every two days of 200 miles and with organizational motor equipment as scanty as it was, the service was not feasible. This situation was finally solved by having a mobile QM laundry assigned for duty.
d. Large hospital units, when ordered to move to another location and which involves water transportation, should be allowed at least two weeks to pack up, that is, two weeks grace after the last patient has departed. This would give supply and utilities sufficient time to obtain packing material, sort equipment properly, turn in overages and property held on memorandum receipt and shipping ticket, to safely box and crate the equipment and mark it for shipment and to move it to the railhead. It is recommended that adequate supplies of the proper crating material be made available. The crates prepared by the engineers were not strong enough to withstand rough handling and much breakage resulted.
e. When unit equipment arrives at a port each officer on board ship who is responsible for his organizational equipment in the hold should be immediately contacted personally by a representative of the port transportation corps and given a port SOP covering the unloading and removal of his equipment. Much equipment was lost due to the fact that officers responsible for property were not allowed to check their property off the ship. Unit property was so mixed up in loading and unloading that some of it was never found by the unit. (Comment by the writer: Some loaded trucks after leaving the docks were hijacked on their way to their unit, arriving empty).
f. Past experience has indicated that port battalions delegated to unload ships and military police detailed to protect unit property stored in port warehouses and dumps need much closer supervision and surveillance by honest and conscientious non-noncommissioned and commissioned officers. The loss of material handled and guarded by these groups is staggering. There are far too many individuals who have access to other's property who willfully permit themselves and others to pilfer and carry away unit equipment which always is of vital importance to the hospital concerned.
g. Coordination of this office with other administrative offices was easily achieved, and presented no special problem.
h. A difficulty encountered in movements is the problem of inaccessibility of files during movement. This necessitates delays in correspondence which continues even though the hospital is closed. It is possible for troops to keep openly a limited number of files in their possession during movement, as their personal equipment is all they can handle.
i. This hospital was unable to obtain files or desks.

(Here I, the writer, wish to comment. In these days there were no electric typewriters, copy machines, etc.. We worked with manual U.S. Royal, L.C. Smith typewriters, and to make copies we used as many as 4 to 5 carbons. So if you made a "typo error" it was necessary to erase the mistake on the original plus the carbon copies. We did have a ditto machine; typing the ditto sheet required a steady hand with steady striking power on each key; if the "o" key or the "0" key were hit too hard, the entire middle of this letter would be cut out of the sheet. This made a messy reproduction. We tipped crates on their sides and sat at the open end with the typewriter on top; we were able to obtain some chairs from the school where we were located. Many bedside tables, ward tables, etc. were made out of crating material.)

This problem was met by the construction of equipment through cooperation of the utilities department and the personnel of the offices by building these fixtures on the spot. The men have a great deal of pride and enthusiasm in setting up their departments and show a great deal of initiative and resourcefulness.

2. Problems in Personnel.
a. Adequacy of T/O and Suggested changes:
(1). T/O in distribution of ratings appears to be inadequate in that no provisions are made for the utilities section and guard.
(2) An efficient utilities section lays the ground-work for the success of the hospital unit. It is this section that must complete the work of the engineers, and must, without outside assistance, maintain all physical aspects of the hospital. In this department there must be electricians, plumbers, bricklayers, carpenters, masons, mechanics, and quite often engineers and draftsmen. Whether an organization is fortunate enough in having such men assigned to it at its inception or whether the abilities are produced through actual experience, the fact remains that such men are in a hospital organization. A grave injustice is committed in the T/O in not making provisions for these men. Two years of overseas operation has conclusively shown that provisions made in T/O and T/E for the utilities department in this size hospital installation are entirely inadequate. The T/O for a 500 bed station hospital makes allowance for only four men, whereas, during the first six months of operation in Italy, utilities has put to its credit 3950 man days of labor and utilized $6,980.00 in requisitioned materials, not to mention maintenance service on thousands of dollars worth of medical equipment. Such a T/O necessarily places very rigid limitations on rating for the department and serves to discourage master craftsmen, such as electricians, plumbers, carpenters, painters, and welders, who are indispensable to the efficient operation of the department.
(3) This hospital has learned from experience that a permanent guard detail best serves the requirements of interior guar duty. It is felt that in hospital located in isolated areas an allowance for an increased T/O be made to take care of guards. This unit has had to set aside 36 men as exterior guards while other units in a sufficiencly fenced in area require only gate guards. This guard detail takes over the function of exterior guard, and in the history of the organization, they have also served as town or village military police. The unassigned or the men with little or no technical training make up the guard detail. As experience has shown in all units, a goodly number of men who lack color and personality are those who are unassigned and on the tail-end of the list for choice assignments. After a period of time those men quite often develop into the best and most dependable men in an organization. A reservation in the T/O, not to be filled until an organization has been in full operation for a given period of months, should adequately care for these men.

