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Chapter XII

Contents

Part III

MEDICAL SUPPLY IN THE WAR AGAINST JAPAN


CHAPTER XII

Pacific Medical Supply in the Period of Defense

MEDICAL SUPPLY IN THE MIDDLE PACIFIC

Preparation for War

As international tensions increased in the summer and the fall of 1941, every effort was made to strengthen U.S. defenses in the Pacific Area. Handicapped by lack of modern material, the War Department, nevertheless, sought not only to reinforce or establish bases on Midway, Wake, Guam, Christmas and Canton Islands, and on other islands, but also to assemble 500,000 tons of supplies and 20,000 troops for use in the Philippines.

In the Hawaiian Department, located at Fort Shafter on the island of Oahu, T.H., medical preparations for war were coordinated by the department surgeon, Col. (later Brig. Gen.) Edgar King, MC. Honolulu, T.H., was zoned with 20 aid stations strategically established and supplied, while the Preparedness Committee of the Honolulu County Medical Society set up teams of disaster surgeons who would be ready for call by the U.S. Armed Forces. At the same time, arrangements were made for ambulance service. A plasma bank, which was financed with a $4,000 grant from the Honolulu Chamber of Commerce, was organized by Dr. Forrest J. Pinkerton. Several collecting stations were established, and the laboratory work was accomplished at the Queen's Hospital. Meanwhile, a group of women were making surgical dressings for the Hawaii Chapter of the American Red Cross, under the immediate direction of Mrs. A. V. Molyneaux, chairman of the production unit, and supervised by Mr. John F. Gray, a field director of the American Red Cross. On 25 November and 4 December 1941, a total of 58,000 Army-type surgical dressings were sent to the station hospital at Schofield Barracks, T.H., at the request of Colonel King.

Medical supplies stored at the Hawaiian Medical Supply Depot at Fort Shafter were considered suitable for the requirements of the Hawaiian Department. A considerable amount of the reserve equipment had been made ready for any emergency.1

Organization of the Medical Supply System for War

At the outbreak of hostilities, war reserves of the Hawaiian Medical Supply Depot were immediately picked up in depot stocks and utilized to build

1(1) Biennial Report of the Chief of Staff of the United States Army, 1 July 1941 to 30 June 1943, to the Secretary of War. Washington: U.S. Government Printing Office, 1943, pp. 3-5. (2) Annual Report, Surgeon, Hawaiian Department, 1941. (3) Memorandum, Brig. Gen. Edgar King, for Editor, History of the Medical Department, 22 Mar. 1950.


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FIGURE 99.-Tripler General Hospital.

provisional hospitals and expand existing facilities. These stocks, in general, were grossly deficient in many respects. Hospital assemblages stored as units were found to be only partially complete, and, in some instances, the equipment was of World War I vintage and of little real value. Available current depot stocks were utilized to offset these deficiencies wherever possible. Where items were not immediately available in depot stocks and time precluded requisitioning on the Zone of Interior, procurement of local commercial stocks was effected to the greatest extent possible. This source was limited, however, as most commercial stocks were also procured from the. Zone of Interior. The Surgeon General's Office, meanwhile, made an estimate of the requirements that would be generated by the attack on Pearl Harbor.

In the meantime, shortly after the attack, 18,000 surgical dressings were furnished to the Tripler General Hospital, Honolulu (fig. 99), and the U.S. Naval Hospital at Pearl Harbor in response to emergency calls to the Red Cross. Also, on the same morning of 7 December 1941 and during the next 2 days, 750 units of 250 cc. of plasma were provided to both Army and Navy hospitals. The major collection stations were bleeding donors at the rate of 50 per hour. During the first 15 days, 3,400 donors were bled.


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Located at Fort Shafter, the Hawaiian Medical Supply Depot had a complement of 6 officers and 32 enlisted men and was responsible for supplying the Tripler General Hospital, the station hospital at Schofield Barracks, the provisional hospitals established subsequent to Pearl Harbor, and the dispensaries serving service and tactical units. All requisitions prepared by the depot were routed through the Surgeon's Office, Headquarters, Hawaiian Department.

Arrival of the 5th Medical Supply Depot

On 16 April 1942, the 5th Medical Supply Depot, organized under TOE (table of organization and equipment) 8-661 and under the command of Lt. Col. James P. Gill, MC, arrived in the Hawaiian Department from the Zone of Interior with 11 officers and 90 enlisted men. The Hawaiian Medical Supply Depot was inactivated 2½ months later, and all personnel and equipment were transferred to the 5th Medical Supply Depot.

To supply the service commands on the islands of Maui, Kauai, and Hawaii, branch depots were established. The branch depot at Schofield Barracks, designated Post Dispensary No. 2, was further enlarged by the construction of five additional warehouses serving 40,000 troops at its peak of operations. Another warehouse was added at Fort Ruger, T.H., making 11 warehouses in all on the island of Oahu.

Many critical items of supply were dispersed for storage in the various hospitals on Oahu and outlying islands. This move was considered essential to minimize the destruction of supplies by enemy bombing. A new warehouse was constructed on the north shore of Oahu outside Schofield Barracks, and plans were made to construct a receiving warehouse at Fort Shafter to receive critical items and stores before dispersal. A subdepot at Hickam Field, Honolulu, was established in July to service Army Air Forces personnel only. This process reached its peak late in 1942 when the 5th Medical Supply Depot was spread over 36 storage locations aggregating 185,000 square feet.

War reserve stock carried by the Hawaiian Medical Supply Depot before 7 December 1941 was issued after the Pearl Harbor attack. Stocks in 1942 thus consisted of 31 units of final reserve for the island of Oahu, 6 units for the island of Hawaii, and 4 units each for the islands of Maui and Kauai.

At times, the supply of certain items was exhausted, but usually, a substitute item was available or local purchase was made until radioed requisitions could be furnished from the mainland. Requisitions were generally filled within 7 days after receipt.

Plans for Overseas Action

The first established plan for supply of overseas combat operations was transmitted on 22 January 1942. Concurrently, the San Francisco Port of Embarkation was designated as the port to which all supply matters for the


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command would be referred. At that time, the maximum supply level was set at 70 days, based on requirements for the Army, plus the Navy and the Marines, civilians, prisoners of war, and Allied Nations personnel, where applicable. In July 1942, the level was raised by the War Department to 90 days. By this time, the medical maintenance unit and siege unit were being used to automatically supply the Hawaiian Department while requisitions were submitted to the San Francisco Port of Embarkation as a supplemental means of supply for noncontrolled items.

Receipts of Supplies

During 1942 and 1943, before the War Department shipping document was in use or the later strict regulations governing the rapid forwarding of shipping documents from ports of embarkation to overseas bases had been issued, it was a rare occurrence for the Medical Department to be advised of the arrival of its supplies until they were actually discharged and lying on the piers at Honolulu. As a consequence, it was impossible to furnish the means of transportation to the dispersed warehouse facilities of the medical supply depot. To overcome this possible source of confusion, it was necessary to assign an officer of the depot and a staff of four to eight enlisted men to work at the piers in close liaison with the port authorities. Informed as to the supplies on order and proposed storage locations, the detachment provided an invaluable service in clearing the docks of medical supplies. This pier liaison section also was responsible for handling similar responsibilities in shipments made by the 5th Medical Supply Depot to forward areas and to outlying islands.

Requisitioning by Units

All using agencies and supply points obtained replenishment of medical supplies by monthly requisitions on the 5th Medical Supply Depot through the office of the base service command surgeon, where they were edited for authorization and availability. Tactical organizations obtained supplies in a like manner, except that requisitions from subordinate units of higher echelons required the approval of their surgeon. Moreover, supply sections were maintained by the various divisions, and issues to subordinate units were made from the divisional supply points.

Organization Equipment

When tactical units were being staged in the command, a major problem was encountered in receiving and identifying organizational equipment shipped from the Zone of Interior. Many tactical units arrived with incomplete medical equipment which had to be supplemented before their departure for combat missions. Scarcity of stocks at that time inflated the problem. As a result, all organizational equipment (hospital assemblies excepted) was picked up in depot stocks, and the units upon arrival were directed to submit requisitions to the depot to cover any shortages in unit equipment. Hospital assem-


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blies that arrived before the unit was deployed were stored intact in the depot pending issue. If a unit assembly did not arrive before the unit's departure, components were issued from depot stocks, and all shortages were backordered. In such instances, the unit assembly upon arrival was dismantled, and the components were picked up in depot stock.2

Support of Defense Units of the Hawaiian Department

Tripler General Hospital, the center for treatment of many battle casualties of Pearl Harbor, reported a fair supply of sulfanilamide powder on hand and a sufficient quantity of plasma donated by civilian physicians. The problem of safe storage of such critical items was resolved by constructing a large, stormproof warehouse and by using concrete storerooms in the Farrington and Kamehameha areas of the hospital.

At the 1st Station Hospital, medical supplies were stacked initially in tents and on platforms in the dock area; then, they were removed to a coconut grove, 2½ miles from the hospital, and unpacked and classified. A portable electrocardiograph machine, received on 15 October 1942, aided a great deal in diagnostic procedure. The lack of other equipment, however, was a persistent handicap.

The 148th General Hospital, because it had not been provided with a consolidated shipping list of equipment, was unable to account for all items of the 1,000-bed hospital unit delivered to the port of embarkation in mid-January 1942. It was only by constant checking with the office of the Port Quartermaster that many short items were discovered and supplied before the unit's shipment to the Hawaiian Department in April. Upon establishment of the unit near Mountain View, Hawaii, two small warehouses, each 50 by 20 feet, were used-one, as a utility storeroom and workshop, and the other, as an issue storeroom. Supplies in closed stock were kept in a larger warehouse located at Olaa, T.H., 6 miles away.

The 26th Station Hospital experienced similar unloading and storage problems upon its arrival from the mainland. The supplies, consisting of 1,763 crates, were manhandled mostly by hospital personnel and were stored in and filled seven hospital tents in the dock area. Because of misleading labels on the shipping boxes and limited storage space, unpacking was not systematic. The department surgeon caused the medical supply dump serving both the 26th and the 1st Station Hospitals to be moved to a coconut grove 2½ miles away. There, supplies were stored in tents and partially unpacked and classified. By April, tent warehouses were established in the hospital area where permanent warehouses were being constructed. Repeated moves had caused unnecessary labor and personnel trouble; however, little loss or waste was experienced.

2(1) See footnote 1(2), p. 393. (2) Ronka, Enzio K. F.: History of Professional Experiences, World War II, in Central Pacific Base Command or Hawaiian Department. [Official record.] (3) Whitehill, Buell: Administrative History of Medical Activities in the Middle Pacific. [Official record.] (4) Annual Report, 5th Medical Supply Depot, 1942.


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FIGURE 100.-A. 2d Lt. Allan W. Phelps, MAC, medical supply officer, Task Force 4591, and native workers. B. Interior view of the medical supply warehouse on Christmas Island.

Because supplies were received directly from both Fort Mason, San Francisco, and the Hawaiian Department, there was some duplication of equipment, but this situation was soon corrected.

The 24th Infantry Division had its full table of basic allowance of medical organizational equipment with very few items not available. Nonstandard medical equipment included a treatment and instrument chest, oxygen equipment, linen chest (towels, pajamas, and bathrobes), and a protective clothing chest. Emergency medical equipment was stored at the Kahuku Hospital, the Waialua Hospital, and at the two medical dumps. Supplies were stored in 9- by 12-foot houses at Pupukea Heights and Eucalyptus Forest. Essential nonstandard items, such as Pentothal sodium (thiopental sodium) for intravenous anesthesia, dry plasma, and normal saline solution, were issued to larger medical units of the division. Mountain rescue equipment, consisting of a basket litter


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modified by a board bottom and supplemented by ropes, was maintained by the 24th Medical Battalion.3

Task Force 4591

Almost immediately after the Japanese struck, U.S. forces began to spread to scattered islands in that area of the Pacific.

Before World War II, most flights over the vast areas of the Pacific had been in sea-based planes. On 29 January 1942, slightly less than 2 months after Pearl Harbor, Task Force (movement) 4591 slipped out of the San Francisco Harbor en route to Christmas and Canton Islands and Bora Bora in the Society Islands-its mission being to help strengthen the bridge of airbases across the Pacific.

A section of this task force arrived at Christmas Island 10 days later and, after a rather laborious delivery of the cargo, set up a 100-bed station hospital which proved functional despite the obsolescence of the medical chests which had been packed during World War I.

The medical supply officer for this pioneering task force was 2d Lt. (later Capt.) Allan W. Phelps, MAC, who had been in the Army only 6 weeks when he departed from San Francisco. His medical resupply point was the Hawaiian Medical Supply Depot at Fort Shafter, and soon the deleterious effects of outside storage on precious medical stocks was realized. An excellent Polynesian thatched medical supply warehouse was contracted for and built, using as a medium of exchange unneeded red flannel bandage (fig. 100).

MEDICAL SUPPLY IN THE DEFENSE OF THE PHILIPPINES

Prewar Preparations

Before General of the Army Douglas MacArthur was appointed Commander, USAFFE (U.S. Army Forces in the Far East), the war plans for the Philippine Department were being vigorously revised to meet war needs. The induction of Philippine Army troops into USAFFE and the possibility of a prolonged period of resistance to invading forces made it necessary to modify the war plans by developing a large reserve of hospital beds in Manila, P.I. Toward this end, a general hospital was issued to the Manila Hospital Center, part of another was stored and used at Limay on Bataan, and two others were left in the Manila depot. At the same time, officers and enlisted men of the Philippine Army were trained in a special school for medical supply officers at the Philippine Medical Supply Depot. Timely requests for medical equipment for hospitals and field operations resulted in the arrival of two general hospitals 2 weeks before the war began as well as five

3(1) Letter, Col. A. C. Miller, MC, Commanding Officer, Tripler General Hospital, to Surgeon, Hawaiian Department, 15 Apr. 1942, subject: Supplemental Annual Report (attached to Annual Report, Tripler General Hospital, 1941). (2) Annual Report, 1st Station Hospital, Hawaiian Department, 1942. (3) Annual Report, 148th General Hospital, 1942. (4) Annual Report, 26th Station Hospital, 1942. (5) Annual Report, Surgeon, 24th Infantry Division, 1942.


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(250-bed) station hospitals. Also, 90 regimental dispensaries either were in preparation for shipment overseas or were already en route to the Philippines by that date.4

Medical supply plans called for the enlargement of the medical supply depot in Manila which was to be relocated on the outskirts of the city to be less vulnerable to air attack. Construction of subdepots at Tarlac, Los Banõs, and Cebu had not gone past the planning stage when the Japanese attacked.

Medical Supply Activities on Luzon

The reality of war reached the Philippines on 8 December 1941, with the bombing of Clark Field. The subsequent bombing of Nichols Field and the strafing of the McKinley area made it advisable to move medical personnel and patients to the vicinity of Manila.

All available hospital supplies in Manila were hastily purchased and distributed to all points of Luzon. With the order to evacuate Manila on 23 December 1941, the Philippine Medical Supply Depot was located near General Hospital No. 1 on the Bataan-Mariveles Road, and by 29 December, a subdepot was established at Orion on Bataan, to furnish frontline troops with supplies. This depot was abandoned on 4 January 1942, when it was bombed.

From 23 December 1941 to 1 January 1942, personnel of the Philippine Medical Supply Depot worked with very little rest. Every vehicle that left Manila for Bataan reached its destination. The depot supplied General Hospital No. 2 with necessary supplies which were supplemented by small shipments from Cebu and Iloilo. The demand for quinine, sulfonamides, and vitamins was greater than the supply.

Medical service in the field was greatly handicapped because of having to rely on improvised 1917-type medical chests. Although new field equipment had been ordered and was on the way, none had yet been made available despite the efforts of the department surgeon. There was practically no reserve of medical supplies for the Philippine Army units, and there was a serious lack of laboratory equipment, such as microscopes, needed to help in the fight against intestinal infections and malaria.

During the Bataan campaign, many Philippine Army units, which had reached Bataan without adequate organizational or individual equipment or without training in the conservation of supplies, suffered unduly from various diseases. During the enemy breakthrough of 20 and 24 January 1942, medical companies lost a large portion of their equipment. As the Japanese cut supply routes by infiltration, serious shortages of litters and blankets occurred. Surgical equipment became nonexistent. Because of the severe shortage of antimalarial drugs, a maximum of 8 gm. of quinine was allowed for each case

4This section is based on Cooper, Wibb E.: Medical Department Activities in the Philippines from 1941 to 6 May 1942, and Including Medical Activities in Japanese Prisoner of War Camps. [Official record.]


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of malaria. Every effort was made to prevent hoarding by unit supply officers. The problem was somewhat eased by airshipment from Cebu of small amounts of quinine and Atabrine. Unit supply officers were urged to salvage dressings and bandages and to practice extreme economy in the use of all types of medical supplies.

On 30 January 1942, a subdepot was established on Corregidor to hold all supplies and equipment for Bataan above a 6-week level. Supplies were stored in trenches to safeguard them from shell and bomb fragments and from strafing. Flammable materials were buried in pits.

On 8 April 1942, all critical supplies on hand at the main Bataan depot were removed to General Hospital No. 2, located east of General Hospital No. 1 on the Mariveles-Cabcaben Road. By evening, an attempt was made to ship supplies from the Cabcaben dock, but it failed. Supplies finally reached Corregidor on 9 April.

After the capitulation of Bataan, three shipments of quinine, sulfonamides, and vitamins sent from the south were received by plane and submarine. The majority of supplies of the Philippine Medical Supply Depot on Corregidor were stored in the Malinta Tunnel. On 22 April, the depot was destroyed by shellfire. Surrender to the Japanese followed on 6 May 1942.

Medical Supply of the Visayan-Mindanao Force

Having established headquarters at Cebu on 27 August 1941, six American officers established a training program for troops of the Philippine Army in the Visayan Islands and Mindanao. The medical service was handled by the medical detachments of the divisions. Before the war, plans were made not only to establish a medical base at Cebu with one general hospital, utilizing the facilities and personnel of the Southern Islands Hospital as a nucleus, but also to establish another general hospital at Talisay. The promised equipment of one general hospital was lost in the sinking of the U.S.S. Corregidor in Manila Bay.

After combing the islands for medical supplies, it was discovered that there were some drugs available from three wholesale drug houses in Cebu. Fortunately, a large amount of food and medical supplies was confiscated from the SS John Lykes docked at Cebu. A large quantity of quinine tablets was located in the Koronadal Valley Project and in the hospital of the North Negros Sugar Co., which had just received its semiannual requisition.

One or two large consignments of quinine were flown in from Australia, but were forwarded to Bataan where, at the time, the need was greater.

Before surrender came, it became necessary to ration quinine and to use it only for treatment rather than as a preventive measure. Medical officers were ordered to discontinue its use as soon as the patient was able to return to duty.


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MEDICAL SUPPLY ACTIVITIES IN AUSTRALIA-1941-42

Early Organization

On 12 December 1941, a convoy led by the cruiser U.S.S. Pensacola was diverted from its Philippine Islands destination to Brisbane, Australia. Task Force, South Pacific, upon arrival in Brisbane became USFIA (U.S. Forces in Australia) with Maj. Jesse T. Harper, MC, appointed surgeon. However, 2 weeks later, USFIA became USAFIA (U.S. Army Forces in Australia) with Maj. (later Lt. Col.) George S. Littell, MC, as surgeon.

Changing Mission Concepts

Until the U.S.S. Pensacola convoy was diverted to Australia, the primary mission assigned to its commander was to get the convoy to the Philippines. It was not contemplated nor planned to station large numbers of U.S. troops in Australia. When USAFIA was established under the command of Maj. Gen. (later Lt. Gen.) George H. Brett, its mission still was to organize a service of supply to support the Philippines. The plan contemplated establishing bases in Australia for long-range aircraft operations, however, and General Brett was instructed to make his command predominantly air.

Thus, the early efforts of USAFIA were directed toward the shipment of critically needed supplies-food, drugs, and ammunition-to the Philippines and toward the preparation of bases for the reception of planes from the United States for transshipment to the Philippines. In addition, the general and special staff sections of Headquarters, USAFIA, were operating the supply and administrative services for all U.S. Army troops in Australia. By March 1942, the strategic pattern in the Pacific Area had changed radically, and the mission of USAFIA changed in consequence. There were three objectives under the new mission concept: (1) to provide administrative and supply service for the U.S. Army troops already in Australia; (2) to deploy these troops strategically to meet the threat of enemy invasion; and (3) to plan for long-range buildup of U.S. Army bases in Australia and for the reception of combat troops, of which two divisions were en route. These threefold objectives continued to be the concern of USAFIA, and later that of USASOS (U.S. Army Services of Supply), until early 1943.

Early Medical Department Activities

The activities of medical supply are always inextricably bound to those of the other activities of the medical service. Before the middle of April 1942, there was not much in the way of a formal medical supply organization in Australia. Despite this handicap and the burden of virtually single-handed operation, the Surgeon (first, Major Littell, and then, Col. (later Brig. Gen.) Percy J. Carroll), USAFIA, accomplished much.


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Before the fall of the Philippines on 6 May 1942, two main tasks were facing the surgeon: (1) The medical care, including hospitalization, for the rapidly increasing number of U.S. Army troops in Australia; and (2) the procurement of, and shipment of, sorely needed medical supplies to the Philippines. To these was added, later, the planning for a medical service for the greatly expanded Australian supply base.

There was only one obvious solution to the task of medical care for U.S. Army troops. On 15 January 1942, as a result of a high-level meeting with Australian authorities, an agreement was reached for complete medical support, including hospitalization, by the Australians. It was contemplated that this support would be needed for 3 to 4 months for 25,000 U.S. Army troops. Based on this agreement, U.S. Army medical units as they began to arrive and function would be authorized to requisition medical supplies directly from Australian sources.

Although the immediate problem of hospitalization for U.S. Army troops had been temporarily solved by using Australian facilities, the surgeon and his small staff continued to expend their energies trying to find sites for the U.S. Army medical units already in the theater and for those on the way. Existing facilities in Australia to house hospitals of 100 or 200 beds were just not available, much less for 500 to 1,000 beds. Later, this had a marked impact on medical supply activities because all current designs for hospital assemblages had to be modified.

Medical Organization

Meanwhile, the medical service had undergone parallel organizational and personnel changes in rapid succession. From the arrival of the U.S.S. Pensacola convoy in Australia in December 1941 until 2 February 1942, Major Littell, as surgeon, and a few medical officers had operated the entire medical service of the theater, including the medical supply efforts for relief of the Philippines. On 2 February, Major Littell was replaced as Surgeon, USAFIA, by Lt. Col. (later Brig. Gen.) George W. Rice, MC, who had been sent to Australia for this specific assignment by The Surgeon General. On 7 February, just 5 days after his assignment, Colonel Rice was in turn replaced by Colonel Carroll. The latter had just arrived in Australia after a medical odyssey during which he had accompanied more than 200 seriously wounded patients from the Philippines on the USAHS Mactan, a creaky Philippine interisland freighter designated as a hospital ship. Being the ranking medical officer of the theater, he was appointed surgeon. The medical merry-go-round came to a standstill, at least temporarily.

After Major Littell, who also served as the surgeon's executive officer, was appointed medical supply officer, he was also designated commanding officer of the first medical supply depot established in Australia on 14 February 1942. The site of the 9th Medical Supply Depot was a former taxicab garage in Melbourne (fig. 101).


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FIGURE 101.-Site of the 9th Medical Supply Depot Base Section 4, Melbourne, Australia, was a former taxicab garage.

Major Littell and his cohorts had carried on much medical supply activity before his appointment as medical supply officer. They had succeeded in rounding up a sizable mass of medical supplies even before the depot was established. Now, they were finally able to assemble these under one roof and to properly sort, pack, and inventory them. These supplies came from the U.S.S. Pensacola convoy, from local procurement, from borrowing from the Australians, and from other, sometimes unorthodox, means. For example, an order of the theater commander enabled the medical supply officer to requisition 600 sorely needed mattresses from the U.S.S. West Point which docked in Melbourne on 6 June 1942. Local requirements were also surveyed, and requisitions were submitted to the United States blindly because neither medical supply catalog nor trained supply personnel were available.

Relief for the Philippines

During January, February, and early March 1942, the surgeon and his staff put in many frustrating hours trying to obtain medical supplies for shipment over the long, tenuous supply lines to the Philippines (map 28). Requisitions for General MacArthur's hard-pressed forces arrived with pitiful regularity. Quantities needed were such as to swamp the capabilities of a country like Australia with a population of less than 8 million. In addition, the difficulties of running the blockade either by air or by water were formidable. Nevertheless, some 10 airshipments and 2 water shipments of quinine,


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MAP 28.-Supply routes to the Philippine Islands, 1941-42.

morphine, anesthetics, antihelminthics, vitamins, and other vital drugs did get through. Colonel Carroll, a nonsmoker, was infuriated by reports that pilots in trouble were dumping medical supplies rather than cigarettes.

The efforts by the surgeon and his staff to round up the quantities of medical supplies that they did were only short of miracles. Colonel Littell and Maj. (later Col.) John D. Blair, MC, scoured the cities of Melbourne and Sydney, raided incoming vessels, gathered up distressed cargo, borrowed from the Australians, and purchased locally every bit of medical supplies they could find. Then, they personally packed it in boxes, loaded it on trucks, and drove it to the airfields where they helped transfer it to planes.

In spite of all these efforts, the bottom of the barrel was soon reached. On 27 February 1942, Colonel Carroll emphasized the severity of the situation in his diary: "The medical supply officer is having great trouble getting together sufficient supplies to fill the radio requisitions from PLUM [code for Philippines]. The Australians are short and we will have to replace their


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depleted stocks as soon as we can get things on the way." With the fall of Bataan on 9 April 1942, virtually all organized efforts to aid the Philippines came to a tragic end.5

Reorganization of Headquarters

With the arrival of General MacArthur in Australia on 17 March 1942, the entire organizational framework was redesigned by the creation of a general headquarters with General MacArthur as Supreme Commander, Southwest Pacific Area. Headquarters, USAFIA, now became the overall administrative and supply headquarters for all U.S. Army Forces in Australia, being in effect a theater headquarters for U.S. troops.6

Arrival of Medical Supply Depot Personnel

On 6 April 1942, the first organized medical supply depot personnel arrived in Australia. This consisted of one section of the 4th Medical Supply Depot (later redesignated the 9th), comprising 3 officers and 42 enlisted men. The need for trained supply personnel was so acute that this group, pitifully small though it was, had to be shared. Accordingly, it was split into two groups. One group, comprising 1 officer and 13 enlisted men, was sent to staff the depot at Melbourne, and the other, with the remaining personnel, was assigned to Brisbane where an additional depot was being opened. Because of the continued shortage of supply personnel, this latter group was later again split, and an officer and small detachment were sent to open a depot in Townsville (map 29).

This section of 45 men, constituting the entire medical supply depot organization for the theater for 6 months, operated three depots efficiently during the buildup and did a superior job under very adverse circumstances. The three officers deserve mention as they continued to serve in supply capacities throughout the duration of the war. Maj. (later Lt. Col.) Arnold J. Woodman, DC, operated the Melbourne depot;Capt. (later Maj.) Leonard H. Kolb, MC, the Brisbane depot; and Maj. Edward T. Wolf, the Townsville depot.7

Organization for Medical Supply

On 12 April 1942, a group of 18 officers of the Medical Department including 2 nurses arrived in Australia after a rugged 30-day trip from San

5This section on the early developments of medical supply activities in Australia is based on (1) Annual Report, Chief Surgeon, U.S. Army Services of Supply, Southwest Pacific Area, 1942. (2) Diary, Col. Percy J. Carroll, MC, December 1941-30 June 1942. (3) Daily Diary, Medical Service, U.S. Forces in Australia, 10 Dec. 1941-31 July 1942.
6Matloff, Maurice, and Snell, Edwin M.: Strategic Planning for Coalition Warfare, 1941-42, United States Army in World War II. The War Department. Washington: U.S. Government Printing Office, 1953, pp. 169-171.
7(1) See footnote 5, above. (2) Quarterly Reports, 9th Medical Supply Depot, Base Section 7, Southwest Pacific Area, 1 June 1942 through September 1943.


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MAP 29.-Medical supply depots and base sections in Australia, April 1942.

Francisco on an unescorted Dutch freighter. Among this group was Maj. (later Col.) Alfonso M. Libasci, MC, who was trained in depot operations but had had no staff experience. Only one other officer of the group, Col. Oscar P. Snyder, DC, was Regular Army. The others were newly activated Reserve officers. Major Libasci (fig. 102) was assigned as chief of the Supply and Fiscal Section, relieving Colonel Littell.

Medical supply objectives-The newly created Supply and Fiscal Section of the surgeon's office consisted of a chief and two Medical Administrative Corps officers-one of whom served as fiscal officer and the other as procurement officer; a second lieutenant who served as executive assistant to the chief; and a few clerks. The new chief of medical supply faced a formidable task. Although much had been done by his predecessor and done well, there was still much to be done, little time to do it, and little to work with. Major Libasci brought into the theater in his personal baggage the only available copy of a medical supply catalog. It was months before additional copies were received.8

Theater medical supply plan-On 11 May 1942, just 1 month after arriving in the theater, Major Libasci submitted his medical supply plan for the theater to the Assistant Chief of Staff, G-4. The plan was approved with-

8(1) See footnote 5, p. 406. (2) Personal observations of Col. Alphonso M. Libasci, MC, USA (Ret.).


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FIGURE 102.-Col. Alfonso M. Libasci, MC, Chief, Supply and Fiscal Section, U.S. Army Forces in Australia, 1942.

out delay and soon became the pattern for other supply services. It covered all phases of supply operations, including depot locations and distribution areas, storage and issue procedures, classification of medical supplies, requisitioning procedures, procurement policies, and control of depot stocks.

The depot plan provided for base, intermediate, and advanced depots. Base depots, planned for the port cities of Sydney, Brisbane, Townsville, and Adelaide, would ship to intermediate and advanced depots located in remote areas. All medical supply depots were designated as branch depots under the technical control of the surgeon. This authority, given by G-4 with extreme reluctance after a tough battle, was an essential requirement.

The supply plan delineated requisitioning procedures and clarified once and for all the existing confusion in connection with the classification of medical supplies. There seemed to be universal confusion between the medical supply catalog classification into classes 1-9 and the G-4 classification into classes I-IV. As a result, supply personnel had erroneously submitted requisitions for medical class 4 supplies instead of G-4 class IV. This resulted in great shortages later.

Class I supplies were shipped to Australia from the United States without requisition in the form of medical maintenance units, each unit comprising


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a 30-day supply for 10,000 troops. The plan provided for reception of these medical maintenance units at the port depots, which, in turn, would automatically feed the intermediate and advanced depots. Medical units, in turn, could requisition only the items on the medical maintenance unit list initially until stocks of other items arrived in the theater. The catalog contained a mimeographed list of medical maintenance unit items.

Class II supplies were obtained by requisition from the United States, in quantities based on consolidated monthly reports of shortages in unit assemblages reported by medical organizations as they arrived and were set up in the theater. These supplies were issued to the medical units reporting such shortages in unit assemblages without requisition.

Class III supplies were fuels and lubricants.

Class IV supplies were those items that did not fall into any of the other categories and later constituted the bulk of all medical items. These were to be obtained from the United States on a requisitioning basis and were issued to units on a monthly requisitioning basis.

Other provisions of the plan outlined supply and storage procedures in depots and base sections, inventory control methods, monthly inventory reports for the medical supply officer, and so on. This basic plan integrated the entire medical supply effort and laid the foundation for future policies and expansion.9

Medical supply progress-Great strides were made in medical supply during the first few months. All assets were inventoried and consolidated, and central stock records were established for the theater as well as for each depot. Requirements of all classes were computed, and requisitions based on projected troop strength were prepared and forwarded to the United States. Procurement in Australia was thoroughly surveyed and coordinated through the appropriate Australian departments. Supply depot personnel needs were determined and requisitions prepared and submitted.

By June 1942, there was a medical supply depot in each active base section and each had at least a 30-day level of class I supplies (medical maintenance unit items). Table of basic allowance items of class II supplies also had begun to arrive, so that by the end of the month, unit assemblages were 92 percent complete. Stray shipments, coded boxes, distressed cargo, and so forth were sorted, repacked, inventoried, and placed in stock for issue. Supplies began to arrive from the United States in quantity, and medical supply became a going concern. But, at this stage, austerity prevailed because all that was available for issue were items received to provide for table of basic allowance shortages or medical maintenance unit items.

During late June 1942, the Australians proposed a merger of medical supply stocks into jointly operated and stocked medical depots, but an alter-

9(1) Letter, Maj. A. M. Libasci, MC, to Assistant Chief of Staff, G-4, 11 May 1942, subject: Medical Supply Plan for Australia. (2) Letters, Colonel Libasci, to Colonel Tyng, dated 5 and 31 May and 2 July 1942, respectively. [This summary was presumably made at a later date since Major Libasci is consistently referred to as Colonel-a rank he did not attain until early in 1944.]


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FIGURE 103.-The wreck of the freighter SS Rufus King on a barrier reef near Brisbane, Australia, July 1942.

native proposal to permit reciprocal emergency requisitioning upon each other's depots was accepted. This system worked well throughout the war.

On 20 July 1942, