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Chapter XXXIV

Books and Documents > Medical Department of the U.S. Army in the World War, Volume III, Finance & Supply

CHAPTER XXXIV

SURGICAL INSTRUMENTS

In 1914, the year in which the Great War began, practically 80 per cent of the steel instruments used in the United States came from abroad. During that year reports of retail dealers to the United States Tariff Commission indicated that 50 to 75 per cent of all instruments sold during that year were of foreign manufacture. The bulk of the importations came from Germany. France supplied a few delicate cutting instruments, such as eye scissors, and England furnished the majority of the suture needles used by American surgeons. This placed the foreign manufacturer in a predominant position.1

Because of the position of the foreign manufacturer, the American manufacturer n as unable to turn out surgical instruments of comparable quality at competitive prices. The disparity in prices was due largely to two factors: The difference in cost of labor and methods of manufacture. There was also a prevailing impression among retailers and surgeons that instruments of foreign manufacture were better plated, more uniform in teniper, correct in pattern, smoother in finish, and had better points, joints, and serrations than the domestic. Many of them were not made at all in the United States, or if made were made to order and at a much higher price.1

While most of the instruments used by the American profession were made in Germany, very few of the patterns originated there. They were practically all designed in America. American surgeons have shown the same inventive genius and originality which have made American machinists and designers famous. Surgical instruments are rarely patented; they may be made by any manufacturer. When an American manufacturer had perfected a design and made a few instruments, and it became evident that the type would be saleable, some retailer or importer would secure a sample and send it to Germany where it would be copied, dies would be made, quantity production started, the profession circularized, and the instrument sold at less than the American cost.1

In September, 1914, the Imperial German Government declared an embargo on the exportation of all surgical supplies, including surgical instruments, and in spite of the many protests from manufacturers of surgical instruments, refused to lift the embargo except in so far as it granted special licenses. Supplies of German instruments continued to trickle into the United States during the remainder of 1914 and to some extent during 1915, but by the middle of 1916, on account of the embargo and the very efficient blockade, they had ceased entirely. England and France likewise required practically the entire output of their own factories for their own use. Surgical needles became increasingly more difficult to secure, until in the spring of 1917 the maximum


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amount Great Britain would permit to be exported to the United States was 6,000 gross for the year, and this for military as well as civilian needs. A new source of supply of surgical instruments had been discovered in Japan, but it attracted very little attention until the latter months of 1916.1

The shortage of instruments became noticeable in 1915, and the drain on the retailer’s stocks became severe. Domestic manufacturers found themselves called upon to supply not only the domestic needs but to meet the pressing needs of the military forces in England and other allied countries.1

In the midsummer of 1916, when the Mexican border mobilization occurred, the state of the surgical instrument trade in the United States was at its lowest ebb. The stocks of previous importation had been practically exhausted, and the domestic manufacturers had but begun to expand to meet the increased demands for surgical instruments which was soon to reach such gigantic proportions. While they were in a much better position to meet the demands of the Army and Navy in 1917 than they would have been in 1914, they were overburdened with orders from retail dealers and from European countries.1

This condition was soon to prove the saving feature of an exceedingly grave situation. The regular instrument makers had increased their productive facilities and had been able to acquire enough skilled labor to supply the demand during the three years when the Atlantic was closed to importations into the United States from Germany. When the United States entered the World War, these increased facilities on the part of the domestic manufacturer provided an appreciable nucleus of an instrument-making industry which made it possible to meet the emergency which arose during the war.2 With this situation in mind, it became evident, even before war was declared by the United States, that if the instrument makers of this country were to be able to meet its military requirements it would be absolutely necessary to reduce the number of patterns of instruments in order that quantity production might be had and that the time and effort of all manufacturers might be devoted to these particular patterns. To this end the Secretary of War, as chairman of the Council of National Defense, called a conference, in the early part of 1917, of medical officers of the Army, Navy, and Public Health Service, and civilian practitioners of the highest type, representing all specialties, to work in conjunction with commitees of manufacturers.1 The duty devolved upon this committee was the determination of what instruments were necessary, what were available, and what could be produced in quantities within a reasonable time. Superfluous types of instruments were eliminated and the number of designs reduced to the minimum. The list, as finally tabulated, contained, 800 different items selected from 7,000 as catalogued by manufacturers and dealers. This standardization assured uniformity of equipment, but it did more than that. The reduction in the number of items guaranteed a demand of each article in quantities sufficient to justify the introduction of new and expensive machinery and the reorganization of methods of production.