b. Rotation Policy.
(1) Rotation as it works, has proven poor for the morale of the men in this organization. It has been the experience in this unit, to have transferred into it, men with more overseas service than the unit. These men, many times with the unit only a few months, are given the first opportunity for rotation. This hospital has been overseas 22 months and has returned only 3 men of the original unit on rotation. Freezing of ratings left open by rotation should be corrected. Normal replacements are, as often as not, men with ratings. A frozen rating in the T/O discourages incentive and initiative.

c. Replacements.

(1) All replacements are reclassified men and usually men whose service records reflect unsatisfactory service. All of these men must be trained again, within the unit, for new assignments. Few, if any, have Army experience that can be used in a medical installation. When replacements are received during the period when the hospital is operating at full or more than full capacity, the smooth functioning of the organization is disrupted. The theoretical policy of the United States Army is to place men of higher intelligence and qualifications in the medical department. The service could be greater benefited if replacements, or unfits, as they should be termed, were returned to the United States in exchange for properly trained replacements. Men who have been classified as limited assignment at induction and who have the advantage of proper training, should be sent overseas as replacements in the medical department.

d. Rest Camps
(1) Proved good for the morale of the personnel. The unit had seven days in North Africa at a sea shore resort with opportunity for additional rest for as long as the resort was available.
(2) All nurses have been given the opportunity for DS at the Nurses' rest hotels in this theater. This has been a great benefit to the nurses and has afforded an opportunity for rest, relaxation, a change from routine duties, and the privilege of visiting places of historic interest.
(3) Opportunities for rest for male officers has been lacking until recently.
e. Passes:
(1) An opportunity for all enlisted personnel of good character to take off on periodic passes of three day duration to visit any place within the base section would be a morale booster.
f. Discipline, service records and payment of patients:
(1) Discipline of patients was not difficult to maintain. Prompt payment of patients is of great value in maintaining morale. This applies especially with respect to battle casualties, many of whom, because of long periods of service at the front, become considerably in arrears. This hospital paid patients who have not been paid in full for periods of as great as one year. The practice of giving patients payroll priority by finance disbursing sections was highly commendable.
(2) Soldier's individual pay records (WD AGO form no 28) were found to be of no practical value in connection with payment of patients. They were seldom up-to-date, data was often inaccurate, and, especially in the case of battle casualties the record was lost. It was found to be more expedient to take an affidavit from the soldier for this information and to rely upon accounts being finally cleared up when soldier's service record caught up with him.
(3) Many soldiers do not know the exact amount of authorized deductions from their pay.
(4) Many members of the Army, including officers, did not know their arm of service. This applied particularly to members of replacement commands and headquarters commands.
(5) It was found to be of utmost importance that soldier's service record be promptly forwarded to the hospital when transfer to the detachment of patients had been affected. Some unit commanders showed a reluctance to do this, and would not forward the records in the apparent belief that retention of the soldier's records in their unit insured soldier's return to the unit.
This seemed especially to be the case of the soldier who was highly regarded in his former unit.
(6) In some cases the time spent in the hospital afforded the soldier his first opportunity for some time to clear up discrepancies and make changes in allotments, dependency allowances, insurance. Usually, however, he was gone from the hospital before reply from the Unites States was received. In some before they reached the soldier, especially during operations in North Africa.
(7) As a general rule, patients have a marked antipathy to being returned to duty through a replacement depot, largely due to the possibility that they will be held at the replacement depot for a long period of time before being returned to their unit.

