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Chapter I

Contents

CHAPTER I

The Medical Supply System

MEDICAL SUPPLY BETWEEN WARS

The disruption of the national economy and the delay in delivery of military supplies which developed during World War I convinced Congress of the wisdom of industrial preparedness. The National Defense Act of 1920 charged the Assistant Secretary of War with the "supervision of the procurement of all military supplies and other business of the War Department pertaining thereto and the assurance of adequate provision for the mobilization of materiel and industrial organizations essential to war-time needs." The italicized phrase conveyed authority for the far-reaching procurement planning program which began in 1920 and continued until our entrance into World War II.

Organization for Procurement Planning

The administrative organization for the accomplishment and supervision of Medical Department procurement planning was established on three levels: the Office of the Assistant Secretary of War, the Surgeon General's Office, and the depots of the Medical Department. The overall responsibility of the Secretary was delegated to a Procurement Division established in the War Department late in 1921. On the second level, a procurement planning section was set up in the Finance and Supply Division of the Surgeon General's Office, in June 1922. Designated variously as 'section,' and 'subdivision,' this element of the Finance and Supply Division was charged with "the collection of information and compilation of data pertaining to sources of [medical] supply." It began its work with only one full-time officer.1

The field organization for procurement planning was determined by the location of Medical Department depots and was affected to a lesser extent by the establishment in 1923 of 14 War Department Procurement Districts. These 14 districts were combined into 4, with headquarters at New York, N.Y., Chicago, Ill., St. Louis, Mo., and San Francisco, Calif. The choice of cities was determined largely by the location of depots handling medical supplies and by the distribution of the industries concerned. Reorganization of War Depart-

1(1) Memorandum Orders No. 1, Office of the Assistant Secretary of War, 25 Oct. 1921, subject: Procurement Division, Office of the Assistant Secretary of War. (2) Annual Report of The Surgeon General, U.S. Army, 1922. Washington: U.S. Government Printing Office, 1922. Series cited hereafter as Reports of TSG, with appropriate dates. Monthly progress reports on Procurement Planning were submitted to the Assistant Secretary of War, beginning in 1924. In April 1925 quarterly reports were substituted, and in 1931 these were replaced by annual reports.


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ment procurement activities in 1933 had little or no effect upon the procurement planning activities of the Medical Department. Although an additional center was established at Birmingham, Ala., it remained comparatively inactive and was abolished in 1939. For all practical purposes, procurement planning activities of the Medical Department were confined throughout this period to the four cities designated in 1923.2

Personnel engaged in procurement planning in the field also handled current procurement. In St. Louis and San Francisco, the procurement officers of the depots were assigned procurement planning as an additional duty. The medical supply officer at the Chicago Quartermaster Depot doubled as the procurement planning officer. Only in the medical section of the New York General Depot, which handled the overwhelming bulk of Medical Department procurement, were personnel assigned exclusively to procurement planning, the number of officers varying from one to six.3

Accomplishments in Procurement Planning

If the difficulties, delays, and embarrassments that had hampered Medical Department operations in World War I were to be avoided, it was clearly necessary to determine in advance (1) what supplies and equipment would be required in the event of war, (2) in what quantity, and (3) from what manufacturing facilities they could be obtained. The preparation of specifications and tables of equipment, and the computation of requirements, were carried out in Washington, D.C.; the location and survey of facilities, and the preparation of production schedules, were the responsibility of the field offices.

The determination of requirements involved, first of all, the preparation of specifications for medical supplies and equipment. The usefulness and military serviceability of the items to be procured were given primary consideration, but experience in World War I had made it apparent that exclusive attention to these aspects would hamper the procurement effort. To describe characteristics which would be ideal might easily result in specifying an item which could not be manufactured in sufficient quantities. "The best is the enemy of the good" applies with special force to wartime procurement. It was the policy of The Surgeon General, therefore, to bear constantly in mind the desirability of making Medical Department specifications conform to the best commercial practices in size, quality, and packaging. Close contact was maintained with national trade associations and the Federal Specifications Board, as well as with the Bureau of Medicine and Surgery of the Navy Department.4

In 1928, a total of 3,712 items in the supply catalog required specifications. By the end of that year, specifications for 1,213 of these items had been prepared and had received the approval of the War Department. This number

2(1) Memorandum, The Adjutant General to The Surgeon General, 9 Mar. 1933, subject: War Department Procurement Zones. (2) The Story of Medical Department Procurement Planning, 1920-1940. [Official record.] (3) Annual Report of Procurement Planning, Medical Department, 1 July 1934.
3Reports of TSG, 1923-39.
4Reports of TSG, 1925-27.


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was increased to 1,494 by 1932. In 1933, however, a new policy was adopted, which slowed down the process of preparing specifications, but which injected a large element of realism into those which were approved. All specifications prepared during 1933 and subsequent years were subjected to the test of purchasing before they could be approved as official U.S. Army specifications. Until such approval was received, they were described as "Medical Department tentative specifications." By 1937, the test of purchasing had been applied to such an extent that 1,062 items of medical supply were covered by Army specifications. This number was increased to 1,137 in 1938 and to 1,570 in 1939. The Medical Department Supply Catalog in the latter year listed a total of 4,652 items, 3,018 of which comprised the component parts of individual equipment, organizational equipment, and equipment of field hospitals, known collectively as "war items."

Estimating requirements.-In the meantime, the procurement planning section of the Finance and Supply Division had been steadily engaged in determining the quantities of medical supplies which would be needed in the event of war. Of all the tasks connected with procurement planning, none was more tedious, complicated, and uncertain in its accomplishment than the computation of requirements. Although not primarily guesswork, as the critics of procurement planning occasionally charged, the process did involve considerable prophecy, which was almost as hazardous. Requirements figures, moreover, were subject to frequent change and revision to keep abreast of medical and pharmacological advances and to reflect changes in mobilization plans. Within these limitations, requirements figures were a necessary part of procurement planning. Questionable though they might be, they offered the only comparatively stable goal towards which procurement efforts could be directed.

In the computation of requirements, the first important element to be determined was the "troop basis"-the size and composition of the Army which was to be raised if war should come. This information was provided by general mobilization plans prepared by the General Staff and approved by the Secretary of War. In the fall of 1921, the first mobilization plan in the Nation's history was prepared, calling for a total of 1.5 million men. This plan was revised in 1928 and again in 1933, when a considerably larger force was contemplated. In 1938, the Protective Mobilization Plan was approved. This included an "Initial Protective Force" of approximately 400,000 and authorized successive augmentations, if the emergency required it, to an aggregate strength of 4 million men.5

Tables of equipment and allowances constituted the next important element entering into the computation of requirements. These tables indicated the types and quantities of medical supplies and equipment to be furnished to each troop unit in the mobilization plan. From 1925, the Surgeon General's Office intermittently prepared and revised tables of equipment and allowances. By

5(1) Letter, The Adjutant General to The Surgeon General and others, 13 Oct. 1921, subject: Computation of War Requirements and the Determination of Surplus. (2) Tyng, Lt. Col. F. C., MC, "Speech for Advanced Class, Carlisle Industrial Mobilization," 19 Oct. 1938. [Official record.]


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1927, tables had been prepared for the most important types of Medical Department field installations, including general, surgical, convalescent, evacuation, and station hospitals of various sizes; hospital trains, convalescent camps, and Army dispensaries; expansion equipment for field hospitals; and medical regiments, which were then the most important troop units for the evacuation and treatment of battle casualties. In common with other aspects of procurement planning, these tables were subject to frequent change; a thorough revision, begun in 1930, was practically completed by the end of 1931.6

Mobilization plans and equipment and allowance tables made possible the computation of initial supplies and equipment which would be needed by various troop units, but they provided little information as to the quantities that would be consumed in training or in battle. Additional information was necessary before maintenance requirements could be computed. To predict the future by an examination of the past, the Procurement Planning Section resorted to the supply and medical statistics of World War I. Maintenance factors thus developed, indicated probable rates of use for each item of supply and equipment, both in the Zone of Interior and in the theaters of operations.7

The revised mobilization plan of 1933 made it necessary to recompute all requirements figures, a task completed for the Medical Department late in 1935. By this time also the cubic volume and the weight of nearly half the medical items had been determined, thus providing valuable information for the preparation of shipping schedules. Beginning in 1936, the monthly cost of medical supplies to be procured in the event of war was estimated for each item, and the total cost of each month's requirements for mobilization was computed. The Protective Mobilization Plan of 1938 forced still another sweeping revision of Medical Department requirements figures, a revision which had not been completed when German divisions crossed the frontier into Poland.8

Locating manufacturing facilities.-While the Surgeon General's Office was estimating the quantities of medical supplies which would be required in time of war, the procurement planning sections of medical depots were locating and surveying the manufacturing facilities which could produce these supplies. Potential producers were located by various means: contacts with trade and manufacturing associations; references to Thomas' Register; and by use of the Bidders' List, which was maintained in the purchasing section of all depots and which contained the names of all manufacturers and dealers who had bidden on Medical Department contracts. When a summary appraisal of a facility indicated its probable usefulness to the Medical Department, the procurement district informed The Surgeon General, who asked the Assistant Secretary of War to allocate the facility to him. This device gave the Medical Department a virtual

6Reports of TSG, 1927 and 1931.
7(1) Strong, Maj. E. R., MC, "Procurement Planning II." [Official record.] (2) Speech, Maj. Gen. Robert U. Patterson to Army Industrial College, September 1931.
8(1) Reports of TSG, 1931, 1934-36, and 1939. (2) Letter, Col. H. K. Rutherford, Director, Planning Branch, to The Surgeon General, 27 Mar. 1939, subject: Acceleration of Procurement Planning.


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monopoly of the military production of the factory affected. By 1928, a total of 1,294 facilities, nearly half of them located in the area extending from Philadelphia, Pa., to Boston, Mass., had been earmarked in this way for the Medical Department. Numerous changes reduced the number of single allocations to 467 by 1937, a number which remained virtually unchanged through 1939.9

After a manufacturing plant had been allocated to the Medical Department, it was surveyed to determine its capacity and to evaluate its equipment, its sources of power and raw materials, the adequacy of its transportation, and the number and quality of its employees. The surveys themselves, however, were of widely differing reliability. If the procurement planning officer lacked interest or ability, the survey was hasty and superficial; if the management of a plant cared little for governmental orders or was skeptical of procurement planning, not enough information could be obtained.10 In too many instances, moreover, restrictions upon travel funds forced reliance upon correspondence instead of on personal inspection.

While the procurement planning officers in the field were making these surveys, medical supply officers in Washington examined the data collected and apportioned Medical Department requirements directly to the allocated facilities. Tentative schedules of production were prepared and presented by the appropriate district procurement planning officer to each manufacturer concerned. The schedule, when approved by the manufacturer, was termed an "accepted schedule of production"11 and was filed in the Surgeon General's Office. While these schedules obligated neither party, they did serve to inform the manufacturer of the Medical Department's probable needs, and to give The Surgeon General an estimate of a plant's ability to satisfy the needs. It was expected that the schedules would enable procurement officers, upon the outbreak of war, to place contracts promptly for all medical supplies and equipment required in mobilizing a large army.

Between 1923 and 1939, considerable progress was made in the preparation of these schedules. By 1930, a total of 1,713 items had been covered; by the end of 1935, the number had grown to 2,985. In 1938, the task was virtually completed although numerous revisions were expected as changes in Medical Department requirements and the capacity of manufacturing plants became evident. Indeed, the schedules of production, as guides to procurement, could have little value if they were not constantly revised. No manufacturer could be sure of producing a stated quantity of items after the outbreak of war unless he knew that raw materials, tools, and labor would be available, and

9(1)Allocation of Facilities, 1928. [Official record.] (2) Progress Report of Medical Department, Supply Branch, 30 June 1932. (3) Report of TSG, 1937. In addition to the single allocations, there were 6 joint allocations, 54 allocations for the Army and Navy Munitions Board, and 3 for the Office of the Assistant Secretary of War.
10(1) Statement of Col. Earle G. G. Standlee, MC, to Lt. (later Capt.) Richard E. Yates, MAC, 9 Jan. 1945. (2) Letter, Capt. Earle G. G. Standlee, MC, to Medical Supply Officer, New York General Depot, 15 Oct. 1936, subject: Survey of Facilities.
11Before 1926, the term "war order" was used to describe these schedules. In that year, however, use of the term was discontinued because the schedule was not in fact an "order" in any legitimate sense. It was no more than an estimate of capacity to produce a given item.


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naturally, this assurance could not be given far in advance. At best, therefore, the schedules merely indicated quantities which could be produced under favorable conditions; at worst, they represented hasty, ill-considered estimates rendered by a busy factory manager who wished to rid himself of the procurement planning officer and to return to more agreeable tasks.12

Throughout these years, procurement planning officers were estimating the quantities of strategic, critical, and essential raw materials that would be needed if the United States went to war. For those materials that were the exclusive procurement responsibility of the Medical Department, specific procurement plans were prepared, including the quantities required, sources of production, and studies of substitutes. Raw materials which were not procured by the Medical Department, but which entered into the manufacture of medical supplies, received less extensive study. Estimates of Medical Department requirements were submitted to the Assistant Secretary of War and then forwarded to the technical service having procurement responsibility, which then consolidated the requirements of all services and prepared specific procurement plans.

Training supply personnel.-A final phase of procurement planning, which engaged the attention of the Medical Department during the two decades preceding World War II, involved the training of Regular Army and Reserve officers for the supply responsibilities of a great war. During World War I, the Medical Department had approximately 400 officers in its supply service, a majority of whom held temporary commissions and promptly returned to civilian life after the conflict ended. When procurement planning began, a determined effort was made to commission in the Sanitary Corps Reserve a number of executives in the industries producing medical supplies. This would have made available to the Medical Department highly skilled men who could, with efficiency and economy, carry on the extensive procurement operations which war would entail.

The prospective Reserve officers proved surprisingly reluctant. They objected to the 15 days of active duty or the enrollment in a correspondence course, required of Reserve officers each year, and they feared the provisions of the penal code which described heavy penalties for agents of corporations who, while employed by the Federal Government, transacted business with their own firms. By 1924, only 62 of these executives had accepted commissions. The number increased to 106 in 1926, and leveled off at 110 in 1927. Increases, if any, during subsequent years are not recorded, but it is probable that the Medical Department considered this element of the Sanitary Corps Reserve to be sufficiently large. The training program for Reserve personnel, although not extensive, was steadily pursued from 1925 until the outbreak of war. Each year from 5 to 16 Reserve officers were called to active duty for 2 weeks. During this time, they served in the Surgeon General's Office, the Office of the Assistant Secretary of War, the New York General Depot, the St. Louis Medical Depot, or other field installations. Whatever their assignment, they were given opportunity to become familiar with Army practices, with the needs of the

12(1) Reports of TSG, 1930, 1935, and 1938. (2) See footnote 10(1), p. 5.


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Medical Department, and with the specific procurement plans which had been prepared.13

The training of Regular Army officers for procurement and supply duties was far more intensive. In 1922, a Medical Supply Training School was established at the New York General Depot, and six officers were enrolled. The instruction was intended to convey a general familiarity with all supply functions of the Medical Department and with a detailed knowledge of procurement. This school functioned until February 1924, when the establishment of the Army Industrial College in Washington rendered it inadvisable for the Medical Department to maintain a separate school. Supply officers, however, continued to receive an important part of their instruction in the Medical Section of the New York depot.

Operating directly under the Office of the Assistant Secretary of War, the Industrial College instructed supply officers from all technical services in the many-sided problems of industrial mobilization. In addition, each student officer prepared a plan for the procurement of an important item with which his own technical service was concerned, and the plans thus prepared by medical supply officers were incorporated into the plans of the Surgeon General's Office.

The Army Industrial College soon became the capstone of the Medical Department's training program for supply officers. A 2-year tour of duty in the New York General Depot was normally followed by 1 year in the Surgeon General's Office and a 1-year course at the Army Industrial College. During the 1920's from three to five medical officers finished this curriculum each year, and were assigned to procurement planning and supply duties in the Surgeon General's Office or in one of the medical depots in the field. In the 1930's, only 2 medical officers each year were enrolled in the Army Industrial College, but, by the end of that decade, 41 had been graduated. In addition, a number of officers who never attended the Industrial College had received extensive procurement training in Medical Department field installations.

War Reserves and Stockpiles

Shortly after the end of World War I, the Medical Department examined its surplus supplies and made plans to establish an adequate War Reserve. In April 1924, The Surgeon General submitted to The Adjutant General a detailed statement, elaborating the necessity for reserves of medical supplies and listing the types and quantities which should be stored. "The Medical Department," he declared, "becomes upon mobilization, responsible for the immediate provision of adequate hospital facilities and care. There is no training period. Sickness and injury wait for no man." If the necessary supplies and equipment were not readily available, "suffering and loss of life would

13(1) Memorandum, Col. Edwin R. Wolfe, MC, to the Assistant Secretary of War, 9 Mar. 1922. (2) Procurement Plan of the Medical Department, 31 Dec. 1922. [Official record.] (3) Reports of TSG, 1924, 1926, and 1927. (4) In 1929, the Medical Department estimated that it would need 95 reserve officers for procurement duties in the event of war. "Personnel on Procurement Planning, Fiscal Year 1930." [Official record.]


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result and a storm of criticism would be engendered. Not to provide it is to neglect the lessons of the Spanish-American and World War and to reverse the practice of the Medical Department for the last twenty-five years, a policy which has been successfully defended before and approved by Congress." The Surgeon General then listed supplies and equipment which should be stored as unit assemblies for a large number of field hospitals, hospital trains, medical laboratories, medical regiments, and other installations. In addition, he requested authority to hold in reserve considerable quantities of strategic and critical drugs, field dressings, and surgical instruments.14

In September 1924, The Surgeon General was authorized to store as war reserves a portion of the assemblies and items which had been requested. Much of the material was assembled from World War I surpluses. Some unit assemblies were sharply reduced in number, and others were eliminated entirely; the strategic and critical drugs were approved without change; all field dressings were struck from the list, except 1 million first aid packets; and the quantities of surgical instruments were greatly reduced. "You are further directed," The Adjutant General concluded, "to initiate a program extending over four years for building up the existing shortages at the rate of $25,000 a year."15

The War Reserve thus approved by The Adjutant General was estimated to be sufficient, when shortages were eliminated, to supply two field armies, or 1 million men, for 2 months. The production lagtime of most items far exceeded 2 months, but there were other, more serious deficiencies in the War Reserve. The stocks of medical supplies were not in the proper depots, nor were they suitably assembled. The total value of the authorized War Reserve, including the Quartermaster items in the unit assemblies, was slightly over $24 million, but the value of the stocks actually on hand in February 1926 was less than $9 million. Thus, there was a deficiency of some $17 million,16 and the only authorized provision for filling this large gap was the program to spend $25,000 a year for 4 years. Repeated efforts to obtain additional funds brought no result. In 1933, a new authorized War Reserve provided a smaller quantity of medical supplies and equipment, but 2 years later, The Adjutant General was informed that even the smaller requirements could not be fulfilled. Among the more serious shortages were hospital assemblies, medical kits, and veterinary kits.17

In the accumulation of strategic drugs, the Medical Department's efforts attained a larger measure of success when authority was granted in 1925 to establish stockpiles containing 113,000 pounds of opium, 13,000 pounds of nux

14Letter, Maj. Gen. M. W. Ireland to The Adjutant General, 18 Apr. 1924. This letter was examined by Capt. Richard E. Yates, MAC, in the preparation of the original draft of the Zone of Interior portion of this volume, but has since been lost or destroyed.
15(1) Letter, Maj. Gen. H. H. Tibbetts to The Surgeon General, 6 Sept. 1924. (2) See footnote 14, above.
16Includes a surplus of approximately $2 million in two units.
17(1) See footnote 7(1), p. 4. (2) Letter, Col. Edwin P. Wolfe, MC, to The Adjutant General, 21 Dec. 1925, subject: Status of War Reserve, and 1st indorsement thereto. (3) War Reserves-Prepared in Response to Letter of February 11, 1926. [Official record.] (4) Letter, Lt. Col. T. J. Flynn, MC, to The Adjutant General, 4 Nov. 1935, subject: Revision of Status Reports Required by AG 381.4.


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vomica, and a quantity of cocaine sufficient for 2 years. This program entailed very little expense for the supplies of opium and cocaine, seized by the Federal Narcotics Control Board, were transferred to the Medical Department without cost. By the end of 1938, the stockpile of opium had been increased to 192,000 pounds, and 133,200 pounds of quinine were in the reserve. Largely at the instigation of the Medical Department, additional supplies of both drugs were procured over the next 3 years.18

TRANSITION TO WAR, 1939-42

From the outbreak of the war in Europe in September 1939 until the attack on Pearl Harbor, the United States gradually called into being a portion of its great potential military strength and prepared to enter the conflict if necessity should so dictate. This period of more than 2 years was marked by a succession of important developments abroad, each of which served as a warning to the United States and influenced Congress and the President to increase the pace of military preparations. From the standpoint of the supply officer, this 2-year period was a difficult one. It was neither peace nor war, but a frustrating mixture of both. The hypothetical "M-day" on which procurement plans were to be invoked never came. Mobilization took place piecemeal, but was nevertheless far advanced by the time Japanese bombs struck Pearl Harbor.

Organizational Changes

Until a major reorganization in the summer of 1942, the supply functions of the Surgeon General's Office continued to be performed within the Finance and Supply Division, of which Lt. Col. (later Col.) Francis C. Tyng, MC (fig. 1), became chief in May 1939. Neither was there any significant change in responsibilities during this period, except for the elimination of the Procurement Planning subdivision late in 1941 and the transfer of the planning activity to current procurement. The period was marked primarily by expansion to keep pace with the needs of the expanding Army. The 7 officers and 27 civilians who made up the Finance and Supply Division in September 1939 had grown to 16 officers and 201 civilians by December 1941. The depot system by the latter date had 125 military and 2,700 civilian employees.

To administer the growing medical supply organization, experienced men were brought in from civilian life, and Regular Army officers were given special training. A few days before the German invasion of Poland, a number of individuals "especially suited to industrial preparedness" were commissioned and assigned to the Finance and Supply Division. Plans were made for their training in the offices of the Assistant Secretary of War and The Surgeon Gen-

18(1) Memorandum, Lt. Col. R. D. Harden, MC, to Col. E. E. MacMorland, Ord C, Office of the Assistant Secretary of War, 21 Nov. 1938. (2) Civilian Production Administration, Industrial Mobilization for War, vol. I, p. 75. (3) Study SR-428-326, "Stockpiles of Strategic and Critical Materials. Part I. Opium: Probable Source and Cost of a Postwar Stockpile," August 1944. Foreign Economic Administration, Office of Economic Programs, Supply and Resources.


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FIGURE 1.-Col. Francis C. Tyng, MC, Chief, Finance and Supply Division, 1939-43.

eral and in Medical Department field installations. The Army Industrial College continued to train a number of Medical Corps officers. Three Regular Army officers were graduated in 1940. In 1941, 4 Regular Army officers and 8 Reserve officers finished the course, bringing to 56 the number of medical officers who received training at the Army Industrial College during the years 1924-41. In addition, special efforts were made to provide training for Reserve officers who had not relinquished their civilian occupations. In 1940, 23 of these officers took a course of instruction in procurement at the Medical Section, New York General Depot, for which they had been prepared by a correspondence course given a few months earlier.19

Planning for Procurement

The supply activities of the Surgeon General's Office during this period were largely of a planning and supervisory nature. The Finance and Supply Division maintained close contacts with the Office of the Assistant Secretary

19(1) Memorandum, Lt. Col. R. E. Murrell, MC, to the Executive Officer, OTSG, 31 Aug. 1939, subject: Procurement Planning, SGO. (2) Reports of TSG, 1940. (3) Memorandum, Lt. Col. C. F. Shook, MC, to Col. Charles Hines, Secretary, Army and Navy Munitions Board, 20 Feb. 1940.


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FIGURE 2.-Maj. Gen. James C. Magee, The Surgeon General, U.S. Army, 1939-43.

of War, and later, with the Under Secretary of War. As the rearmament program gained speed, these agencies of the War Department observed the procurement progress made by the technical services and enunciated broad policies for their guidance. The Finance and Supply Division received these directives, interpreted them to its field installations, and compiled the many reports required by higher authority. In addition, the division rendered aid to depots, procurement officers, and manufacturers who needed help in obtaining preference ratings, component parts, labor, machine tools, transportation, and other essentials in the fabrication of medical supplies.

Closely connected with procurement planning, and of critical importance in supply preparedness, was the Medical Department War Reserve. Hastily assembled from unbalanced stocks at the conclusion of World War I, the War Reserve was inadequate during the 1920's and 1930's; it was still inadequate, both in quantity and quality, when the United States was precipitated into the war. The reserve was poorly assembled and packed, contained obsolete items, and was not large enough to provide for even modest wartime needs. Maj. Gen. James C. Magee, The Surgeon General (fig. 2), commented bluntly on the matter to the General Staff in May 1940. "Theoretically," he declared, referring to the


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unit assemblies of the War Reserve, "there are available 54,750 fixed beds. But it must be clearly understood that the supplies and equipment are of 1918 vintage, incomplete in modern operating room equipment, wholly deficient in essential laboratory equipment, totally lacking in X-ray, physical therapy and hydrotherapy equipment, and stocked with scientific items" already obsolete or rapidly becoming so. This state of affairs had been caused by lack of money, for which, in turn, a general indifference to any kind of military expansion was responsible. "No funds for medical preparedness were allotted the Medical Department since the close of the World War until 1940 when the sum of $295,000 was appropriated and used in the replacement of obsolete items and modernization of combat equipment required for the I.P.F. [Initial Protective Force]." In November and December 1939, estimates were submitted to the Budget Officer, War Department, of funds needed to complete the shortages for the Protective Mobilization Plan ($2,696,685) and to provide essential items for an enlarged Regular Army and National Guard ($5,327,000). Both programs, however, were disapproved by higher authority. The Surgeon General then presented a detailed statement of the hospital assemblies urgently required upon mobilization and which, because of delay in procurement, should be built up before the war. "I have not," he concluded, "at the War Department's disposal for any emergency one complete, modern 1,000 bed general hospital for instant dispatch."20

A year later, thanks in part to the limited mobilization inspired by Hitler's success in Europe, but more immediately to General Magee's efforts, there were more than 30 properly equipped general hospitals in the War Reserve, together with half as many 750-bed evacuation hospitals and a number of smaller units.21

Procurement of Medical Supplies

Although procurement planning and additions to the War Reserve continued during this period, the most important duty of the Finance and Supply Division was the procurement of medical supplies and equipment for an expanding Army and National Guard. On 8 September 1939, the President authorized the Regular Army to increase its strength to 227,000 enlisted men, with a proportionate increase in officer personnel. At the same time, authority was granted to augment the National Guard to 235,000 men. Additional increases in the Regular Army and National Guard were made during 1940, and in the summer of that year, the National Guard was called into the Federal service. On 1 July 1940, the Medical Department was procuring supplies and equipment for a Military Establishment of 800,000 men. The largest peacetime Army in the Nation's history, 1,650,000 men, was gradually mobilized; but,

20Letter, Maj. Gen. James C. Magee to The Adjutant General, 10 May 1940, subject: Status of Medical Department for War.
21Hearings Before the Subcommittee of the Committee on Appropriations, House of Representatives, 77th Congress, First Session, on the Military Establishment Appropriation Bill for 1942, p. 491 (8 May 1941).


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even so, the great increase in Army strength placed severe burdens upon a procurement service which had been geared to a much lower level.

Purchasing officers at the New York General Depot (which procured 90 percent of the medical supplies during this period) and in other depots maintained a Bidders' List including the names of all known manufacturers and dealers capable of filling Medical Department orders. The names of all contractors who had previously filled Medical Department orders were placed on the list; others were added as they were able to convince the Medical Department that they could supply the items needed. Manufacturers or dealers who wished to be included were given lists of standard items purchased by the Medical Department and were notified of future purchases of those items in which they expressed an interest. Prospective bidders were also found in other ways. The Federal Reserve System, for example, undertook to uncover manufacturing sources in its various districts and suggested many names to the Finance and Supply Division in Washington. The Office of Production Management also exerted itself to acquaint manufacturers with the needs of the Army, and, through its Division of Contract Distribution, obtained the names of manufacturers who had idle machinery and were thus able to accept either subcontracts or prime contracts. Prospective subcontractors were referred to prime contractors, and the latter were brought to the attention of the purchasing officers of the Army.22

Procurement planning, during the 1920's and 1930's, had been conducted upon the assumption that the technical services would place practically all their contracts with facilities allocated to them. It was hoped by this device to avoid the kind of interservice competition that had delayed procurement and rendered it more costly during World War I. The assumption was quickly abandoned when the rearmament program of 1940-41 got well underway. Neither the President nor the Congress established the economic controls necessary to put the allocations system into effect. The Bidders' List of the Medical Department was not restricted to allocated facilities; it contained the names of all manufacturers and dealers who could furnish medical supplies, regardless of allocation. Of the 253 facilities used, only 172 (or 68 percent) had been allocated to the Medical Deparment.23

The system of allocations had not kept pace with the needs of the technical services. New factories had been established, old factories had been converted to war production, and the Medical Department, in common with other technical services, had developed or adopted new items. These changes had not been matched by a thorough revision of the allocations, and thus the allotted facilities were not adequate for War Department needs. Neither were the requirements estimates of the procurement planning days adhered to. Pro-

22(1) Letter, Lt. Col. F. C. Tyng, MC, to Mr. H. C. Timberlake, 14 Dec. 1940. (2) Letter, Col. John W. Meehan, MC, to Senator Francis Maloney, 26 Sept. 1941. (3) Letter, Maj. M. E. Griffin, MC, to 12 District Offices of the Defense Contract Service, Office of Production Management, 20 Oct. 1941.
23Memorandum, Lt. Col. C. F. Shook, MC, to Lt. Col. F. C. Tyng, MC, 1 Mar. 1941, subject: Report Upon Senate Resolution 71.


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curement officers distrusted the requirements figures and considered them to be unrealistic. They had been computed in anticipation of an M-day, when the Nation would spring to arms and a deluge of war orders would issue from the Army. But the slow and steady increase in procurement during 1940-41 did not fit into this pattern. It was very difficult to determine what proportion of the planned requirements should be procured at any particular time.24 Indeed, when procurement reached floodtide in 1942 and 1943, it was still difficult to tell what part of the anticipated requirements had, in fact, been met.

Instead of relying upon computed requirements figures, the Finance and Supply Division, until 1942, placed its trust in the "depot replenishment system." Each depot submitted to the Surgeon General's Office a stock report showing the receipts and issues of each Medical Department item. Semiannual reports were submitted for nondeteriorating items, while deteriorating items were reported quarterly. These reports, covering approximately 4,500 items, were posted to consolidated stock cards in the Surgeon General's Office; from this information, the probable issues during the next reporting period were calculated. To the probable issues in each item were added the initial supplies and equipment needed to equip new units which were being formed. Thus were obtained the "normal" quantities of each item which should be procured. Although initial equipment could be calculated with fair accuracy, it proved impossible to evolve a satisfactory formula for determining replacement needs. The "normal" quantities of each item were simply increased by an amount deemed sufficient to satisfy needs that were growing at a rapid, but undetermined, rate. It was, in a word, a matter of judgment, but judgment that proved in the sequel to have been generally sound. This "hit and miss" method, as it was described by some supply officers, continued to characterize procurement until July 1942, when the Army Supply Program went into effect.25

Estimated procurement requirements were transmitted to the purchasing depots in the form of purchase authorizations. Invitations were then issued to all qualified firms on the Bidders' List, after a lapse of 15 to 60 days, depending upon the urgency of the purchase; the bids were opened, and a contract was made with the lowest bidder. This system had been employed during the unhurried times of peace. It had provided sufficient supplies at the time they were needed and at the lowest possible prices; but it was not adapted to war, nor to hasty preparation for war. Under these conditions, price becomes a secondary factor, and time of delivery and quantity of supplies become prime considerations. This period was marked, therefore, by departures from competitive bidding and by the adoption of negotiated contracts which were designed quickly to obtain from industry the vast quantities of supplies and equipment needed. In July 1940, an act of Congress gave the technical services

24(1) Procurement Planning, 1939-41. [Official record.] (2) Letter, Lt. Col. F. C. Tyng, MC, to the Assistant Secretary of War, 28 Nov. 1940, subject: Review of Organization, Procedures and Methods Pertaining to Procurement.
25(1) Memorandum, Lt. Col. John J. Pelosi, MC, to Lt. Richard E. Yates, MAC, 7 Dec. 1944. (2) Memorandum, Col. Paul I. Robinson, MC, to Chief, Supply Service, 11 Aug. 1944, subject: Purchasing Policy.


15

enlarged authority to make open market purchases, and thus to negotiate contracts without competitive bidding.

One of the first steps was to establish liaison with the manufacturers of medical supplies. As early as 1939, The Surgeon General established industry advisory committees on drugs, surgical instruments, and other types of supplies and equipment, and received valuable advice from them on the problems of large-scale procurement. These advisory committees continued to function as advisers to The Surgeon General until September 1940, when they were absorbed by the Army and Navy Munitions Board with a commensurate broadening of responsibilities.

Although purchase authorizations issued in midsummer of 1939 were two and one-half times as large as those issued in the previous summer, it was believed that industry could easily carry the load, except for surgical instruments and a few other items in which trouble had long been expected. For many years, the United States had been largely dependent upon German manufacturers for surgical instruments. This dependence was interrupted by the expansion of domestic manufacturers during World War I; but early in the 1920's, Germany once more captured the U.S. market and held it until the British blockade was established in September 1939. The few surgical instrument factories in the United States were thus presented with an increasing demand, from both military and civilian hospitals, and for export to France, England, and Latin America, which they could not satisfy; nor could production be quickly expanded. Machine tools were difficult to procure; forgings were not available in the large numbers required; and, even more serious, the skilled labor employed in the manufacturing processes could not be quickly trained. The conversion of silver and jewelry manufacturers to the production of surgical instruments offered only limited relief.

It was inevitable that the purchase requirements for the period 1939-41 should be considerably greater than deliveries. This produced a condition of chronic shortages which constituted the most serious problem with which the Finance and Supply Division was faced. In this period of unprecedented expansion, the huge requirements were not fully anticipated and procurement was often initiated too late to produce the supplies when they were needed. The difficulty was further aggravated by the "procurement lag"-the interval of time elapsing between the acceptance of a contract and the delivery of the supplies-which became longer as shortages of labor and raw materials became more acute.

Storage and Distribution

When the Army began its expansion late in 1939, facilities for storage and distribution of medical supplies were geared to serve a small Military Establishment in the quiet days of peace. The main depot of the Medical Department was located in Brooklyn, N.Y. This was the Medical Section of the New York General Depot, which was the distribution point for all overseas garrisons and for all states east of the Mississippi River except Tennessee and Mis-


16

FIGURE 3.-Building No. 40, St. Louis Medical Depot.

sissippi, which were supplied from St. Louis. The only branch depot belonging exclusively to the Medical Department was the one in St. Louis (fig. 3), which served most of the Midwestern and Rocky Mountain States. The medical sections of the San Antonio, Tex., and San Francisco General Depots were the distributing points respectively for the Southwest and the Pacific coast. Depots for the storage of the War Reserve were located at Columbus, Ohio, New Cumberland, Pa., and Schenectady, N.Y.

Into the active depots of the Medical Department, the supplies and equipment were shipped by manufacturers and dealers, who were informed of the


17

proper destination by the contract or purchase order. When received at the depot, the supplies were physically inspected to determine if the proper quantity had been received and if they conformed with other terms of the contract. A mere tally-in accomplished the former purpose, but inspections to determine quality, especially of drugs and biologicals, required laboratory examinations. Samples were forwarded to the laboratory of the Medical Section, New York General Depot; and, until results of the examination were received, the shipments being tested were withheld from issue.

Supplies and equipment, after being accepted by the depot, were stored according to item number, and were issued on the basis of requisitions received from the medical supply officers of posts, camps, and stations of the depot's distribution area. These requisitions, normally submitted through Corps Area Headquarters, were of three types. Semiannual requisitions were received on 31 March and 30 September. Quarterly requisitions, generally confined to deteriorating items such as drugs and rubber goods, were due on the first day of January, April, July, and October. Emergency requisitions were submitted as required, but, even these, unless they were based upon dire need, were first cleared through Corps Area Headquarters. A period of 3 months was required to process the semiannual requisitions because they were all received at the same time, and only a limited number of packers were available in the depots. Posts, camps, and stations maintained sufficient stock levels, however, to last until the beginning of the next requisitioning period. The emergency requisitions were filled quickly, sometimes in a single day; and the quarterly requisitions for deteriorating items were also processed promptly.26

It will be observed that the storage and distribution functions of the Medical Department, at the beginning of the rearmament program, were conducted on a small, economical scale. Indeed, economy was a most important feature, for appropriations were not generous, and it was necessary to effect all possible savings. The number of civilian employees was kept very low, depot upkeep expenditures were maintained at a minimum, and shipping methods and routes were selected with economy as the foremost criterion. But, as the size of the Army grew during the period 1939-41, and as the procurement of medical supplies markedly increased, it became necessary to expand the depot facilities of the Medical Department. Although the most important part of this expansion occurred in 1941, it began in 1940. By the end of 1940, the Medical Department had a total of 1,203,387 square feet of storage space, of which 575,899 square feet was used for current operations and 537,428 for storage of the unit assemblies in the War Reserve. Aggregate storage space had more than quadrupled by December 1941, when 5,690,028 square feet was so used.27

The heavy load which the expanding Army placed upon the Medical Department's storage and distribution facilities brought about other changes in addition to the increase in depot space and operating personnel. Methods

26History of the St. Louis Medical Depot, 1936 through 1939. [Official record.]
27(1) The Depot Facilities Program of the Medical Department. [Official record.] (2) Memorandum, Maj. D. A. Peters, SnC, to Brig. Gen. Albert G. Love, 23 Nov. 1942.


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and procedures which had been adequate for the modest work of the depots during prior years could not cope with the vastly augmented tasks imposed by the rearmament program. Electrical accounting machines were installed, both in the Surgeon General's Office and in the depots, in 1941, although they were not fully mastered for another year. Materials-handling equipment, which so greatly added to the speed and economy of storage operations, also originated before Pearl Harbor. Improvements in the collection and packing of stock, to fill requisitions, were necessary as soon as the workload increased; and by the use of the assembly line system, these tasks were better performed. Inventories were taken more frequently and in a manner which interfered less with current operations.

Helpful though they were, however, these improvements did not fully solve the immense problem of distribution that confronted the Medical Department during 1941. As the Army expanded through voluntary enlistments and the action of Selective Service, training camps multiplied throughout the country; and each camp had its station hospital and its group of regimental dispensaries. In addition, an increasing number of medical troops were being trained for service with tactical units. These installations and troop units needed great quantities of medical supplies, and the medical supply officer of each post looked to his distribution depot to supply the need. In July 1940, there were 110 station and general hospitals, having a total of 22,000 beds. By July 1941, the number of hospitals had grown to 180, and the total beds had increased to 80,000,28 necessitating shipment of large numbers of hospital assemblies and great quantities of maintenance supplies to posts, camps, and stations. During this early period, stocks were inadequate to supply the large number of hospitals then being constructed. Both the procurement lag and the inadequacy of the War Reserve rendered shortages inevitable. Although the depots made emergency purchases from local sources, many assemblies shipped to the hospitals were only 50 to 60 percent complete. Old 1918 hospital assemblies were torn down and rearranged to meet modern needs, but shortages of medical supplies in the hospitals continued. It is improbable, however, that the scarcity of medical supplies seriously hampered the professional work of doctors and surgeons, who fortunately did not have to cope with any major epidemic.

MEDICAL SUPPLY FOR GLOBAL WAR

Organization of the Medical Supply Service

Supply organization in the Surgeon General's Office.-A sweeping War Department and Army reorganization early in 1942 brought the Medical Department under ASF (Army Service Forces), for a short time called Services of Supply. The reorganization as it affected the Medical Department as a

28Magee, J. C.: Activities of the Medical Department in Augmentation of the Army. Army M. Bull. 56: 1-10, April 1941.


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whole need not concern us here.29 So far as medical supply was concerned, the closer relationship with the Service Forces inevitably meant a streamlining of the supply organization in the Surgeon General's Office to conform more closely to the overall pattern. The new organization went into effect on 1 July 1942. The supply functions were separated entirely from fiscal activities, and a new Supply Service was created with five divisions under it: Production Planning, Requirements, Purchases, Distribution, and an International Division. By September 1942, there were 41 officers and 431 civilians on duty in the Supply Service, compared with the 16 officers and 201 civilians who had operated the combined Finance and Supply Division when the United States entered the war. The number had grown to 94 officers and 591 civilian employees by 1 March 1943, when the service was again reorganized.30

The March 1943 reorganization divided the Supply Service into two branches concerned respectively with Supply Personnel and Office Management, and seven divisions: Requirements, International, Resources, Procurement, Price Analysis and Renegotiation, Specialties, and Distribution. Among the new organizational units, the Resources Division devoted its attention to alleviating the raw material shortage which, during this period, was hampering the production of medical supplies and equipment. The Price Analysis and Renegotiation Division was established to analyze contract prices submitted by manufacturers and to carry out the terms of the renegotiation statutes which had been enacted by Congress in 1942 and 1943. The Specialties Division, which included an Optical Branch, Laundry Branch, and X-ray Service Branch, was not an operating division. Rather, its function was to study the peculiar problems encountered in the procurement and distribution of certain specialized items and to make this information available to the other divisions. It had administrative and coordinating functions almost entirely.

This reorganization had been recommended by Mr. Edward Reynolds, former president of the Columbia Gas and Electric Corp. of New York, and then Special Assistant to The Surgeon General. When Maj. Gen. Norman T. Kirk became The Surgeon General in June 1943, Colonel Tyng, Chief of the Supply Service, was relieved and Mr. Reynolds became Acting Chief. In the spring of 1944, he was commissioned a colonel, Medical Administrative Corps, and was appointed Chief of the Supply Service (fig. 4). A further reorganization, meanwhile, had eliminated the separate branches and reduced the seven divisions to five: Supply Planning and Specialties, International, Renegotiation, Procurement, and Distribution and Requirements. Thus were eliminated the Resources and Requirements Divisions, while the functions of the latter were merged with those of distribution. This trend toward simplification was carried a step further in September 1943, when the Supply Planning and Specialties Division was abolished; but in November 1943, it was

29For more detailed treatment, see (1) Medical Department, United States Army, Organization and Administration in World War II. Washington: U.S. Government Printing Office, 1963, pp. 72-93. (2) Millett, John D.: U.S. Army in World War II. The Army Ground Forces. The Organization and Role of the Army Service Forces. Washington: U.S. Government Printing Office, 1954, pp. 36-42.
30Memorandum No. 1, Supply Service, OTSG, 1 Mar. 1943, subject: Organization of Supply Service.


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FIGURE 4.-Col. Edward Reynolds, MAC, Chief, Supply Service, Surgeon General's Office, 1943-46.

reinstated as the Supply Planning Division with expanded functions. In addition to its administrative and coordinating duties in procurement of optical equipment and supplies, this division had the responsibility of preparing and distributing the Medical Department Supply Catalog and Equipment Lists and with aiding in the development of new items.31

This last reorganization, however, was marked by a far more important change and by the beginning of a trend which continued until the end of the war. The Procurement Division was renamed the Purchase Division, and was transferred to the Army Medical Purchasing Office, successor to the New York Procurement District. A liaison branch of the Purchase Division was established in the Supply Service in Washington, which maintained close contacts with the Army Medical Purchasing Office and independently performed certain functions related to procurement. The movement of the Purchase Division to New York reduced the number of officers assigned to the Supply Service from 94 to 75. At the same time, the Reports and Records Branch was set up as a separate unit to compile the many reports required by the staff divisions of Headquarters, ASF, and to keep the Chief of the Supply Service

31Memorandum No. 1, Supply Service, OTSG, revisions of 16 June and 29 Nov. 1943.


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constantly informed of the progress made in the procurement and distribution program.

The largest and least cohesive part of the Supply Service, at this date, was the Distribution and Requirements Division. Staffed by 33 officers and a substantial civilian group, this division was composed of five branches: Storage, Requirements, Issue, Maintenance, and Inventory Control, the latter being attached to the Army Medical Purchasing Office in New York. When one considers this division's important duties in computation of purchase requirements, control of stock levels, operation of depots, repair of medical equipment, and distribution of medical supplies, it is apparent that its efforts were spread over a large area and included many parts of the entire supply program. The largest task which yet remained for administrative reorganization was to break down this unwieldy division and to assign its duties to separate divisions on a functional basis.

A slight reorganization in March 1944 reduced the number of divisions to four by eliminating the Supply Planning Division; and increased the separate branches to three by the addition of the Materiel Demobilization Unit and the Catalog Branch. These new offices assumed some duties of the abolished Supply Planning Division; the remainder were lodged in the Liaison Branch, Purchase Division. A more thorough reorganization was effected in June 1944, when the Distribution and Requirements Division was abolished. In its place were established the Stock Control Division, Issue Division, and Storage and Maintenance Division. The Renegotiation Division was transferred to the Army Medical Purchasing Office, and a liaison unit of that division was established in Washington. The Inventory Control Branch, a part of the Stock Control Division, remained in New York. At this time, also, the offices of the Deputy Chief for Supply Control and the Deputy Chief for Storage Operations were established as consulting agencies for the Chief, Supply Service, and were staffed by qualified civilians.32

As the war neared its end, the movement of Supply Service units to New York continued. In November 1944, the remaining branches of the reorganized and enlarged Stock Control Division were transferred to the Army Medical Purchasing Office. The single exception was the Requirements Branch which retained its Washington location until July 1945. In the meantime, in March 1945, the independent Catalog Branch went to New York. Shortly before the German surrender in May 1945, plans were made to move other parts of the Supply Service to the Army Medical Purchasing Office, but these plans were abandoned when it became apparent that the procurement and distribution programs would soon be sharply curtailed.

Field organization for medical procurement.-When the United States entered the war, the actual purchase of medical supplies and equipment was divided between the Medical Section, New York General Depot, and the St. Louis depot, an arrangement dictated by fear that sabotage or even enemy bombing might knock out the New York facility. The St. Louis depot had pur-

32OTSG Manual of Organization and Standard Practices, Organization Chart 3.09, 24 June 1944.


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chase responsibility for drugs, chemicals, and stains (class 1); X-ray equipment and supplies (class 6); furniture, physiotherapy equipment, mess equipment and supplies (class 7); veterinary equipment and supplies (class 8); and field equipment and supplies (class 9). The Medical Section of the New York General Depot purchased the remaining medical items, which included surgical dressings, surgical instruments, laboratory equipment, and dental supplies and equipment.

Early in 1942, the New York Medical Depot was established as the successor to the Medical Section, New York General Depot. In August 1942, the New York Medical Depot was moved to Binghamton, N.Y., but its Purchasing and Contracting Section remained in the city to become the nucleus of a newly activated New York Medical Department Procurement District. This purchasing office was divided into four Buying Sections, a Conservation and Production Control Section, and an Operations Section, which was concerned with administrative matters.33 Each Buying Section (later called Purchasing Branch) procured items in a single commodity group, thus permitting procurement officers to specialize on a particular class of items and to become familiar with the capacities and problems of the producers. As procurement operations expanded, personnel steadily increased. In December 1942, the New York office had 58 officers and 338 civilian employees; by June 1943, the number of officers had increased to 74 and civilian employees to 413.34

The St. Louis Medical Department Procurement District, established in August 1942, had an organization similar to that of the New York office. Originally there were three Purchasing Branches: Drugs and Chemicals; X-ray and Physiotherapy Equipment; and Miscellaneous Equipment and Supplies. To obtain greater clerical efficiency, the second and third branches were consolidated in April 1943, the new unit being designated the Hospital Equipment Branch. As the procurement load increased, other departments were established to perform functions involved in production control, inspection, public relations, renegotiation, and office administration. During calendar year 1943, personnel increased rapidly. The number of officers rose from 12 to 63, and the number of civilian employees from 161 to 241.35

These two purchasing offices, first as depots and later as procurement districts, contracted for practically all of the medical supplies used by the Army during the war. The St. Louis depot lasted throughout the war, but the procurement district was abolished in September 1943, when it was considered safer and more economical to consolidate all Medical Department procurement in New York as the Army Medical Purchasing Office. In the words of the ASF circular36 which activated the new unit, the office was "responsible for the actual procurement of medical supplies, including production control,

33Annual Report of Activities, New York Medical Department Procurement District, fiscal year 1943.
34Annual Report of the Supply Service, OTSG, 1943.
35See footnotes 33 and 34, above.
36Army Service Forces Circular No. 79, 15 Sept. 1943.


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issuance of priorities, survey of facilities, and inspection of supplies." At this time, branches were established in Chicago and St. Louis, the main duties of which were to aid contractors in procuring raw materials, component parts, and labor. At this point, the Purchase Division of the Supply Service was transferred to New York, where it became an integral part of the Army Medical Purchasing Office. Thereafter the Supply Service, for all practical purposes, centered in New York rather than in Washington.

Personnel and training.-By mid-1943, the Medical Supply System, exclusive of the overseas theaters, had expanded its personnel to 800 officers and 15,050 civilians on duty, both in Washington and in the field. Turnover of personnel was caused largely by the constant drain upon the Surgeon General's Office and the depots to fill the personnel requirements of a global supply system. At the same time, however, The Surgeon General was able to draw upon the service of many keymen from civilian industry. Among those most helpful were Mr. Herman C. Hangen of J. C. Penney Co., Mr. Mead M. Messick of Montgomery Ward & Co., Mr. C. W. Harris of Butler Brothers, and Mr. W. A. Hower of Van Raalte Silk Co.

For training medical supply personnel, various courses were provided during the war years, both by ASF and by the Surgeon General's Office. The Medical Supply Officers Orientation Course provided training in military customs, courtesy, procedure, and medical supply for the new officers reporting to the St. Louis Medical Depot for duty in medical supply work. In early 1943, ASF established a three-phase course for training of commissioned depot personnel. This was known as the ASF Depot Course. The first period was conducted at the Quartermaster School, Camp Lee, Va., and covered all operational phases of Army warehousing, organization of the Army for supply, handling and transporting of supplies, property accounting, packaging and crating, and open storage. The second period, conducted at the St. Louis Medical Depot, was identical with the Medical Supply Officers Orientation Course. For the third phase, student officers were assigned to one of the medical supply distribution depots to gain experience in previously studied supply activities.37

In June 1943, two courses-Phase II of the ASF Depot Course and the Maintenance Course-which were conducted at the St. Louis Medical Depot, were designated "The Medical Supply Service School." Training of units organized under tables of organization and equipment was added to the Medical Supply Service School curriculum during 1944. This training consisted of functional employment in the St. Louis Medical Depot, orientation as to overall training in the supply field, and field training. Medical Supply Platoons (Aviation) were trained during 1943-44 at Savannah Medical Depot to prepare them for ready use overseas.

37Annual Report, Training Division, Operations Service, OTSG, fiscal year 1943.


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Role of the American Red Cross

Relationship between ARC (American Red Cross) and the Supply Service increased in scope during the war period. Major ARC activities in the area of supply for the Army were the blood program38 and the surgical dressing program. The Army, however, furnished or purchased medical supplies required by ARC for various purposes and supported its war relief program logistically.

Blood program.-Plasma units were compact, and possessed long keeping qualities not true of whole blood, which was good for use only up to 21 days after collection (fig. 5). These favorable characteristics of dried plasma permitted ease of use and handling in the combat areas. Through cooperation of Army, Navy, National Research Council, ARC, and commercial biological manufacturers, a blood plasma procurement program calling for the production of a minimum of 700,000 units of dried plasma for the Army was instituted in fiscal year 1942. The Surgeon General considered the plasma program to be of such significance by February 1943 that he appointed Col. Charles F. Shook, MC, as Liaison Officer, OTSG, responsible for contact with ARC, and for furtherance and proper management of this vital program. When Colonel Shook was transferred to the Mediterranean theater as Surgeon, Services of Supply, Maj. Frederic N. Schwartz, MAC, took charge of the program and remained in that capacity until termination of the war.

Until August 1943, plasma was manufactured in units of 250 cc. At that time, the size was changed to 500 cc. because this was the normal amount administered, and this larger unit conserved shipping space and reduced the total amount of critical materials (rubber, steel, and tin) required. The blood plasma program progressed to a grand total of 3,070,806 small units, and 3,115,877 large units by 1945.39 Although blood banks were established in overseas combat areas, sufficient quantities of whole blood for treatment of casualties could not be obtained, and by August 1944, supplemental shipments from the United States became imperative. The Army Medical Department provided for the needs of the European theater for type "O" blood through the services of ARC via facilities of the Air Transport Command. The Navy used a similar method in providing for needs in the Pacific. After V-E Day, the ARC ceased collecting blood for military services from all except the major cities of the United States. On 10 August 1945, the ARC was advised that the Army would not require blood for processing into dried plasma as soon as V-J Day was announced officially.

Surgical dressing program.-During the expansion period before the entry of the United States into the war, it was discovered that the Army Medical Department had grossly underestimated its need for surgical dressings. Frustrated because industry was too deeply involved in other forms of war production to cooperate, The Surgeon General turned to the Red Cross

38For further details, see Medical Department, United States Army. Blood Program in World War II. Washington: U.S. Government Printing Office, 1964, pp. 101-137.
39Hornbacher, Arthur: Blood Plasma. [Official record.]


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FIGURE 5.-Chest, Plasma, Complete, consisted of Medical Department chest, plain, and 20 units of plasma, normal, human, dried, 250 cc.

for help. The response was overwhelming, resulting in the accumulation of large stockpiles of dressings between 1941 and 1944. The Medical Department reciprocated by furnishing the Red Cross with needed supplies. Several medical assemblies were furnished as well as stocks, such as blood plasma, drugs, dressings, and surgical instruments for prisoners of war on both sides, and supplies for Allied countries.

Following V-E Day, the Army reevaluated its requirements and assets to release, before V-J Day, as much excess material as possible to civilian channels. Basing action on the Surplus Property Act of 1944, items in excess of Army requirements, such as blood derivatives and surgical dressings, were first reported as excess, then obtained in large amounts to be used in civilian


26

emergencies or for charitable purposes throughout the United States and overseas areas.

Demobilization Planning

Planning for demobilization began in the Surgeon General's Office in August 1943. The early stages of the demobilization program were carried out under several officers progressively: Col. Paul I. Robinson, MC, Col. Stuart G. Smith, MC, Col. William L. Wilson, MC, then back to Colonel Robinson. On 5 February 1944, the Commanding General, ASF, advised the chiefs of Technical Services that materiel demobilization planning was a command responsibility at each echelon in the chain of command. The Surgeon General had already established a unit for this purpose directly under the chief of the Supply Service. By the end of fiscal year 1944, a series of plans for period I (redeployment, readjustment, and demobilization between the defeat of Germany and that of Japan) had been developed which reflected current procedure and policy changes set forth in the ASF Materiel Demobilization Plan. The Surgeon General's plan directed action regarding inauguration of the revised procurement program for period I; determination of contracts to be terminated; methods of receiving, storage, caring for, and disposing of finished and unfinished products; review of research and development projects; revision of spare parts lists; and efficient handling of military lend-lease shipments.

Special studies were made on potential requirements for medical items sought by outside agencies such as the Red Cross, United Nations Relief and Rehabilitation Administration, and Civilian Relief in Liberated Areas. Also, the stockpiling of a peacetime war reserve was essential. Disposal of medical property needed careful handling. To flood the market with surplus Government stocks at the conclusion of the emergency would have adversely affected small business. The plan proposed that certain items be distributed to eligible federal, state, county, and municipal health institutions and sanitary health agencies on a grant basis under a control system to establish the fact that these institutions could not afford to purchase health articles required for their missions.

The objectives of this proposal were to get the maximum number of surplus medical items into worthwhile use and out of Government storage in the shortest possible time; to cause minimal impact on industry; to cause minimal tax burden for accomplishment of important health advances; and to effect improvement in medical care throughout the United States, thus reducing the number of persons physically ineligible for military service.

Many actions of the Materiel Demobilization Plan were placed in effect as operating procedures before V-E Day arrived. Agencies were alerted, and on V-E Day, the remaining actions of the plan were placed in effect. A specific plan was devised to furnish units in the Far East with medical equipment from stocks available in the European theater.


27

The plan for readjustment and demobilization after V-J Day was prepared by the Supply Service under Col. Jenner G. Jones, MC, and Maj. Richard J. White, Jr., MAC. Specific activities and responsibilities of the Supply Service were outlined as follows:

1. Review procurement objectives for the balance of 1945 and 1946 for all medical items; compute procurement programs to reflect demobilization phasing; determine War Reserve requirements and a peacetime Army Supply Program based on the appropriate troop basis; cancel and reschedule programmed procurement to meet period II procurement objectives; terminate all contracts approved for termination and expeditiously settle all such contracts; determine and report quantities which were surplus to the War Reserve and peacetime army requirements for periods II and III.

2. Discontinue security inspections except at privately operated facilities having highly classified information which was believed to require continued personnel security protection against espionage.

3. Redistribute military property excess in overseas theaters and bases for period II, as well as in the Zone of Interior; initiate and implement policies and procedures for redistribution of all property declared surplus.40

Supplies en route to the Pacific and Asiatic theaters had to be diverted and disposed of, and all requisitions canceled. Space for storage of these items had to be provided on a continuous basis. Civilian supplies had to be procured and shipped as scheduled, and surplus property had to be disposed of or stored.

On V-J Day, these plans were placed in operation.

LOGISTICAL SUPPORT OF COMBAT AREAS

Because logistics is designed to support the tactical effort, it is not surprising that marked differences developed in different theaters of operations. The war in the Pacific was largely an island-hopping war with multiple and repeated naval, air, and amphibious operations. On the other hand, the war in Europe and Africa was largely ground warfare over more expansive areas. Naval and amphibious combat operations were preludes to ground warfare involving large numbers of troops on broad fronts resulting in large numbers of casualties. Operations in the Mediterranean, a combined British and American theater, were an alternating combination of amphibious and landmass fronts that began with the landings in North Africa, then shifted north into the Mediterranean Islands and on to the European Continent. Because of the widely separated landings and areas of combat, a decentralized type of supply system prevailed until forces were concentrated on the Italian Peninsula.

40Memorandum, Brig. Gen. Edward Reynolds, to Director, Industrial Demobilization, ASF, and others, 6 Aug. 1945, subject: Supply Service-Interim Plan-Period II (Readjustment and Demobilization).


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Medical Supply in Europe

Many factors influenced the evaluation of the medical supply system in the European theater. One of the early problems was the constant changing of operational plans and priorities for the theater as the fortunes of war, worldwide, ebbed and flowed. The operations were mounted in England, a strong and industrialized ally. There was no language barrier. Even though the United Kingdom and its industry were already burdened with prosecuting the war against the Axis, our Government believed that the British could supply U.S. forces with large quantities of material through "reverse lend-lease" and thus conserve shipping space.

Another important factor was that the war was fought on a large landmass with relatively good rail and road networks, and with existing telephone and telegraph systems providing a basis of rapid communication. As the war progressed, more and more hospitals and depots were established on the Continent, although throughout the war hospitals and depots in the United Kingdom continued to support the operations.

Maj. Gen. Paul R. Hawley (fig. 6) was not only chief surgeon of the theater, but he also headed the medical service of the Communications Zone. As the war progressed, he had tremendous medical resources-personnel and material-under his control. General Hawley, a man of great ability and drive, was strong enough and wise enough to use them effectively. The fact that the entire medical service for the U.S. forces in the European theater was under one chief aided immeasurably in the successful medical support of the war.

From the outset, professional influence was strong. General Hawley surrounded himself with prominent and outstanding specialists in every clinical field, who actively influenced the techniques and the quality of medical and surgical care. These consultants were of great value in developing supply policies, advising on requirements, and especially in teaching their professional colleagues in hospitals some of the rudiments of Army supply. Many medical officers, most of them fresh from civilian life, had no concept of what was available, of Army supply terminology, or of how to go about obtaining what they needed. Frequently the weakest link in the supply chain was between the hospital or unit medical supply officer and the doctor, both of whom were frequently inexperienced in Army supply. The needed item was in the supply room or warehouse but the supply officer did not know its use and the doctor did not know it was there, what it was called, or how to get it.

Identification was often a serious problem. Doctors were familiar with drugs by their common or trade names whereas the Army carried them under their official U.S.P. or N.N.R. titles. Likewise, surgical instruments and other equipment, not infrequently, were known in different sections of the United States by various names, which were dissimilar to Army nomenclature. General Hawley's consultants were given an orientation and each became familiar not only with the supply items of his specialty, but also with mechanics of the


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FIGURE 6.-Maj. Gen. Paul R. Hawley, Chief Surgeon, European theater.

overall medical supply system. Time and again on their visits, they were able to bridge the gap to medical installations and see that the item was put in the hands of the professional man.

The long evacuation policy-120 days during most of the war-resulted in a large patient load and much definitive treatment within the theater. At the height of the operations, the medical service in the European theater had 192,000 beds41 occupied by patients. This was reflected in huge requirements for medical supplies.

A favorable factor was the availability of prisoner-of-war labor. In the United Kingdom, both Italians and Germans were utilized, whereas on the Continent only Germans were available. Many were skilled or semiskilled men, accustomed to hard work. Usually employed under their own noncommissioned officers, prisoners proved to be a valuable adjunct to the medical service.

Because of the above-mentioned factors, plus many others, the medical supply system in the European theater developed along strongly centralized lines, and was ultimately patterned closely after the Zone of Interior system. The Supply Division of the Chief Surgeon's Office closely controlled all opera-

41Monthly Progress Report, Army Service Forces, 28 Feb. 1945, Section 7.


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tions. It enunciated policies and procedures, determined theater requirements, requisitioned supplies from the United States, distributed stock among the depots, and supervised depot activities. Although the theater, behind Army boundaries, was divided into advance, intermediate, and base sections, these geographic commands exercised little influence beyond assistance to the medical supply operation. In other theaters of operations where geographic commands were widely dispersed, the reverse tended to be the situation, resulting in decentralized systems in which the real authority rested with the geographic area commanders.

Medical Supply in the Pacific

In the Pacific, in addition to vast distances and small, scattered land areas, there were extremes of climate ranging from the cold, damp conditions of the Aleutians to the tropical islands of the central Pacific. Tropical diseases called for special drugs and the hot, damp atmosphere of the Solomons and other island groups demanded special equipment. At the same time, shipping space was at a premium while central depots were necessarily remote from the scenes of combat. Until the final stages of the war in the Pacific, scarcity was the rule so far as medical supplies were concerned.

One contributing factor in this situation occurred even before the war itself. By way of preparation for the emergency that appeared clearly in the making, a substantial portion of the Medical Department's reserve supplies had been sent to the Philippines. Equipment for four general hospitals and quantities of dressings, drugs, and instruments were on hand. Personnel was inadequate for combat, but commendable progress had been made in training Filipino physicians and enlisted men to augment U.S. military medical personnel. Plans for deployment were complete. Medical leadership was present and there is every indication that excellent medical teamwork was exercised in the preattack period. A medical supply depot was functioning and a medical regiment was available. Additionally, in accordance with plans, the equipment for one general hospital was in storage at Limay, Bataan.

When the Philippines were attacked, Sternberg General Hospital (fig. 7) became a medical center in a matter of days and accepted evacuees from the station hospitals at Clark and Nichols Fields. But, on 24 December, according to plan, movement of troops to the Bataan Peninsula was begun and medical personnel, supplies, and hospitals had to be moved. These were the experiences that our troops were to face in other areas of the South Pacific and Southwest Pacific over the next 4 years: poor roads or none at all, jungle, insectborne diseases, infectious diseases, scanty foods, ferocious combat, mud, rain, dust, discomfort, refugees, and the necessary improvisations to cope with all of these problems.

In December 1941, Maj. O.V. Kemp, MAC, an aggressive medical supply officer (for Col. Wibb E. Cooper, MC, Department Surgeon) with foresight and intelligence had purchased many consumable medical supplies from the merchants in Manila-antimalarial drugs, instruments, gauze, and cotton.


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FIGURE 7.-Sternberg General Hospital, Manila, Philippine Islands, 1940.

These were stored in Bataan and Corregidor and, without doubt, augmented the ability of medical troops to carry on. During the combat on Bataan, many medical chests had to be abandoned during the retreat. One general hospital was captured by the Japanese and, consequently, available medical supplies were depleted.

The fall of the Philippines was inevitable because the United States was unable to reach them with the necessary augmentation force. But this was not fully realized by our troops, and their performance was exemplary. On 9 April 1942, medical personnel were caring for 7,000 patients in Hospital No. 1 which was captured on that day. Progressively, quinine and Atabrine (quinacrine hydrochloride) had been depleted until these drugs were not available for malaria prophylaxis, and only limited amounts could be used for treatment. Reinfections were almost immediate to those who obtained temporary cure. Food became a serious problem, and from 1 April 1942 until surrender, the allowable calories per man had been reduced to no more than 900. There were no vitamins and no gas bacillus serum. From 9 April until 10 May 1942, Corregidor (our remaining garrison) carried on. The medical units with the troops rendered as much medical care as possible and the serious cases were


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transported to the Malinta Tunnel Hospital. This tunnel was 1,400 feet long and at intervals twenty-five 400-foot laterals branched out from the main tunnel. The tunnel was strengthened with reinforced concrete and equipped with a ventilation system. It served well in these last days to give such medical care as could be rendered under the continuous bombardment by the Japanese.42

In the Visayan Islands and Mindanao, the same shortage of antimalarial drugs was recorded. Food, however, was plentiful. One well-supplied hospital, earmarked for storage at Cebu and which was intended to be the nucleus for a large general hospital, was lost when the U.S.S. Corregidor was sunk. This was somewhat of a disaster to medical supplies, particularly since the hospital was stated to be so well stocked.

Nothing but praise can be recorded for the medical supply personnel in the Philippines during the presurrender days. Requirements had been anticipated. Stocks were on hand and stored in strategic locations. Others had been requisitioned. Most serious shortages were in antimalarial drugs. But these were strategic items in world supply and, in situations such as the Bataan defense, determination of what is enough of these drugs and the discipline to enforce their proper use present most difficult problems. The civilian Japanese population and our own troops were afflicted in the same manner, and losses of vital items at such a time and in such circumstances are almost impossible to prevent.

After the Philippines, the medical supply story in the Pacific was one of difficulties and delays, but of ultimate building up of necessary stocks to sustain the offensive that began in August 1942 with Guadalcanal and slowly gathered momentum until the abrupt ending of the war by the use of the newly devised atomic bombs.

42For a more detailed account of the medical side of the evacuation of the Philippines, see Daboll, Warren W.: The Medical Department: Medical Service in the Asiatic Theater. United States Army in World War II. The Technical Services. [In preparation.]

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