The manufacturers of surgical instruments and appliances were not idle while the committee on standardization struggled with the problem of selection, elimination, and reduction of types. Representatives of the largest instrument makers met in Washington April 11, 1917, to form an organization


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representative of that industry.3 At that meeting a committee on surgical instruments and hospital equipments was formed at the suggestion of the medical section of the Council of National Defense. To the committee was assigned the task of devising the best and quickest methods of supplying surgical instruments to the Army, Navy, and Public Health Service.

A call was sent to all the principal instrument makers for a conference with the committee in Washington, April 15, 1917, to arrange plans for the immediate production of the surgical instruments required by the Government. At this meeting the prospective requirements of the Army and Navy were presented and explained by representatives of the medical departments of those services. The investigations of the committee indicated that the facilities available at that time in the United States would not produce over 10 per cent of the steel surgical instruments required. It was agreed that every known source of production must be improved and perfect coordination and complete cooperation had among the actual manufacturers if the requirements were to be met. To some the situation appeared almost hopeless.4 There were financial, raw material, and labor problems to be met. Of this the labor problem appeared to be the most difficult of all. It required months and often years to acquire the necessary skill and technique to make surgical instruments, and there was no time for training unskilled workmen. Then, too, there was the prospective loss through enlistments and by the draft of a number of trained workmen. However discouraging the situation appeared, the problem remained to be met with firmness and determination. Through the efforts of the committee the entire industry was mobilized. Plants were reorganized and new methods introduced.

The great task confronting the surgical instrument manufacturers was solved by (1) making the most economical use of existing plants, (2) the establishment of a few new firms, and (3) utilizing to some extent facilities afforded by establishments in allied branches of the metal working industries. Manufacturing resources were systematically mobilized. Resources were pooled by large and small manufacturers to fill Government contracts as rapidly as possible. Contracts were divided, each firm selecting the articles it could handle to advantage. Teamwork or cooperation in production made possible the most economical use of plants and labor forces specializing on a scale never before attempted. The contracts, calling for hundreds of a given item where only dozens had been produced before, enabled the manufacturers to purchase or design new machinery, dies, and processes, and to introduce, in fact, quantity production.1

The reorganization and introduction of new methods and expansion of existing facilities were not equal to the production of the vast and ever-increasing quantities of instruments being required. Other measures became necessary, new sources of supply had to be found, and new facilities developed. Certain types of surgical instruments had their analogy in the products of allied industries, such as hand tools, table and pocket cutlery, and the like. These industries later were to be classified by the War Industries Board as nonessential industries. It was thought that they might be interested in the manufacture of surgical instruments. Early in 1918, in cooperation with the War


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Industries Board and other governmental agencies, a survey was made covering:5 (a) The best class of workmen who were formerly engaged in industries, then nonessential, and whose training would lend itself to the manufacture of surgical instruments; (b) workmen who had had experience in the manufacture of articles of the soft metal group, nickel-silver, copper, brass, silver, etc.; (c) lines of industry which had stocks of these metals on hand: (d) contractors who were not already furnishing supplies for war purposes; (e) industries which in peace time manufactured cutting tools, saws, pliers, etc.

Following this survey, the associated jewelry, silversmiths, and table and pocket cutlery industries were requested to attend a special meeting with a view to ulldertaking the manufacture of surgical instruments.6 At this meeting a set of samples accompanying every article on the war supply table was demonstrated. An official who was acquainted with the materials used and in the manufacturing procedures presided at the meeting. Attending manufacturers were provided by an official with all necessary information. The samples were tagged with the proper name and number and also with the price bid for the article to the regular manufacturers by the Medical Department. The manufacturers at the conclusion of the meeting expressed a willingness to help in making surgical instruments, and many of them were quite enthusiastic over being called in to help in war procurement from which they had thus far been excluded. After the meeting proposals were sent out from Washington for all the items on the supply table. In this instance they were sent to between 200 and 300 prospective bidders as against 40 or 50 in former instances. Bids were received from approximately 200 bidders. Awards on these bids were given to approximately 35 regular and 56 converted factories. Investigations were at once undertaken to determine whether the successful bidders were equipped to make and deliver the articles on which they had hid. Wherever uncertainty existed the award was made only tentatively until the converted plant had been inspected by a special official. If the plant on this inspection was found satisfactory, the award was definite. If unsatisfactory, the bidder was partly or entirely eliminated as a factor.6

It was possible to select many single articles from among manufacturers of outside products. For example, in the case of bone mallets, made of boxwood and extensively used. A former manufacturer of roller skates was found who had a large quantity of Turkish boxwood on hand. He was interested in the manufacture of bone mallets and furnished them with surprising promptness and at a fraction of the price which previously had prevailed.5 The manufacturers of household scissors easily adapted themselves to the making of surgical scissors and provided a satisfactory supply. Surgical drills and trephines were of much importance. Manufacturers of carpenters’ drills were interested and produced perfect instruments. Hardware and tool makers furnished saws, chisels, gouges, and other items related to their peace-time product. 6

The converted industry had a problem difficult to solve at the beginning. They had to be taught to make articles about which they knew very little. They were instructed and supervised periodically by surgical instrument inspectors from the New York medical supply depot. All processes, from the


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forging to the finished article, were more or less constantly under supervision. Although very few deliveries were made by them before the armistice came, they demonstrated that, had the war gone on, production was in a fair way to meet requirements.2

The first problem in acquiring surgical equipment appeared in the first call for the assembled cases to be delivered complete by each bidder. The complication arose from the fact that no single bidder could produce in his own plant all the articles in the complete case. A number of manufacturers to whom proposals for bids were sent failed to bid, feeling that they would be unable to obtain from competing manufacturers the articles they were unable themselves to produce. This difficulty was overcome by conferences between the manufacturers wherein satisfactory arrangements were made for the interchange of articles. This interchange between the manufacturers proceeded with almost no friction and the assembled, complete cases were delivered within reasonable time. All the assembled cases were made by the regular surgical instrument manufactures. The instruments requisitioned individually were made by the regular manufacturers at the beginning of hostilities and until other sources of supply became available.6 Practically all the surgical instruments required by the Medical Department were so nearly standard that machine methods already existed so far as machines could be used in their construction. No articles were required in quantities large enough to justify the construction of special machines for their manufacture. Special small tools for shapings in machining were always necessary. Such tools were made by trained toolmakers. Very few of the surgical instrument manufacturers had toolmakers enough to cover the demand. They were obliged to have their tools made in special tool-making shops, and those they found overloaded with tool making for other essential industries. This caused much delay in actual delivery from the regular surgical instrument manufacturers, who rarely found it possible to supplement their own toolmakers.7

No trouble was experienced in obtaining all the surgical knives needed. Most of them were obtained from drop forgings by the regular surgical knife makers who had their own dies and drop hammers for making the forgings. When the makers were unable to furnish the quantities needed, no material difficulty was found in supplementing their output by the products of pocketknife and butcher and household knife makers. Most of them had their own die makers and drop hammers and also the grinders and polishers to finish the forgings. The steel used in making knives has a rather high carbon content, varying from 0.90 to 1.20. No great difficulty was experienced in obtaining a sufficient quantity of this steel. The difficulty was in getting special sizes of steel which were not the standard stock sizes. The manufacture of surgical knives was not affected by this because they were usually made from standard-size steel. If the exact sizes wanted were not quickly obtainable in an emergency, a somewhat different size could be utilized with a slight excess of labor in their manufacture.7


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Surgical scissors were all made from drop forgings except the one style which went into enlisted men’s belt cases. Many of these were made of cast iron for lack of time required to get the forgings. They were better than none and were quite inexpensive; furthermore, they were the only kind available and had to be used, although they were not reliable.7 All the bone-cutting forceps were made from drop forgings both by the surgical manufacturers and the converted plants.7

The great problem encountered was to obtain sufficient drop forgings from the existing dies. These dies produce only limited quantities before they wash out and have to be repaired or replaced. The vast quantities of instruments required for war purposes called for additional drop-forging dies. The specially high-trained labor for that industry was woefully short and was overloaded far beyond capacity. The instrument makers usually had their dies and forgings made outside. The few plants which made their own dies and forgings were equipped only for a normal demand.

The finishing and the proper assembling of steel forceps is the most time-consuming part of the labor in constructing them. The polishing is absolutely hand labor. Even after pickling to remove the scale, the outer surface must be ground away with emery. A skilled grinder or polisher can remove an excess of 0.005 inch without spoiling the surface and in the shortest possible time. A less skilled workman can not do the work with so small a margin of excess without spoiling the forging. He requires much more time to finish his work than the skilled man. Several grinding and polishing operations with different grades and sizes of abrasives are necessary before the part is ready for nickel plating. This particular part of the manufacture of steel instruments can be done only by the very highest skilled labor.5

The converted plants were confronted not only with the problem of training polishers for steel forceps but also with that of assembling and adjusting the forceps after they had been polished. Hemostatic forceps required details of construction differing somewhat from those of any other commodity. The serrations in the jaw, which must mesh properly, and the spring tension required in some of the jaws and in all of the shanks, especially when the jaws were curved, seemed to be an almost insurmountable obstacle to them even after proper instructions. The men did not acquire the skill readily, and long delay was experienced before any appreciable production materialized.7

In giving the converted plants samples of the articles they were to produce inquiries were always made concerning their ability to acquire the dies for making the drop forgings. Their reply to this inquiry as a rule, was, that their engineers were accustomed to laying out dies for steel or for soft metals and that further instructions on that head were hardly necessary. One of the firms produced forgings almost twice as thick as they should have been, and to remove the excess was practically impossible. If correct drop forgings could have been furnished these plants, material production might have been made. Many of the converted plants which accepted contracts for steel forceps held firmly to the theory that soft-metal polishers could be easily trained into steel


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polishers. This theory, however, did not prove true. The soft-metal polishers did not adapt themselves easily, and it was many months before they produced anything worth while.7

The smoothing and polishing of the inside of the rings on the forceps has always been done by what is called strapping. Several of the new firms constructed special machines for doing this by a new process, but their effort was wasted. The machines did not do the job faster than the simple strapping method.7

These converted industries had very little trouble in making articles of soft metal. They made those articles with very little instruction or special help.6

In the later months of the war new plans were put into effect for overcoming the shortage of forgings. The plan contemplated amid partially completed was based upon the forgings being furnished by the Government. Contracts were to be made with reliable drop-forging establishments for the production of the blanks. These plants had their own drop hammers and trained die makers; this assured correct shapes and proper steel. The forgings were to be delivered to special finishers who were qualified to do the work. This work was to be done under the supervision of competent inspectors. The Medical Department was thereby assured of a more uniform product and delivery in ample quantities. All parts were standardized, even the screws used in forceps, scissors, etc. These standard parts were to be supplied with the forgings and also to be used in the repair of instruments. Arrangements were completed so that parts could be properly tempered or heat treated at New York, Philadelphia, and Chicago. The regular instrument makers were asked and willingly agreed to assist Government inspectors in their respective localities.5

The smaller shops were unacquainted with the procedure for making bids to the Government and the details for delivery. They were not familiar with the financial aspects of billing and collecting the actual money with which to meet their pay rolls. These small makers did not have sufficient capital to carry their accounts until they received reimbursement from the Government. Farming out material for partial finishing and plating was resorted to only in isolated instances.7
 
The surgical instrument committee was interested in the quality of the instruments to be furnished on Government contracts. It feared that unless measures were taken to prevent it, inferior instruments might be supplied. In order to protect the reputable manufacturer and to prevent the introduction of spurious instruments, orders were issued by the War Department which required that all metal instruments furnished the Medical Department of the Army should be impressed with the trade-mark of the actual manufacturer. If the manufacturer did not have a trade-mark, his initial or other identifying mark was to be stamped on the instrument. Instruments which were not a product of the contractor’s plant, but which had been obtained from other sources by the contractor, were required to bear only the trade-mark or the initial or other identifying marks of the person in whose manufacturing establishment they were made. This requirement did not preclude the use of imported


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instruments, but it did serve a useful purpose in identifying any which were later found defective.8

Besides the difficulty arising from a shortage of skilled labor, the surgical instrument makers, during the months of January to March, 1918, were confronted with a shortage of fuel.9 Early in January the Fuel Administration had been established to coordinate the distribution of fuel and to conserve the supply. Under the restrictions proposed by the Fuel Administration, some difficulty was at first experienced in securing a proper amount of coal. All manufacturers who were devoting the major part of their production for Government contracts were favored in the matter of fuel and measurements effected whereby their minimum requirements in the matter of coal were made until the fuel situation eased with the coming of the spring weather.

The surgical instruments standardization board, which compiled the list of instruments to be standardized, also revised the various instrument cases on the standard supply table of the Medical Department.10 Such changes were made in the cases as were necessary to adapt them to the instruments in the standard list. In preparing the new list of contents to these cases a particular catalogue number of each instrument was given where the instrument had been standardized. In the few cases where the instrument had not been standardized, the instrument required had been furnished for many years, and a sufficient number of dies were available to insure an adequate quantity. New instrument cases were added from time to time as the needs of the hospitals required. The number of new cases, however, was small. The principal among them were the auxiliary eye cases, the ward dressing set, and the brain, oral, and plastic surgery outfits.

PURCHASE

The instructions for the early purchase of surgical instruments were contained in the general instructions to purchase medical and hospital supplies issued to the depots at New York and Washington on May 25, 1917.11 The instructions for the purchase of veterinary instruments were issued to the medical supply officer at St. Louis on May 21, 1917.12 In making these purchases, proposals for instruments were forwarded to bidders through the committee on surgical instruments and hospital equipment. The committee apportioned the instruments to be supplied among the various manufacturers according to their abilities and notified the purchasing officers of the number and kinds of instruments each manufacturer was to furnish. 13

While the quantities of instruments required on the original schedule of supplies for an army of 1,000,000 men were large, it was realized that the future requirements of an ever-increasing army would be still greater. To provide for these increasing requirements, the officers in charge of the medical supply depots at New York, Washington, and St. Louis were instructed on September 18, 1917, to duplicate the existing contracts for surgical instruments as to both quantity and price. These contracts were to be prepared and submitted to the manufacturers for signature. If they were unwilling to accept the contracts or the prices, the Surgeon General was to be notified. 14 The makers accepted the contracts without comment and the work proceeded.


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In January, 1918, the schedules of procurement sent to the three purchasing depots included a large number of instruments. In June, 1918, another schedule was sent them. The quantities of instruments given on the automatic supply table received from the commanding general of the American Expeditionary Forces in France were larger than had been anticipated and called for a material increase in the procurement and productive schedules of surgical instruments.

A grave emergency having arisen in France in August, 1918, from an acute shortage of surgical instruments,15 effective measures to meet the need became urgent. Accordingly, instructions were given to the officer in charge of the medical supply depot in New York and to the officer handling the purchase of surgical instruments in the general purchasing office, in Washington, to purchase, from stock in the hands of dealers wherever it could be found, instruments on the standard supply list, or others very nearly like them. Purchases were made, accordingly, in New York City, Philadelphia, Cleveland, Chicago, St. Louis, Cincinnati, and Pittsburgh. These instruments went forward on a fast transport and arrived speedily at their destination. They proved sufficient to meet the emergency which had arisen.

During the earlier months, after the establishment of the large hospitals at the various training camps throughout the United States, it was not possible to furnish as many instruments as the local surgeons thought desirable. While manufacture was proceeding as rapidly as possible under the facilities then available, the output of all the factories was not sufficient to provide the instruments required. Complaints were received from some camps, for example, Camp Lewis, concerning the shortage of instruments and that the surgeons were being required to use their own instruments.16 Many of the surgeons had brought with them to the camp the instruments used by them in their private practice. To overcome the shortage of instruments thus reported and to relieve the surgeons from the need of using their own instruments, instructions were issued for the purchase of all privately owned instruments in use at the hospitals which were considered necessary for their proper operation.16 These instructions resulted, however, in the purchase of comparatively few instruments. Many of the surgeons having instruments and using them at the hospitals refused to sell them. In a few instances the surgeons, with the approval of the camp commander, went to near-by cities and purchased instruments from local stock. The instruments so purchased were later vouchered and paid for out of Medical Department funds.

INSPECTION

The inspection of surgical instruments is always a difficult procedure. No specifications and no simple tests had been worked out for the information and guidance of inexperienced personnel in making inspections. To formulate specifications would have taken so much time that the Medical Department would have had very little equipment before the end of the war. It was practicable for a few inspectors actually trained in the manufacture of surgical instruments to visit the factories from time to time, to watch the process of manufacture, to suggest changes and improvements, and to inspect the instruments in their various stages from inception to finish. A few such experienced instrument men


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were secured, and these were supplemented by examiners from the appraiser’s division of the customhouse at New York. The inspections which were made were deemed adequate, because each of the inspectors knew the character and the reputation for reliability of the various manufacturers, importers, and dealers in the industry. On deliveries from dependable sources, inspections of a few articles passed the lot.2 Less dependable sources received more attention. The regular sources of supply of surgical instruments were generally satisfactory and gave but little concern as to usability of the material. The finish often fell below the normal requirements, but consideration had to be given to the insistent demand for rush deliveries, to the lack of time, which forced under-finish, and which had to be overlooked if the material was found to be effective for its purpose.

Certain instruments were imported from Japan. The earlier imports were not dependable. Thorough inspection was required and often resulted in the rejection of the greater part of the delivery. During the later months of the war, however, the instruments imported from Japan rapidly improved in quality, and many of them were found satisfactory.

For many years prior to 1914, practically all surgical needles used in the United States were imported from England. The greater part of these needles were made by two firms, located at Redditch, England, 17 which specialized in the manufacture of needles and were able to supply the demand both of Great Britain and the United States without difficulty.

With the outbreak of hostilities in 1914, the export of surgical needles from England was greatly curtailed. As the demand for man power at the front increased, the number of skilled workmen at home diminished and the output fell off. The British Government was thereby confronted with the necessity of reducing the output of surgical needles and of conserving the available stock for the use of its own forces. This need arose partly from the shortage of steel and partly from the reduction in manufacturing personnel. The few surgical needles manufactured during the years 1914-1916, inclusive, contributed but little toward supplying the needs of the country. Imports into the United States rapidly diminished.

The stocks on hand in the United States at the outbreak of hostilities in 1914 and the dwindling supply which continued to find its way from England had sufficed for the civilian needs until the entry of the Medical Departments of the Army and Navy into the market for needles for military purposes. A large number of cases of instruments had been ordered by the Medical Department of the Army in the late summer of 1916. Each one of these cases contained a dozen needles. In July, 1917, the contractors reported that they were still awaiting the major part of the needles required to fill these cases.18 The number of needles required for the instrument cases needed for the Army of 1,000,000 men caused an acute shortage. Under the British export restrictions they could not be obtained from England. After the United States had decided to join the Allies it was thought that these restrictions might be sufficiently relaxed to provide for its military needs. Accordingly, a letter was addressed to the Secretary of State on April 17, 1917, by the Secretary of War, setting forth the difficulties experienced by the Medical Department in procuring


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surgical needles in sufficient quantities for Army purposes as a result of those restrictions; the assistance of the State Department was solicited in securing their relaxation.19 The request was promptly transmitted by cable to the American ambassador at London, that the British markets be opened to purchases of surgical needles for the United States forces.20 On May 7, the Secretary of State was advised that the Medical Department of the Army had endeavored to purchase 14,300 dozen needles during the previous year, of which only a part had been delivered. The needs of the Army for surgical needles during the ensuing year were placed at 68,000 dozen, or approximately 6,700 gross.21 The military needs of the United States for surgical needles was placed before the British Foreign Office by the American ambassador, but apparently without material results. In the meantime, correspondence between the contractors in the United States and the manufacturers at Redditch had been going on. The makers reported that an export license was necessary to enable them to supply the needles which had been ordered by the contractors.22 A request was made that the American Embassy secure authorization for the purchase of these needles, and a letter to that effect was addressed to the Secretary of State on July 18, 1917.23 The matter was again taken up by cable and the Secretary of State was advised, August 13, as follows: 24

The British Government is willing to allow the exportation to the United States of not more than 5,000 gross surgical needles during the next 12 months on condition that the distribution will be made under United States Government control. This represents the maximum which in all probability can be spared from the limited production in this country. It is extremely desirable that in ordering needles from the United Kingdom the assortment be limited to as few models as possible. We understand that these needles if distributed under United States Government control can be obtained at the same price which the British Government has fixed to the manufacturers of these needles. Needles ordered by Haslam, 500 gross; Charles Lentz & Sons, Philadelphia, 100 gross; Powers & Anderson, Richmond, 35 gross; Porter Bros., New York, 70 gross, can be released for shipment as soon as ready, if they are consigned to the United States Government, or its nominees. These lots will be part of the 5,000 gross set apart for the United States. Telegraph to whom these needles should be consigned. Suggest cooperation, with Council of National Defense.

In the meantime in the process of negotiations between the American ambassador and the British Foreign Office, the following information was received July 25, 1917:25

With reference to the note No. 4235 which, your excellency was good enough to address to me on July 3 regarding the exportation of surgical needles from Great Britain to the United States of America, I have the honor to state that while the most favorable consideration possible is being given to application for licences to export these goods to America, the supply is for the moment insufficient to meet the requirements of the War Office in this country.

Efforts to secure an increase in the number of surgical needles allotted to the United States continued, and on August 30, 1917, the following cable was sent by the Department of Commerce to the commercial attaché in London: 26

Consign needles commanding officer, Army Medical Supply Depot, six twenty-eight Greenwich Street, New York, who will control distribution. Five thousand gross wholly inadequate for country’s requirements. Request more.


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Although the British Government found it impracticable to increase the apportionment of surgical needles to the United States, deliveries of the quantities authorized were made with commendable promptness. The shipments were consigned to the officer in charge of the medical supply depot at New York, who made distribution to the firms for whom they were intended. These firms used the larger part of the needles on their orders in completing the contracts with the Government.

When it became evident that a sufficient number of surgical needles could not be imported from Great Britain to take care of the military requirements, a survey was made of the possible facilities within the United States which might be converted or developed for the manufacture of needles. It was believed that if sewing-machine needles could be produced satisfactorily, surgical needles might also be produced by a slight modification of the plant and by the training of the necessary personnel. A survey was made of the factory and facilities of the one manufacturer in the United States who was producing surgical needles. This survey, made on September 13, 1917, disclosed the fact that the company occupied two floors of a substantial manufacturing building. The firm had acquired, a year and a half previously, the needle-making machine already referred to. They had not experimented in the manufacture of needles and had had a great many trials and tribulations. They were at that time actually turning out needles in smaller quantities of satisfactory quality. It was probably from the experience that the company had had that they were at least six months ahead of anyone else who might enter the field. They were filling orders from surgical supply houses in a small way. It was suggested that the Government take over the entire output of needles and cancel all orders that the company had, and that the Government give them such assistance financially and otherwise as might be necessary to increase their output within as short time as possible to a specified quantity of needles per day.27

At a conference between representatives of the Council of National Defense and the Surgeon General it was agreed that efforts be made to obtain an offer of a contract from Randall, Faichney & Co., the owner of the equipment just mentioned, on 22,000 gross of surgical needles representing 6 different sizes as listed in the catalogue of surgical instruments.28 The Singer Sewing Machine Co., which had been approached and had expressed a willingness to undertake the manufacture of surgical needles, was to be requested to submit an offer on 22,000 needles at the present time.28 The Ostby & Barton Co., were requested a few days later to submit samples and to quote prices on 12,000 gross of needles.29 In the event that the sample needles prepared by these three firms proved satisfactory, contracts for the quantities mentioned were to be given each of them. The War Industries Board recommended, October 5, 1917, that Randall, Faichney & Co., be given a contract for 19,000 gross surgical needles of various types and sizes.29 On November 9, 1917, the Singer Sewing Machine Co., reported that the necessary machinery was rapidly being installed, that dies were nearly complete, and that it hoped within a very short time to be actually making needles. As soon as manufacture had reached that point a price would be submitted. One thousand needles of size 4 had already been


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manufactured and were ready for delivery.30 On November 15, 1917, the Singer Sewing Machine Co., reported the work progressing and requested dates of delivery considered necessary. 31

Samples were submitted, and thereafter the work proceeded satisfactorily and needles were turned out in quantities. The other manufacturers mentioned were also proceeding with the making of surgical needles, and the United States had no longer need to depend upon importation for its surgical needles. These firms continued to manufacture surgical needles until the end of the war, and all of them developed efficient organizations for that purpose. While the needles furnished by them had not measured up in all respects to those which had previously been imported, they were nevertheless satisfactory for the purpose for which they were intended, and no difficulties in their use were experienced.

At the time of signing the armistice large stocks of surgical needles in all the standard sizes were on hand in the various medical supply depots, and existing contracts were terminated on terms favorable to the Government and to the satisfaction of the contractor.

Upon the cessation of hostilities and the termination of the contracts, the organizations of the Singer Sewing Machine Co. and the Ostby & Barton Co. built up with such care for the manufacture of surgical needles, were disbanded and the production of needles discontinued.

REFERENCES

(1) United States Tariff Commission. Tariff information, Series VII. The surgical instrument industry in the United States. Government Printing Office, 1918.
(2) Letter from Lieut. Col. Alfred Littauer, O. R. C., 337-341 Fourth Ave., New York City, N. Y., to Col. Edwin P. Wolfe, M. C., June 11, 1927.  Subject: Surgical instruments during World War. On file, Finance and Supply Division, S. G. O., file 713-539 N.Y.1245.
(3) Letter from Charles J. Pilling, chairman, committee on surgical instruments and hospital equipment, to Dr. F. F. Simpson, medical section, Council of National Defense, April 11, 1917. Subject: Committee on surgical instruments. On file, Finance and Supply Division, S. G.O.,   572/a  C.J.P.
(4) Letter from Charles J. Pilling, Philadelphia, Pa., to W. C. Gorgas, Surgeon General, U. S. Army, January 24, 1918, relative to the surgical instrument situation regarding the Army. On file, Finance and Supply Division, S. G. O.,  572 C.J.P./36.
(5) Letter from Lieut. Col. George W. Wallerich, O. R. C., Chicago, Ill., to Col. Edwin P. Wolfe, M. C., January 29, 1917, relative to surgical instruments during the World War.  On file, Finance and Supply Division, S. G. O., 713-539 N. Y./1258.
(6) Letter from Lieut. Col. Alfred Littauer, O. R. C., to Col. Edwin P. Wolfe, M. C., July 2, 1927, relative to surgical instruments during the World War. On file, Finance and Supply Division, S. G. O.,  713-539 N. Y./1245.
(7) Letter from Lieut. Col. Alfred Littauer, O. R. C., to Col. Edwin P. Wolfe, M. C., July 5, 1927, relative to surgical instruments during the World War. On file, Finance and Supply Division, S. G. O.,  713-539 N. Y./1245.


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(8) Letter from the Surgeon General to the officer in charge, Medical Supply Depots, New York, Washington, and St. Louis, November 15, 1917. Subject: Revised instructions as to markings of surgical instruments. On file, Finance and Supply Division, S.G. O.,  715 Surg. Inst./1.  
(9) Letter from Charles J. Pilling, Philadelphia, Pa., to the Surgeon General, January 31, 1918, relative to fuel. On file, Finance and Supply Division, S.G.O., 574 C.J.P./3.
(10) Proceedings of the board of officers convened at the Field Medical Supply Depot, Washington, D. C., for the purpose of making recommendations for the revision of the instrument cases of the Medical Department of the Army, May 25, 1917. On file, Finance and Supply Division, S. G. O., Document File.
(11) Letter from the Surgeon General to the officer in charge, Medical Supply Depot, New York, May 25, 1917. Supplies for a million men. On file, Finance and Supply Division, S. G. O., 14039-20-14.
(12) Letter from the Surgeon General to the officer in charge, Medical Supply Depot, St. Louis, May 21, 1917. Subject: Veterinary supplies. On file, Finance and Supply Division, S. G. O., 14066-14.
(13) Letter from Charles J. Pilling, chairman, committee on surgical instruments and hospital equipment, to the Surgeon General, August 25,  1917, relative to allotments on veterinary instruments. On file, Finance and Supply Division, S. G. O.,  572 C. J. P./V.
(14) Letter from the Surgeon General to officers in charge, Medical Supply Depots, New York, Washington, and St. Louis, September 18, 1917. Subject: Surgical instruments. On file, Finance and Supply Division, S. G. O.,  713-5-39/136.
(15) Par. 1b, Cable 1606, Headquarters, A. E. F., to The Adjutant General, August 17, 1918, relative to shortage of surgical instruments.
(16) Correspondence between the Commanding Officer, Base Hospital, Camp Lewis, Washington, and the Surgeon General, January to March, 1918, inclusive, relative to the shortage of surgical instruments and to purchase of privately owned instruments in the possession of medical  officers.On file, S. G. O., Finance and Supply Division, 531-127/136.
(17) Letter from the Acting Secretary of War to the Secretary of State, May 7, 1917, relative to the importation of surgical needles. On file, Finance and Supply Division, S.G. O., 14039-31.
(18) Telegram from Alfred Littauer, O. R. C., secretary, committee on surgical instruments and hospital equipment, New York, to the Secretary of War, July 13, 1917, relative to surgical needles, Finance and Supply Division, S. G. O., 14636-76.
(19) Letter from the Secretary of War to the Secretary of State, April 17, 1917, relative to shortage of surgical needles. On file, Finance and Supply Division, S. G. O., 14039-31.
(20) Letter from the Secretary of State to the Secretary of War, April 20, 1917, advising that cable had been sent ambassador at London requesting British markets be opened to the purchasers of surgical needles for American Army needs. On file, Finance and Supply Division, S. G. O., 14029-31.
(21) Letter from the Acting Secretary of War to the Secretary of State, May 7, 1917, relative to surgical needles. On file, Finance and Supply Division,  S. G. O., 14029-31.
(22) Letter from the Kny-Scheerer Corporation to the War Department, Office of the Surgeon General, September 17, 1917, including correspondence with the surgical needle manufacturers. On file, Finance and Supply Division, S. G. O.,  418/6.
(23) Letter from the Secretary of War to the Secretary of State, July 27, 1917, requesting authority for the ambassador, Great Britain, to assist in effecting shipment of surgical needles. On file, Finance and Supply Division, S. G. O., 14636-76.


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(24) Letter from the Secretary of State to the Secretary of War, August 16, 1917, inclosing copy of cablegram of August 13, 1917, from the American, ambassador, London,, England, relative to surgical needles. On file, Finance and Supply Division, S. G. O., 14636-76.
(25) Note No. 145 232 X from the foreign office, S. W. I. London, to His Excellency, the Honorable W. H. Page, July 25, 1917. On file, Finance and Supply Division, S.G.O.,  418/2.
(26)  Letter from Fred. B. Peterson, Exports Administrative Board, Washington, D. C., to Lieut. Col. Carl R. Darnall, Medical Supply Officer, Medical Supply Depot, U. S. A., Washington, D. C., August 30, 1917, relative to cable to the commercial attaché, London, relative to surgical needles. On file, Finance and Supply Division, S. G. O., 533-498/3.
(27) Memorandum of the visit made by G. E. Chatillon to the factory of Randall, Faichney & Co., Boston, Mass. On file, Finance and Supply Division, S. G. O.,533-N.D./269.
(28) Memorandum for Col. Darnall, Surgeon General’s Office, by Everett L. Crawford, Council of National Defense, September 15, 1917, relative to a survey of thefactory of  Randall, Fachney & Co., Boston, Mass. On file, Finance and Supply Division, S. G. O.,  533 N. D./269.
(29) Letter from George E. Chatillon, Council of National Defense, to Col. Darnall; S. G. G., October 5, 1917. Subject: Surgical needles. On file, Finance and Supply Division, S. G. O.,  533 N.D./269.
(30) Letter from the Singer Manufacturing Co. to George E. Chatillon, War Industries Board, Council of National Defense, Washington, D. C.,November 9, 1917, reporting progress in manufacture of surgical needles. On file, Finance and Supply Division  S.G.O., 533 N.D./269.  
(31) Letter from the Singer Manufacturing Co. to George E. Chatillon, War Industries Board, Council of National Defense, November 15, 1917. On file, Finance and Supply Division, S. G. O.,  533 N. D./269.