3. Procurement, Constructon and Location of Fixed Hospitals.

a. In selection any site for a fixed hospital, we believe it is desirable to send oaut an advance unit as early as possible. Such unit should contain the best brains of the organization and should acquaint themselves with the local situation and should be well versed in sanitation and be able to avoid health hazards to personnel. The use of local utilities to supplement hospital equipment should be considered, also, the availability of QM transportation, supplies - both general and medical. The item of greatest priority shall always be the rapidity, ease and skill with which the sick and wounded may receive proper treatment.
b.Special crates should be supplied for special equipment such as sterilizers and autoclaves. It has been our experience that these articles receive extremely hard handling and are subject to breakage during outfit movement. In our experience these items were in worse condition when first received by the unit from the manufacturer than when packed by our utilities.


Plans and Training

a. This unit received approximately three months training at Fort Benning,
Georgia, then shipped overseas and upon arrival at North Africa got up an installation for operation within a few weeks time. X-ray technicians were qualified by accredited schooling. It is felt that key men should have a subordinate trained to do his job. For every key man there should be a replacement without jeopardizing the efficiency of the unit. It is felt also that continuous "on the job" training is of extreme importance with the goal of increasing a man's classification.
b, Malaria discipline was strictly adhered to and paid dividends in that no member of this organization became infected.
c. Training received in station complement units in the United States does not include all the problems inherent in operation in the communications zone overseas, however, the training received in the Zone of Interior is of inestimable value. Training should be given to administrative personnel of a hospital unit of this type as to organization and functions of base section commands overseas while the unit is in training in the Zone of Interior. Upon arrival overseas a large amount of helpful information concerning reports to be rendered and procedures peculiar to the base sections and theater of operations was obtained by personal visits of the personnel to offices of the base section and to similar units already set up and functioning.
d. A liaison officer stationed at the Port of Embarkation who had preevious experience with the same type of unit overseas to acquaint personnel with the situation and problems they may expect to meet, with due regard to security regulations of course, would be a great aid to an organization
e. Text books as supplied are entirely inadequate. Several additions should be made including a good text on pathology and a text a book on eye diseases other than May's which is too elementary.
f. The nursing procedures carried out were similar to those carried on in the North African Theater. Along with the treatment of battle casualties there was a variety in medical cases. There was a change in the source of patients as the war front shifted and the caring for battle casualties changed to service troops and headquarters personnel. There was a variety of interest and a challenge to the nurses as many of them were initiated to the use of penicillian, the care of hepatitis, the association with patients of other nations- the Ghoumes, French and Polish. The diffeerence in habits, customs, diets and languages of these patients created some problems which were met with little difficulty and served as very interesting experiences. In anticipation of a possible emergency with gas casualties, a ward was set up with necessary equipment and two teams were given special training in the handling of gas casualties.
g. The care of personnel of the Women's Army Corps has presented many changes and problems in a hospital that has been assigned to care only for male personnel of the Army. The T/O for nurses has been made with the understanding that patients serviced are male patients. This is a major problem due to the fact that complete nursing care and ward duties must be carried out by the nurses. IN the regular male wards, corpsmen give baths, treatments and are responsible for the general appearance of the wards. Ambulatory patients in male wards are assigned duties that can not be carried out in women's wards. The feeding of women patients presented another problem. A separate mess hall was set up and personnel assigned to carry the food cabinets from the diet kitchen to the wards. In male wards this is a duty of the corpsmen and ambulatory patients. The building of separate latrines had to be considered. Special wards were built to accommodate the female enlisted personnel and officers. Medical technicians of the WAC were assigned to assist in the nursing care and have been a valuable aid in the nursing care. It is most important that the women assigned as medical technicians have special training and qualifications todo this type of work, Civilian women have been employed as maids.
5. Fiscal and Supply Activities
a. The administrative procedures set up by this Base Section for the requisitioning of supplies is highly satisfactory. This hospital shipped all of its expendable medical supplies along with the other equipment in the movement from Africa to Italy and the initial expendable requisition of this hospital in this Base Section was therefore small.
b, There has been very little necessity for local procurement through the Quartermaster except for tableware, enamelware cups, the making of keys for padlocks and for chinaware for messes. Results have been satisfactory to date. The only medical items that this hospital has asked the Base Section Surgeon's Office authority to purchase locally are vaginal douche tips required for treatment of female personnel. It is suggested that these items be made available through the medical supply.

Back To Index | Home