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Chapter XXXV

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

CHAPTER XXXV

SURGICAL DRESSINGS AND SUTURES

TYPES OF DRESSINGS FURNISHED

The standard supply table provided the following list of surgical dressings:1 Bandages, gauze, compressed, 2 -inch, 3-inch, 3½-inch, 6-yard rolls, 1 gross in packet; bandages, gauze, roller, 2 ½-inch, 3-inch, 3½-inch by 10 yards, 6 dozen in a box; cotton, absorbent, 1 pound in rolls, for general hospital use; cotton, absorbent, sterilized, 1 ounce in package for field use; first-aid packets, metal covered; first-aid packets, shell wound; individual dressing packets; gauze, plain, 25 yards, in roll or 100 yards in bolt; gauze, plain, in 5-yard rolls; gauze, plain, sterilized, two ½-yard lengths in package; gauze, sublimated, two ½-yard lengths in package. To these were added during the war: Front-line packet No. 1, red label; front-line packet No 2, white label; front-line packet No.3, blue label.

A full description of the standard prepared surgical dressings and the specifications for absorbent gauze will be found in Chapter XIX. Specifications for gray gauze and for gauze roller are quoted below:

SPECIFICATIONS For GRAY GAUZE

Material.- Gray goods to be made of 1 1/16 -inch staple white cotton, not lower in grade than United States Government type middling, and free from blue benders or tinged cotton.
The material used in the sizing of the yarns for this cloth shall be free from inorganic sizing or loading material, insoluble soaps, paraffin, glue, unsaponifiable oils, waxes, water’ nsoluble gums, or turpentine.

Construction. - The gray gauze shall be not less than 36 inches wide, and the thread count and weight per square yard shall be in accordance with the following table:

Warp

Weft

Approximate weight
per square yard
Grams

20 or19

16 or 15

19

22 or 21

18 or 17

22

28 or 27

24 or 23

28

44 or 43

40 or 39

48


TESTS

Water extract. - One-half yard of gauze extracted with distilled hot water in a Soxhlet extractor for five hours shall yield an extract weighing not more than 3.5 per cent.

Alcohol
extract. - One-half yard of gauze extracted with 95 per cent ethyl alcohol in a Soxhmlet extractor for five hours shall yield a solid extract when dried at 100° C. of not more than 1.65 per cent by weight.

Ether extract -
One-half yard of gauze extracted with ethyl ether in a Soxhlet extractor for five hours shall yield a solid extract when dried at 100° C. of not more than 1 percent by weight.


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Incineration. - One-half yard of gauze incinerated in a platinum crucible shall yield not more than 90 per cent by weight of ash, containing potassium, sodium, magnesium, calcium, iron, and aluminum which were originally in combination with hydrochloric, sulphuric, and phosphoric acids.
Put-up. - Rolls of 1,000 yards or over if possible, otherwise bales of usual size. Rolls or bales to be fully protected with strong kraft paper, or paper of similar strength, and covered with new or clean burlap, equal to 40-inch, 7½ ounces per yard.

Length of cuts. - Goods to be woven in pieces as long as possible, no pieces under 60 yards to be accepted, and with no appreciable quantity of pieces less than 120 yards in length. The pieces furnished on rolls to be sewed in such manner that cloth at the sewing will be full width and filling yards run horizontally across fabric.

Approved.

SURGEON GENERAL’S OFFICE, UNITED STATES ARMY,
October 16, 1918

SPECIFICATIONS FOR PLAIN BANDAGES, ASSORTED

Six dozen in a box (24 each 2 ½ inches, 3 inches, and 3½ inches by 10 yards).

Material. - All
gauze to be in accordance with United States Government Standard Specifications for Absorbent Gauze, in weight, mesh, and chemical analysis. Bandages to be made from gauze having 44 threads to the inch in the warp and 40 threads to the inch in the filling.

Size and wrapping. - Each bandage to be one continuous 10-yard length of material specified above, and to be of the full width specified, to be smoothed out and tightly and evenly rolled. Each bandage to he securely wrapped and sealed, the wrapper to be of good quality white paper, equal to the standard sample on which shall be printed the size of the bandage, in figures, with name and address of the contractor.

Packing. - Bandages to be packed in plain strawboard boxes each containing 24 bandages of each of the three sizes designated, each box to bear a label showing contents, contractor’s name and address, and date of contract. These paper boxes to be packed in strong wooden cases of not less than ¾-inch, finished size, spruce or white pine lumber; 20 paper boxes to each case. Cases to be stenciled on one end with the number of dozen bandages contained therein and the name of the contractor and the date of the contract.

PURCHASES IN 1917

The surgical dressings manufacturers met in Washington in April, 1917, and organized a committee of surgical dressings manufacturers which cooperated with the Council of National Defense.2 The executive committee of this association at that time received the requirements of the Army, the Navy, and the American Red Cross, and apportioned them among the various manufacturers in accordance with their ability to produce. A representative of this committee negotiated with the manufacturers of gray goods in behalf of all the surgical dressings manufacturers for the quantities of gauze needed to produce the surgical dressings required. The surgical dressings required by the Army at that time called for approximately the following quantities of gauze:
   Yards
38½-inch, 44 by 40, 8.2 yards per pound...........................................................................35,000,000
36-inch, 32 by 28, 13 yards per pound...............................................................................10,000,000
36-inch, 28 by 24, 15 yares per pound................................................................................45,000,000
36-inch, 22 by 18, 19 yards per pound...............................................................................   8,000,000
   Total................................................................................................................................. 98,000,000

The cost-plus percentage type of contract was then favorably regarded. The surgical dressings manufacturers requested that the contracts for surgical dressings be made on that basis. Accordingly a special type of contract was


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prepared for surgical dressings on the basis of the cost of cotton gray goods and the necessary fixed overhead, to which was added a profit of 10 per cent. For the form of contract see page 122.

The cost of the gray goods used in these contracts was on the following basis: 4
  Cents per yard

38-inch, 44 by 40; weight, 8.2 yards per pound.....................................................................   5 7/8
36-inch, 22 by 28; weight, 13 yards per pound......................................................................   3 7/8
36-inch, 28 by 24; weught, 15 yards per pound.....................................................................   3 ½
36-inch, 24 by 20; weight, 17 yards per pound...................................................................... 3
36-inch, 22 by 18; weight, 19 yards per pound...................................................................... 2 ¾
 
While the cloth is commonly sold on the basis of the price per yard, in the trade it is quite as often quoted on the basis of the price per pound. It will be seen from the prices per yard already quoted that the price per pound would vary between 48¼ cents and 52½ cents, or an average of about 50 cents. The manufacturers  of surgical dressings had no difficulty in placing their orders for the required amount of gauze. The deliveries called for were for short periods. The demand for dressings was immediate and urgent. Delays, however, were experienced by the manufacturers of finished dressings in the receipt of needed machinery and in perfecting their organizations. Contracts were not ready for signature until nearly the end of August, 1917, although production began in June and July.5 The work had proceeded in advance of the receipt of contracts upon the understanding between the representative of the Medical Department and the manufacturer that contracts would be forthcoming as soon as the forms had been perfected. The mills manufacturing gauze experienced difficulty in securing shipments of cotton from the South.6 Embargoes were frequent and special arrangements had to be made for securing cars for the shipment of raw material. Supplies to fill Government contracts, and definitely known by the railroads to be such, were given preference in shipment. Manufacturers of gray goods were furnished the contract numbers of the surgical dressings manufacturers and instructed to have those numbers placed on bills of lading for the shipment of the cotton needed for the production of the gray goods to fill their orders. In the event that these measures did not suffice, the manufacturers were instructed to apply to the Surgeon General’s Office or to the Council of National Defense for assistance in securing transportation. Priority certificates were issued to the surgical dressings manufacturers and subsidiary priority certificates to the manufacturers of gray goods.7 In spite of this, deliveries on gray goods to the surgical dressings manufacturers continued to lag. Some manufacturers experienced greater difficulties than others. The producers were urged to speed up production. By the end of the year deliveries had been made in sufficient quantities to meet requirements.

In November, 1917, it became evident that further orders must be placed at an early date for surgical dressings to meet the increasing and expected requirements of the following year. Although the committee of surgical dressings manufacturers, as a part of the Council of National Defense, had been dissolved, a war service committee of the same manufacturers had been organized.8 Negotiations continued to be made through the representatives of that committee. On November 28, 1917, a member of the committee was informed that


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the Medical Department desired to place contracts for bandages and surgical dressings for delivery during the first three months of 1918, and that approximately 35,000,000 yards of bandage cloth and surgical gauze would be required.9 The committee was requested to purchase the cloth from the mills and was authorized to represent the interests of the Medical Department in the purchase. It was stipulated that the purchase be made at as reasonable a margin above actual cost of production as possible. Priority in the delivery of the cloth from the cotton mills participating was required.9 The Medical Department undertook to assume responsibility for the cloth in the event of difficulty on the part of the maufacturer of surgical dressings in securing it.9 Following this request, a representative of the surgical dressings manufacturers selected by the Surgeon General to negotiate the purchase of the gauze, accompanied by a representative of the Council of National Defense and a representative from the Quartermaster General, visited the mills in the Fall River district of Massachusetts to negotiate for the purchase of this material. In these negotiations it was found much more difficult to secure a fair price for the materials than in the purchase made earlier in the year.10 This was due in part to increased difficulties in the matter of finance and raw materials, but probably, to a considerable extent, to the belief on the part of the cotton mills that the surgical dressings manufacturers, in previous contracts, had secured unusually favorable prices.11 The contracts were finally placed at a price of approximately 65½ to 68 7/8 cents per pound, with full promise that deliveries would be completed within the first three months of the following year. While representatives of the Government negotiated the contract and arranged the price, the actual contracts were made by the surgical dressings manufacturers, who were to deliver the finished articles to the Medical Department.12 The dressings made from this gauze were 160,000 boxes of bandages, assorted, 2½-inch, 3-inch, and 3½-inch, by 10 yards in boxes of 6 dozen; 200,000 bolts of absorbent gauze, 100 yards to the bolt; and 400,000 rolls of absorbent gauze, 25 yards to the roll. The total yardage required for this purpose was 39,600,000.13

PURCHASES IN 1918

The increasing tendency of centralization of procurement led to the conduct of the negotiations for the purchases early in 1918 of surgical gauze by the Government direct rather than through the surgical dressings manufacturers. At the suggestion of the Quartermaster General, negotiations were handled through the cotton goods section of his department. By this time the requirements of the Army, the Navy, and the Red Cross were fairly well known. In the conduct of the negotiations for gray goods the requirements of these three branches of the service were considered as one. On February 9, 1918, the chief of the cotton goods section, Quartermaster General’s Office, was advised that approximately 160,000,000 yards of surgical gauze would be required between that time and the end of September, 1918.14 The gauze required would be 44 by 40, 32 by 28, 28 by 24, and 22 by 18. It was intended out of this gauze to produce the following surgical dressings:


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First-aid, packets, metal covered.....................................................................................2,400,000
First-aid packet, shell-wound...........................................................................................   800,000
Individual dressing packets..............................................................................................3,000,000
Bandages:
Compressed, 6 yards, 1 gross in box...........................................gross.......................   125,000 
Roller, 10 yards, 72 to the box....................................................... do...........................   125,000
Gauze:
  Plain -
5 yards in carton............................................................................carton.......................   240,000
In 1-yard packets...........................................................................packets.....................   450,000
18 by 22 mesh, 100-yard bolts......................................................yards......................20,000,000
  Sublimated, in 1-yard packets........................................................packets...................12,000,000

The proportions in which the gray goods were required were 67,000,000 yards 44 by 40, 15,000,000 yards 32 by 28, 32,000,000 yards 28 by 24, and 46,000,000 yards 22 by 18.15 The negotiations for the purchase of this gauze were promptly undertaken. The chief of the cotton goods section of the Quartermaster General’s Office, a representative of the War Industries Board, and a representative of the surgical dressings manufacturers met with the mill producers of the Fall River district on February 13, 1918.16 It was found that an artificial market had been created, due largely to the fact that the amount of the prospective Government contract had become known to the mills in that district. As a result the price had gone up 10 cents a pound and material difficulty was had in arriving at a fair price. The representative of the War Industries Board proposed that the price paid on the last purchase of gray goods, plus the extra cost of cotton, labor, and supplies, should form the basis of the price paid for the materials under negotiation. The mills declined to accept the offer, upon which all mills in the Fall River district were notified not to sell any of the contracts under negotiation, or cloth, or the products of the looms, until permitted to do so by the War Industries Board. It was contemplated that the War Industries Board would be requested to fix a price for the material which would yield a fair profit to the manufacturer. The result of this decision led to a material reduction in prices. The market quotation of the week previous to the conference between the mills and the representatives of the Government was approximately 70 cents per pound. The price asked at the conference was 90 cents per pound. The price finally paid was 72½ to 75½ cents per pound.17 After negotiations were completed covering the price, allotments were made to the various mills for the production of the gray goods. The orders were distributed among three groups of mills, the Fall river group, a northeastern group, and a southern group. Negotiations were conducted throughout by the representatives of the cotton goods section of the Quartermaster General’s Office. When the apportionment of the gray goods to the mills had been completed, the contracts with the mills were made by the Medical Department. A representative of that department was stationed at Fall River to supervise the inspection, acceptance, and shipment of the gauze produced by the mills in that district. When the different mills had shipments ready they notified this representative, and he arranged for the inspection of the gauze and its


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shipment on Government bills of lading to the surgical dressings manufacturers, who had contracted to convert them into finished dressings. A similar representative was stationed at Greenville, S. C., and performed like services. The proportion of the gauze on the respective contracts to be sent to each surgical dressings manufacturer was determined in the Surgeon General’s Office and a distribution list furnished its representatives in the Fall River and Greenville districts. Inspection of the gray goods in both areas was made by representatives of the customs service of the Treasury Department, acting on behalf of the War Department.

The quantity of gauze purchased and the proportions of the several constructions are shown in the following table: 18

[Table]

The facilities of the manufacturers of surgical dressings were strained to the utmost in the production of the bandages and field dressings, and it became necessary to find other agencies for bleaching and finishing the plain gauze for ordinary hospital use. Since there were many bleacheries in the United States engaged in bleaching sheeting and print cloth, no reason could be seen why their facilities should not be made applicable to the bleaching of surgical gauze. After some negotiations bleacheries were found willing and able to take over the bleaching and finishing of this material. The earlier outputs of these bleacheries were lacking in absorbency and finish, due to their lack of familiarity with the processes required. The same degree of absorbency is not required in ordinary bleached muslins or print cloths that is required in surgical gauze. The earlier processes at these bleacheries followed their accustomed practice and were not carried sufficiently far to produce the degree of absorbency required. This difficulty was overcome in time, and the output of the bleacheries passed the standard requirements.

The raw materials division of the War Industries Board became quite concerned in the middle of March, 1918, over the quantities of gauze being purchased for the Army. These purchases were thought to excite the market because of the size of the orders--more than 200,000,000 yards. Under such conditions the cotton-mill men would immediately go out to cover any obligations they might incur and the result would be a prompt rise in prices all along the line.19 This led to an inquiry from the surveyor general of purchases to the Surgeon General, concerning the negotiation then in progress for gauze.20 In reply, the Surgeon General advised that these negotiations were being conducted by the supply section of the Quartermaster General’s Office.21 While the quantity of gauze (230,000,000 yards) might seem large, it covered only a six months’ supply in so far as the Army was concerned, the estimate requirement


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of the Army being about 320,000,000 yards for the next year. This estimate was based on the quantity of surgical dressings asked for by General Pershing. 21

The 160,000,000 yards considered in the negotiations already described were expected to cover the period ending with September, 1918. As the military program proceeded and the number of troops in France increased, it became evident that in the period following October 1, 1918, additional surgical dressings would be required. Accordingly, in July consideration was given to the placing of further orders for surgical dressings material in the gray.

On July 30, 1918, instructions were issued for the placing of an interbureau procurement requisition with the Quartermaster Department for the following materials: 22

Gauze:   Yards
   36-inch, 22 by 18 , 19 yards to the pound..................................................................22,202,000
    36-inch, 28 by 24, 15 yards to the pound...................................................................10,795,000
   36-inch, 32 by 28, 13 yards to the pound....................................................................  3,300,000
   38 ½-inch, 64 by 60, 5.35 yards to the pound.............................................................68,738,000
 Sheeting, 36-inch, 64 by 60, 5.35 yards to the pound.....................................................   4,110,000

Interbureau procurement requisition M-21 was accordingly placed with the Quartermaster General on August 2. Receipt of the requisition was acknowledged August 9. The first contract under the requisition was made August 26, and the last contract. October 31, 1918. A previous requisition, M-12, placed early in July, called for 5,000,000 yards of gauze. The contracts actually placed, including overages, amounted to 115,535,000 yards.

Full shipping instructions were furnished showing the distribution to the finishers of the gauze on this requisition. These shipping instructions indicated the quantities of the different meshes to be shipped to the different finishers and surgical dressing manufacturers and the rate at which they were to be supplied. Inasmuch as experience with the last contracts placed by the Medical Department had brought to light the use by the mills of a sizing compound, which was practically insoluble and had rendered it very difficult to effect a satisfactory bleach, the procuring bureau was advised of this tendency and requested to have its inspectors constantly guard against it.

Difficulty was experienced in determining the quantities of gauze furnished on these contracts. A careful compilation of all available data made at the end of May, 1919, indicated the following as of that date:23

Chart

During the months in which the war had gone on in Europe there had come into general use, among the Allies, a type of dressing known as front-line packets. Prior to the entry of the United States into the war these packets had been made in large numbers by the American National Red Cross and


548

supplied for the use of the allied troops. They were considered more covenient for the dressing of wounds than the standard first-aid packet. This was largely due to the fact that the first-aid packet, as furnished by the Medical Department, was intended primarily for the treatment of the wounds ordinarily produced by the high-velocity small-arms bullet. A great many of the wounds incurred during the war were produced by shrapnel and fragments of high-explosive shells. They were accordingly much larger than those produced by the small arms and required a larger dressing. To meet these needs the front-line packets were developed. These packets are described in detail elsewhere (p.320). As the time drew near for the entry of the United States forces in large numbers into the zone of combat, the representatives of the Medical Department in France reported that a large number of front-line packets and other special dressings would be needed in the treatment of the wounded.24 The Surgeon General was advised by cablegram on March 1, 1918, of the relative quantities of the different kinds of dressings required.25 The quantities of these special dressings requested are given below.26

Number of dressings estimated as needed per month, March 1, to September 1, 1918

The Red Cross in the United States stated that the 5-yard gauze roll could not be sterilized completely except by very high pressure. The opinion was held that the 5-yard gauze rolls, if sent unsterilized should he so marked. It. was thought that a proportion of these rolls could be sterilized here and the additional needs be met by substituting the 3-yard roll, which would be sent sterilized.


549

The commanding general, A. E. F., urged a closer liaison and cooperation between the Medical Department and the American Red Cross in supplies of this sort provided for the American Expeditionary Forces. In the conference which followed between the representatives of the Surgeon General and those of the Red Cross in Washington, a working plan was adopted March 5, 1918, as follows: 27

The Surgeon General of the Army to advise the Red Cross the number and assortment of dressings required each month.

The dressings will he delivered to the Medical Department, f.o.b., New York, Boston, Washington, Philadelphia, Atlanta, New Orleans, Cleveland, Chicago, Minneapolis, Denver, San Francisco, Seattle, and St. Louis, packed and marked for shipment in accordance with instructions furnished by the Medical Department.
 
   At the end of each month the Red Cross will advise the Medical Department of the quantity of materials used in dressings delivered during the month, and the Medical Department will turn over to the Red Cross a like quantity of materials in exchange therefor.

Frequent conferences were held between the representatives of these two services until the details of the plan had been perfected. Under this plan the Medical Department placed with the Red Cross a request for the finished dressings desired, and the Red Cross placed with the Medical Department requisitions for materials required to prepare these dressings. The following requisition for dressings was placed by the Medical Department with the Red Cross March 8, 1918.28

It is requested that the following supplies be prepared for early delivery:

  Quantity
Packet, No.1, red label..................................................600,000
Packet, No.2, white label..............................................500,000
Packet, No.3, blue label................................................400,000
Gauze, roll:
5-yard..........................................................................    8,000
3-yard..........................................................................  10,000
Sponges:
Small.............................................................................400,000
Large............................................................................ 350,000
Sterile dressing pads..................................................... 300,000
Unsterile dressing pads:
Type 1 -
   Size 1.......................................................................... 200,000
   Size 2.......................................................................... 150,000
Type 2 -
   Size 1...........................................................................   75,000
   Size 2...........................................................................   50,000

Attention is invited to the following
Packing. - Must be carefully done and must be suitable for overseas shipment.

Marking.-
Each shipping package must be marked with a red cross 4 inches high and with the words, “Medical Department, U. S Army,” in letters at least 1 inch high.
In addition to this marking each package must be marked as directed in the instructions sent with the bill of lading.

Delivery. -
No shipment to be made except on Government bill of lading furnished by this office.  
When shipments are ready this office should be notified and the following information given:
(a)Exact location of supplies.
   (b) Number of packages.
  (c) Weight of each package.
(d)  Cubic feet of space required by each package.
(e)Address to which bill of lading should be sent.

It is requested that a statement of the quantity of immaterial used in making these supplies be furnished this office, in order that replacement of the same may be accomplished in accordance with the arrangement heretofore made.


550

The American Red Cross, in turn, placed with the Medical Department a requisition for 4,000,000 yards of gauze to be delivered to 11 regional representatives in the various cities throughout the United States. The quantities to be delivered to each special representative varied from 150,000 yards at New Orleans and Denver to 800,000 yards at New York.29 Shipment of this gauze was ordered by the Surgeon General on March 8.30

The American Red Cross was requested to place an order with the Surgeon General for the materials other than gauze required to make up a sufficient number of the several kinds of dressings described, in the required proportions of each kind, to exhaust the 4,000,000 yards of gauze furnished. The Red Cross advised the Surgeon General on March 18, 1918, that the following articles enumerated in the order already quoted, were available for immediate issue.31 The other articles would necessarily have to be made up. 

  Gauze rolls, 5-yard...........................................................................8,000
   Sponges:
   Large...........................................................................................350,000
   Small............................................................................................400,000
Sterile dressing pads................................................................... 300,000
Unsterile dressing pads:
   Type 1 - Size 1............................................................................200,000
Size 2.............................................................................150,000
   Type 2 -Size 1.............................................................................. 75,000
Size 2.............................................................................. 50,000
 
The quantities of materials required to supplement the 4,000,000 yards of gauze in proportion of these dressings were estimated to be:

Alsorbent cotton..............................................................pounds...............184,508
Nonabsorbent cotton.......................................................do........................ 93,805
Muslin.................................................................................yards..................657,000

   It was desired that these front-line packets be properly identified. It was considered appropriate that the Medical Department receive credit in the minds of the users for its share in the preparation of the dressings. To insure facility in warehousing and distribution it was necessary that the packing cases be properly marked. To accomplish this end, request was made to the American Red Cross to cause the following instructions to be issued: 32

Packing cases should be marked on one side with a red cross 4 inches high and the words “Medical Department, U. S. Army--From A. R. C.,” in letters at least 1 inch high.
On each end of the box the contents should be plainly stenciled. Thus, “115 dressing pads, type 1, size 2.”
When shipping instructions are received from this office the other markings required, as specified herein, also should be stenciled on the box.
No other marks whatsoever should appear on the cases.
Packages of dressings or other supplies contained in a packing case or other container should bear labels or be stamped with the words "Material provided by the Medical Department, U. S. Army--prepared by American Red Cross.” The name of the chapter may also be given if deemed advisable.
Kind or type of dressing or other articles. Thus, “25 sponges, large, 4 in. by 4 in,.”

The front-line packets and other dressings on this order could not be properly sterilized by the various chapters of the Red Cross at which they were made. It became necessary to secure facilities for sterilizing them before shipment to France. After an extensive survey of the situation it was decided to have these packets sterilized in New York City, or its immediate vicinity. The Medical Department was fortunate at this time in finding an idle plant formerly devoted to the manufacture of ligatures. It was found that this plant


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was equipped adequately with sterilizers to effect the sterilizing of the packets. Accordingly, arrangements were made to ship all the first-line packets to this plant, where they were sterilized and packed for ocean shipment.33 A method of packing was devised in a very short time whereby the package could be placed in bales under moderate pressure and covered with burlap, instead of being packed in boxes.34 By means of this change a material saving was made in the cubic space of shipment. At first some difficulty was experienced in securing a steady flow of these front-line packets from the various chapters to the plant where they were to be sterilized.35 After the system had been in operation for a few weeks this difficulty was overcome, and a steady flow of these packets to France was assured. The medical supply officer in New York was authorized to furnish to the plant sterilizing the packets such quantities of waterproof paper, burlap, and other materials as might he necessary from time to time in the sterilizing of the packets and in their preparation for shipment abroad.36

A further request, omitted from the original orders, was placed with the American Red Cross, May 3, 1918, for the following items in the quantities mentioned, per month for the ensuing six months:37

Oakum pads:
Size 1...........................................................................5,000
Size 2...........................................................................5,000
Sphagnum-moss pads:
Size 1............................................................................6,000
Size 2............................................................................6,000
Bags for shot-bag weights...........................................2,000
Heel rings........................................................................5,000
Elbor traction bans.......................................................15,000
Many tailed bandages.................................................  5,000
Penumonia jackets........................................................  5,000
Scultetus bandages......................................................  5,000
Supporting slings:
Size 1............................................................................  5,000
Size 2............................................................................  5,000
Size 3............................................................................  5,000

Before shipment of the sphagnum-moss dressings to France began they were tested out in Army general hospitals.38 Information concerning them was sought from surgeons who had used them in civilian hospitals. These reports varied as to the suitability of this substance for dressings. The principal objection was the manner in which small particles like leaves shook out of the containers, scattered over the remainder of the dressings and gave an untidy appearance. To obviate this, layers of absorbent cotton were used in conjunction with the moss.39 Other hospitals did not consider the objections material and used the moss for surgical dressings with varying degrees of satisfaction. Having been requested by the medical staff of the American Expeditionary Forces, these dressings were supplied in the quantities requested.40 The material was cheap and its use relieved the cotton situation by that much. The moss was found in large quantities in some of the Northwestern States and in Canada.

In the list of contents of the front-line packets, as originally furnished from France, there were 18,000,000 bandages cut on the bias. These bandages varied in width from 4 inches, in front-line packet No.1, to 6 inches in width, in the front line packets No.3. Two bandages in these packets seemed unnecessary. Accordingly, instructions were given on April 27, 1918, to reduce the number of bandages in each front-line parcel to one. Not only did the two seem unnecessary, but it was becoming increasingly difficult to secure a sufficient


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quantity of material for making the bandages. It was found necessary practically to commandeer the looms of certain mills in the United States to get the muslin necessary to make up the bandages authorized. It was believed that if a greater number of muslin bandages was required at the front than one in each front-line packet, they could he furnished separately. Five hundred thousand of each size were sent monthly in addition to those in the packets.41 To provide the necessary muslin for these front-line packets, muslin bandages, and other special dressings, 2,098,000 yards of muslin were purchased in March 42 and an order for 5,000,000 yards more placed with the cotton goods section of the Quartermaster General’s Office on April 8, 1918.43

The introduction of the muslin bandage involved the finding or the development of new facilities for their production. The various surgical dressings manufacturers making gauze bandages were working at top speed to produce them. Very few of them had either space or facilities for taking on muslin bandages in addition to their other work. It became necessary, therefore, to find facilities elsewhere. Fortunately, about this time certain industries had either passed into the classification of nonessentials or their business had fallen off to such an extent that they were desirous of undertaking war work. A large embroidery manufacturer in New Jersey expressed a desire to undertake the manufacture of bandages and quoted prices which proved satisfactory. Upon investigation this plant was found adequate for the purpose.44

By the end of October, 1918, practically the entire requirements for the American Expeditionary Forces in the special types of dressings, already enumerated, had been met. No difficulty was anticipated for future requirements.

The quantities of these special dressings actually shipped to the American Expeditionary Forces, France, were: 45

Quantities of special dressings shipped to France March to August inclusive, 1918

Packet No.1, red label

1,268,500

Sphagnum-moss dressing pads:

Packet No.2, white label

570,618

Size 1

4,000

Packet No.3, blue label

535.688

Size 2

4,000

Gauze roll:

Rubber cloth supporting slings:

Unsterile, 5-yard

56,905

5½ by 60 inches

30,000

3-yard rolls

17,672

8 by 24 inches

30,000

Sponges:

Sculetus bandages

31,200

Small size, 2 by 2 inches

2,406,625

Many-tailed bandages

40,500

Large size, 4 by 4 inches

2,106,175

Anklets, canvas

50,000

Sterile dressing pads

2,174,310

Canvas hammocks, 20 by 48 inches

12,000

Unsterile dressing pads:

Canvas swathes for Bradford frames

42,000

Type 1

Pneumonis jackets

14,483

Size 1

696,111

Size 2

551,865

Type 2 -

Size 1

217,781

Size 2

160,370

SUBSTITUTE MATERIALS FOR SURGICAL DRESSINGS

During the early months of 1918 considerable doubt was entertained that the quantity of cotton available would be sufficient to meet the requirements for textiles of all sorts and for surgical dressings. Investigations were instituted by various agencies looking toward the development of a. substitute material


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for surgical dressings. Among the substitutes offered for cotton was a preparation of wood fiber rendered absorbent and produced under the title “cellucotton.” 46 In order to determine its merits a considerable quantity of this material was purchased and distributed to the various general and base hospitals throughout the United States, with instructions to give it a thorough trial and report to the Surgeon General on its merits. Reports received on this substance were for the most part favorable. Its absorbency was better than the absorb-cut cotton furnished. For dressings intended primarily to absorb fluid it was fairly satisfactory. However, since it was apt to become hard and uncomnfortable when saturated, for general use in the hospital it proved advisable to limit its use; then it proved entirely satisfactory.47 As a result of these reports the material was purchased in large quantities and distributed to hospitals for use as a substitute for absorbent cotton in all those conditions for which it was found suitable.

The difficulty in providing an adequate quantity of absorbent gauze led to the development of a type of gauze known as “re-use knitted gauze.” This material came in much the same form as knitted cotton underwear. It was formed into a number of shapes which could be readily washed and sterilized for re-use. Forms for drying and forming of units after washing had been devised. Tests of the material were made at several of the general hospitals and found satisfactory. Accordingly, in April, 1918, 100 pounds of re-use knitted gauze were sent to 20 large hospitals. With this gauze was furnished an electric washing machine and a three-form aluminum steam drying and forming unit complete. The results obtained at these hospitals were satisfactory and the use of the material was extended to 41 other hospitals, making a total of 61 in all. Enlisted personnel at these hospitals were trained in the use of the washing machine and the drying and forming outfit, and the work was carried on satisfactorily.48 In some of the hospitals conservation of gauze was effected by washing the gauze in the washing machine furnished for the re-use knitted gauze and drying it on the steam drying and forming unit, after which it was resterilized and used again in the same manner as it was ordinarily used. This materially reduced the quantity of surgical gauze used at these hospitals and a great saving was effected.

SUTURES

The materials from which the sutures used by the Medical Department are manufactured are catgut, horsehair, kangaroo tendon, linen, silk, silkworm gut, and silver wire. The sutures made from these materials are manufactured according to standard commercial practices. They all come in a number of different sizes. The variation in the size of horsehair is the least of all ligatures. Inasmuch as the form in which horsehair is used for sutures is that in which it is produced by nature, varieties in size can he obtained only by sorting the hair as it is cut from the tail of the horse. All the other forms of sutures can be made in any size required.

The sutures listed in the standard medical supply table of 1916, and used as the basis for purchase during the years 1917, 1918, are as follows: 49


554

Sutures for field use:
Catgut -
   Chromicized, sterilized, 18 inches each, 3 sizes in package.
   Plain, sterilized, 18 inches each, 3 sizes in package.
Silk, braided sterilized, 18 inches each, 3 sizes in package.
Silkworm gut, 100 strands in coil.
Silver wire, in yard lengths,
Sutures for hospital use:
Catgut, plain or chromicized, sterilized, 18 inches in tube, assorted sizes.
Horsehair, 100 in coil.
Kangaroo tendon, sterile, 1 suture in each tube.
Silk, graided, sterilized, 18 inches each, 3 sizes in package.
Silkworm gut, 100 in coil.
Silver wire, in yard lengths.
Sutures for veterinary use.
Linen, sterilized, 18 inches each, 2 sizes ( Nos. 16 and 20) in package.
Silk braided, sizes 4, 8, 12, 16, 20, on spools.
Tape, sterilized. 18 inches each, 2 pieces in package.

CATGUT

Catgut sutures ordinarily come in six sizes, fine to coarse--Nos. 00, 0, 1, 2, 3, and 4. They are made from either domestic or imported catgut. The domestic gut is considered superior quality and preferable in color. The material is obtained from the packing houses, cut into strips of such width as will give the proper size, rolled or twisted, and dried. Catgut in commerce usually comes in coils of 100 feet.50 In preparing it for sutures all fatty material is removed by digesting the coils in ether or other fat solvent. After the fat has been removed the coils are cut into the desired lengths, placed in glass tubes of appropriate size and length, sterilized, the appropriate preserving fluid added, and a slip of paper indicating the size and whether plain or chromicized inserted in the tube. The tube is then sealed and again sterilized by fractional sterilization until complete sterility is assured. The methods of preparing and sterilizing the gut and the preserving fluid vary with each manufacturer. Exact specifications covering the mode of procedure could not well be prepared owing to its variations of methods. The specification for plain catgut ligatures adopted in May, 1918, after prolonged study and investigation, are given below:51


SPECIFICATIONS FOR PLAIN STERILE CATGUT

Material. - To be best quality catgut ligatures prepared from the small intestines of sheep, evenly split, freed from all but submucous connective tissue, bleached, uniformly twisted, dried, and perfectly smooth. Each strand of catgut to be sterile, and each is to be tubed with a sufficient amount of an acceptable storing fluid to cover the coil when the tube is held vertical.

Length.- Each strand of sterile catgut shall measure not less than 18 inches in lengths.
 
   Gauge.-
The gauge of strands shall be in accordance with measurements indicated for the following sizes:
Size No. -
   00 to equal Brown and Sharpe gauge 27.
    0 to equal Brown and Sharpe gauge 26.
   1 to equal Brown and Sharpe gauge 25
   2 to equal Brown and Sharpe gauge 24
   3 to equal Brown and Sharpe gauge 23
   4 to equal Brown and Sharpe gauge 22


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The diameter to be taken in three places, at each end and in the middle. At least two of these diameters must agree, the diameters in agreement giving the strand its gauge.

Tensile strength.-The tensile strength for the different sizes of sterile catgut shall not be less than the number of pounds designated for sizes below:
Size No.    Pounds  Size No.  Pounds
00................................................................................................. 3   2................................................................................................ 12
0................................................................................................... 5   3................................................................................................ 16
1................................................................................................... 9    4................................................................................................ 20

   All tensile-strength tests will be straight pull to rupture at least a 4-inch length of catgut without bend or knot. The average of 6 tests will indicate the strength of the material.

Pliability, plasticity, boilability, tubes, labels, coils. - The pliability of sterile catgut ligatures when removed from the tube shall be such as to allow its use as a suture without previous moistening. The ligature must show a normal amount of elasticity or tendon. Tubes shall be made from clear, cleats glass tubing selected for quality and uniformity of wall diameter; tubes when sealed to measure about 2¼ inches in length and 5/8 inch outside diameter. Each tube to have engraved at or near its center a straight fracture mark of uniform depth and widths and to measure in length not less than one-third the circumference of tube; the tube shall break evenly at the fracture mark without splintering. Each strand of catgut shall be evenly coiled and, without twist, introduced into the glass tube in a manner to allow the top loop of the coil to be even with the fracture mark. One free end of the ligature shall pass beyond the coil and fracture mark; this to facilitate removal of the ligature from tube. Each tube to contain one strand of sterile catgut in tubing fluid as specified and printed label showing the kind and size of the contents and the name of the manufacturer. Entire contents to be sterile and final sterilization to be done after both ends of the have been sealed by fusion. The tubes to be boilable for one-half hour without harm to the tubes or contents.

Packing. - Tubes to be furnished in strong, flat paper boxes containing 10 tubes packed in a single row; each box to be properly lined with corrugated paper or furnished with other acceptable device to prevent breaking; each box to be plainly labeled with the kind and size and number of contents and the name of the manufacturer and bear the words “Medical Department, U.S.A.” One hundred such boxes to be inclosed in an outer heavy paper box bearing a similar label. Package to be marked with kind and number of contents and name of manufacturer. All paper packages to be packed in strong wooden boxes suitable for distant shipments, each plainly stenciled on one end with the name and number of con tents and the name of the contractor.

The specification for chromicized catgut were practically identical with those for the plain sterile catgut, with the following addition and modification; under the heading “Material” the following sentence was added: 51

The catgut to be chromicized by a method of treating the potassiumn or sodium dichromate which will yield finished ligatures free from undesirable products of chromium. The absorbability of the chromic ligatures must approximate the time indicated on the label.

The heading “Length” was changed as follows:

Length. - Each strand of sterile chrornicized catgut shall measure not less than 18 inches in length.

During the year 1917 no material difficulty was experienced in procuring a quantity of catgut sutures adequate to meet the requirements. In conformity with the procedure then in vogue a meeting of the manufacturers of sutures was held in New York, May 4, 1917, at which 10 manufacturers were present.52 At this conference prices were discussed and the requirements of the Army and Navy presented. The various types of sutures were apportioned to the mannfacturers present at this conference.52 The prices agreed upon at this conference


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seemed rather high. The price paid for catgut, chromic, 3 sizes in a package, in the purchase in March, was 9¼ cents per package. For catgut, plain, the price was 8½ cents a package. The conference price was 12 cents a package. The price paid in November, 1917, for the same materials was 7½ cents per package. It was found that catgut in tubes, of good quality, could be had in the market in 60-inch lengths, at 9 cents per tube, and the officer in charge of the medical supply depot at New York refused to pay more than 9 cents per tube. This refusal caused some friction with one of the manufacturers, who contended that the material could not he furnished at. that price, stating that the raw gut cost 8½ cents per tube and that the cost of preparation exceeded the cost of the raw gut.50  Prices following this first purchase, which was made in June, 1917, eased up materially.

By the middle of 1918, however, the quantity of catgut sutures required had reached such magnitude that.. it was difficult to meet requirements. Every manufacturer was called upon to furnish practically his maximum output. A thorough canvass was made during the summer and fall of 1918 of the methods of preparing and sterilizing catgut sutures. As a result of these investigations some doubt was had by the inspectors concerning the sterility of the product.53 Arrangements were made by the surgical board in the Surgeon General’s Office to have tests for sterility conducted under its supervision at Chicago, New York, and Boston, and a definite plan to this end was worked out near the end of October, 1918.54 Before it could he placed into effect, however, the armistice had been signed and the urgency of the need for sutures passed.

HORSEHAIR

Horsehair sutures are not much used in Army surgical practice and no large quantities were purchased. They are selected, undyed, black horsehair, cut from the tail of the horse. The early purchases in 1917 called for 13,500 coils,55 100 hairs in coil.

KANGAROO TENDON

Kangaroo tendon is much less used in military surgery than catgut and was accordingly procured in smaller quantities. In order that a standard suture, both as to size and quality, might be purchased, and for the benefit of the personnel called upon t.o make inspection, the following specifications were adopted in May, 1918: 51

SPECIFICATION FOR KANGAROO TENDON SUTURES

Material, -  To be tendons from the tail of a kangaroo, free from other tissue, blood, etc., and very soft so a knot can be tightly tied. Each strand of kangaroo tendons to be sterile and each to be tubed with chloroform or other acceptable fluid in sufficient amount to cover the coil when the tube is held vertical.

Length. - Each
strand of sterile kangaroo tendon upon removal from the tube shall measure not less than 12 inches in length.
 
   Gauge. - The size in diameter of the strand shall be uniform and approximately of the measure indicated for the following sizes:
Fine, to equal Brown & Sharpe gauge 26.
Medium, to equal Brown & Sharpe gauge 24.
Coarse, to equal Brown & Sharpe gauge 22.
Extra coarse, to equal Brown & Sharpe gauge 20.


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The diameter to be taken in three places, at each end and in the middle. At least two of these diameters must agree, the diameters in agreement giving the strand its gauge.

Tubes, labels, coils
. - Tubes shall be made of clear, clean glass tubing selected for quality and uniformity of wall diameter, tubes when sealed to measure about 2 ½ inches in length and 5/16 inch outside diameter. Each tube to have engraved at or near its center a straight fracture mark of uniform depth and width, and to measure in length not less than one-third the circumference of the tube; the tube shall break exactly at the fracture mark without splitting. Each strand of kangaroo tendon shall be evenly coiled and, without twist, introduced into the glass tube its a manner to allow the top loop of the coil to be even with the fracture mark. One free end of the ligature shall pass beyond the coil and fracture mark, this to facilitate removal of ligature from tube. Each tube to contains one strand of sterile kangaroo tendon in tubing fluid, as specified, and a printed label showing the kind and size of the contents and the name of the manufacturer. Entire contents to be sterile amid final sterilization to be done after both ends of tubes have been sealed by fusion. The tubes to be boilaible in water for one-half hour without harm to the tube or its contents.
 
   Packing. - Tubes to be furnished in a single row in strong flat paper boxes containing 10 tubes each, each box to he properly lined with corrugated paper or furnished with other acceptable device to prevent breaking; each box to be plainly labeled with kind and size and number of contents, and the name of the manufacturer, and bear the words “Medical Department, U. S. A."  One hundred such boxes to be inclosed in, an outer heavy paper box bearing a similar label. Packages to be marked with kind and number of contents and name of manufacturer. All paper packages to be packed in strong wooden boxes suitable for distant shipment, each plainly stenciled on one end with the name and number of contents and the name of the contractor.

SILK

Silk sutures in the trade come in a large number of sizes. There are two types of silk sutures, the twisted and the braided. The smaller sizes of the silk sutures are almost always the twisted variety. The medium sizes are both twisted and braided. The larger sizes are almost entirely of the braided variety. The Medical Department uses the braided variety in three sizes--small, medium, and large. Still larger sizes are issued for veterinary use. The sutures for human use are put up three sizes on a card inclosed in an impervious wrapping and placed in an envelope. They are also furnished a single size on an individual card, inclosed in an individual wrapping, and the three of these, one of each size, inclosed in an envelope. Silk sutures for veterinary use are furnished unsterilized on spools.

SILKWORM GUT SUTURES

These sutures are used both in the field and in fixed hospitals. As purchased, they ordinarily come assorted sizes in the package. During the war they were purchased, fine, medium, and coarse, and only one size in a package. During the early purchases considerable difficulty was experienced in obtaining the Army requirements. This was due largely to the fact that the majority of silk worm gut is made in Spain and transportation was not available. After the transportation service had become better organized in 1918, less difficulty was experienced in securing the quantities required. At the request of the chief surgeon, A. E. F., on August 5, 1918,56 an order was placed for the delivery from Spain, direct to the American Expeditionary Forces, of 100,000 coils of silkworm gut sutures. These sutures were purchased for delivery in Paris.


558

Sutures purchased during 1917-18

REFERENCES

(1) Manual for the Medical Department, U. S. Army, 1916. Supply Tables.
(2) Report of Committee on Industrial Preparedness, American Drug Manufacturers’ Association, Annual Convention, New York, N. Y., January 29-30, 1918.  Copy on file, Finance and Supply Division, S. G. O.
(3) Computed from records on file in Medical Section, New York General Intermediate Depot.
(4) Contract dated June 23, 1917, between Col. C. R. Darnall, M. C., and Johnson & ,Johnson, New Brunswick, N. J., for surgical dressings. Copy on file in Field Medical Supply Depot records stored in Medical Section, New York General Depot.
(5) Letter from Henry P. Kendall, Norwood, Mass., to Lieut. Col. H. C. Fisher, Surgeon General’s Office, August 11, 1917, relative to progress in production of surgical dressings.  On file, Finance and Supply Division, S. G. O., 395/1.
(6) Letter from Narragansett Mills, Fall River, Mass., to Col. C. R. Darnall, Washington, D. C.,  September 24, 1917. On file, Finance and Supply Division, S. G. O.,   51/21.
(7) Letter from Henry P. Kendall, Norwood, Mass., to Col. C. R. Darnall, Surgeon General’s Office, October 22, 1917, relative to priority certificates. On file, Finance andSupply Division, S. G. O.,  395 H. P. K./1.
(8) Letter from Dr. H. C. Loris, formerly Chairman of Manufacturers of Surgical Dressings, New York, N. Y., to Col. C. R. Darnall, S. G. O.,  November 27, 1917, relative to disbandingof Association of Manufacturers of Surgical Dressings, organized under Council of National Defense. On file, Finance and Supply Division, S. G. O.,  445 H.C.L./1.
(9) Letter from Col. C. R. Darnall, S. G. O., to Mr. Henry P. Kendall, Lewis Manufacturing Co., Walpole, Mass., November 28, 1917, relative to purchase of gauze. On file, Finance and Supply Division, S. G. O., 437 L.M.C./7.
(10) Letter from Henry P. Kendall, Norwood, Mass., to Col. C. R. Darnall, S. G. O., November 30, 1917, relative to negotiations for gauze. On file, Finance and Supply Division, S. G. O.,  533 N. D./268.


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(11) Letter from Henry P. Kendall, New York City, to Col. C. R. Darnall, S. G. O., November 27, 1917, relative to prospective negotiations for gauze. On file, Finance and Supply Division, S. G. O., 533 N. D./268.
(12) Letter from Mr. Albert L. Scott, Committee on Supplies, Cotton, Goods Section, War lndustries Board to Col. C. R. Darnall, S. G. O., December 6, 1917, relative to purchase of gauze. On file, Finance and Supply Division, S. G. O., 533 N. D./268.
(13) Letter from Mr. H. P. Kendall, Lewis Manufacturing Co., Walpole, Mass., to Col. C. R. Darnahl, S. G. O., December 15, 1917, relative to apportionment of surgical dressings to manufacturers. On file, Finance and Supply Division, S. G. O., 437 L.M. Co./8.
(14) Letter from Col. Darnall, S. G. O., to Messrs. Holbrook, McCormick, and Kendall (no address), February 9, 1918, relative to gauze requirements. On file, Financeand Supply Divsion, S. G. O.,  386 J & J./7.
(15) Letter from the Surgeon General to the section on cotton goods, Quartermaster General’s Office, attention Mr. Holbrook, February 16, 1918. Subject: Orders for gray goods for surgical dressings. On file, Finance and Supply Division, S. G. O., 750-594 Q.M.G./94.
(16) Letter from Mr. H. P. Kendall, Norwood, Mass., to Col. C. R. Darnall, S. G. O., relative to purchase of gauze. On file, Finance and Supply Division, S. G. O.,  395 H.P.K./7.
(17) Letter from Mr. J. E. Osborn, Chairman Merchants’ Manufacturing Co., Fall River, Mass., to Col. C. R. Darnall, April 9, 1918, relative to contracts and prices for gauze. On file, Finance and Supply Division, S. G. O., 533 M.M.C./7.
(18) Purchases of gauze, General Purchasinig Officer, Medical Department, U. S. Army. Revised April 27, 1918.
(19) Letter from Alex Legge, Raw Materials Division, War Industries Board, to Mr. E. R. Stettinius, Surveyor General of Purchases, March 15, 1918, relative to requisitions for gauze being placed by the Government. On file, Finance and Supply Division, S .G. O.,  533 Misc./66.
(20) Memo from Edw. R. Stettinius, Surveyor General of Supplies, for Col. Darnall, Medical Department, March 16, 1918, forwarding letter from Mr. Legge. On file, Finance and Supply Division, S. G. O.,  533 Misc./66.
(21) First indorsement, Surgeon General, to Mr. E. R. Stettinius, Surveyor General of Purchases, War Department, March 19, 1918, relative to purchases of gauze. On file, Finance and Supply Division, S. G. O., 533 Misc./66.
(22) Letter from the Surgeon General to the officer in charge, General Purchasing Office, Washington, July 30, 1918. Subject: Interbureau requisitions for dressing material. On file, Finance and Supply Division, S. G. O., 750-714  S. G./381.
(23) Report compiled by Maj. F. W. Lennox, San. Corps, U. S. Army, May 29, 1919. On file, Finance and Supply Division, S. G. O., 50-714 S. G./381.
(24) Letter from the Chief Surgeon, A. E. F., to the Surgeon General, January 26, 1918. Subject: Surgical Dressings. On file, Finance and Supply Division, S. G.O.,  259F2/236. 
(25) Par. 3, Cable No. 660, H. A. E. F. to The Adjutant General, February 28, 1918, received March 1, 1918.


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(26) Letter from the chief surgeon, A. E. F., to the Surgeon General, February 28, 1918. Subject: Standard Surgical dressings. On file, Finance and Supply Division, S. G. O., 250 FR./236.
(27) Letter from the Surgeon General to Mr. Harvey D. Gibson, General Manager, A. R. C., March 8, 1918, relative to surgical dressings. On file, Finance and Supply Division, S.G.O.,  602 A. R. C./73.
(28) Order No. 1 from the Surgeon General to the American Red Cross, March  8, 1918, for surgical dressings. On file, Finance and Supply Division, S. G. O., 602 A. R. C./82. 
(29) Order No. W-1055, American Red Cross, March 2, 1918, to the Surgeon General’s Office, for 4,000,000 yards gauze. On, file, Finance and  Supply Division, S. G. O.,  602 A. R. C./78.
(31)) Letter from Col. Darnall to Mr. Harvey D. Gibson, A. R. C., March 8, 1918, relative to supplies for surgical dressings. 0n file, Finance and Supply Division, S. G. O., 602 A. R. C. /78.
(31) Letter from the American Red Cross, to the Surgeon General, March 18, 1918, relative to surgical dressings. On file, Finance and Supply Division, S. G. O., 602 A. R. C./82.
(32) Letter from the Surgeon General to the General Manager, American Red Cross, March 22, 1918. Subject: Marking of supplies made for the Medical Department by theAmerican Red Cross. On file, Finance and Supply Division, S. G. O.,  602 A. R. C./78.
(33) Letter from Col. C. R. Darnall, S. G. 0., to Messers. Johnson & Johnson, New Brunswick, N. J., April 1,  1918, relative to sterilization of front-line jackets. On file, Finance and Supply Division, S. G. O.,  386 J & J./10.
(34) Telegram from John A. Hartwel, A. R. C., New York, N. Y. to Col. C. R. Darnall, S. G. O. April 17, 1918, relative to baling front-line packets. On file, Finance and Supply Division, S. G. O.,  713-539  N. Y./596.
(35) Letter from Associate director, Bureau of Stores, American Red Cross, Washington, D. C., to Messers. Van Horn and Sawtelle, 511 East One-hundred and sixty-fourth Street, New York City, June 25, 1918, relative to front-line parcels. Copy on file, Finance and Supply Division,  S. G. O.,  602 R. C./136.
(36) First indorsement, Surgeon General’s office to the officer in charge, Medical Supply Depot, New York, September 10, 1918, relative to packing material for front-line packets. On file, Finance and Supply Division, S. G. O., 713-539 N. Y. D./596.
(37) Letter from the Surgeon General to the American Red Cross, National Headquarters, Washington, D. C., May 3, 1918, relative to surgical dressings. On file Finance and Supply Division, S. G. O.,  602 R.C./117.
(38) Letter from Col. C. R. Darnall, M. C., S. G. O., to Major John A. Hartwell, M. C.. 44 East Twenty-third Street, New York, April 0, 1918, relative to sphagnum-moss dressings, On file, Finance and Supply Division, S. G. O.,  602 R. C./89.
(39) Letter from chief of surgical service, U. S. A. General Hospital No. 1, New York City, to the commanding officer, May 14, 1918. Subject: Report substitutes for absorbent cotton for surgical dressings. On file, Finance and Supply Division, S. G. O.,  602 R. C./107


561

(40) Letter from Maj. John A. Hartwell, M. C., 44 East Twenty-third Street, New York, City, to Col. C. R. Darnall, M. C., S. G. O., May 23, 1918,  relative to use of sphagnum-moss dressings. On file, Finance and Supply Division, S. G. O., 602 A. R. C./107.
(41) Letter from Col. C. Ft. Darnall, M. C., S. G. O., to Maj. John A. Hartwell, M. C., 44 East Twenty-third Street, New York, April 27, 1918, relative to bandages in front line packets. On file, Finance and Supply Division, S. G. O., 602 R. C./112.
(42) Letter from the Surgeon General to the Supply and equipment division, cotton goods branch, Quartermaster General’s Office, March 20, 1918. Subject: Sheetings. On file, Finance and Supply Division, S. G. O., 750-594 A. G./105.
(43) Letter from the Surgeon General to the Acting Quartermaster General, supply and equipment division, cotton goods section, April 8, 1918. Subject: Unbleaehed muslin. On file, Finance and Supply Division, S. G. O.,  51 B & B./15.
(44) Correspondence between the Surgeon General’s Office and the Camden Curtain & Embroidery Co., Camden N. J., during March, 1918,  relative to the manufacture of bias muslin bandages. On file, Finance and Supply Division, S. G. O,  122 C. C. & E. Co./1.
(45) Reply to Courier Cable S-102, par. 3, S. O. S., A. E. F., relative to quantities of special surgical dressings. On file, Finance and Supply Division, S. G. O.,  250 France/523.
(46) Correspondence between the Surgical Division, S. G. O., and the Finance and Supply Division, S. G. O., during February, 1918, relative to substitutes for cotton. On file, Finance and Supply Division, S. G. O., 750-714 S. G./181.
(47) Correspondence between the Surgeon General’s Office and various base hospitals at training camps, February to April, 1918, inclusive. Subject: Cellucotton. On file, Finance and Supply Division, S. G. O.,  531 Misc./100.
(48) Correspondence between the Surgical Division, S. G. O., and Finance and Supply Division, S. G. O., during April and May, 1918, relative to re-use knitted gauze and dressings. On file, Finance and Supply Division, S. G. O., 531 Misc./10.
(49) Manual for the Medical Department, U. S. Army, 1916, corrected to June 15, 1918, pp. 285, 254, 33.
(50) Letter from Davis & Geck (Inc.), Brooklyn N. Y., to Lieut. Col. Hartsock, Medical Supply Depot, New York, August 10, 1917, relative to award of sutures. On file, Finance and Supply Division, S. G. O.,  174 D. & G. Inc./1.
(51) Letter from the Surgeon General to officer in charge, Medical Supply Depot, New York, June 15, 1918. Subject: Specifications for sterile chromicized catgut. On file, Finance and Supply Division, S. G. O., 713-539 N. Y./759.
(52) Minutes of Meeting of Subcommittee on Ligatures held at 100 William St., New York, N. Y., May 4, 1917, at 4:15 p. m. On file, Finance and Supply Division, S. G. O., 174 D. & G. Inc./1.


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(53) Letter from officer in charge, Medical Supply Depot, N. Y., to the Surgeon General, October 22, 1918. Subject: Unsterile catgut. On file, Finance and Supply Division, S. G. O., 713-759 N. Y./1067.
(54) Letter from the Acting Surgeon General to the officer in charge, Medical Supply Depot, New York, October 26, 1918. Subject: Catgut. On file, Finance and Supply Division, S. G. O.,  713-759 N. Y./1067.
(55) Letter from E. F. Sawtelle, 15-17 East 40th Street, New York, Chairman Subcommittee, Class 2, Surgical Dressings, to Davis & Geck, Inc., Brooklyn, N. Y., calling a meeting of manufacturers of sutures. On file, Finance and Supply Division, S. G. O., 174 D. & G. Inc./1.
(56) Par. 7, Cable No. 1557, August 4, 1918, H. A. E. F. On file, Finance and Supply Division, S. G. O., Cables Received Book.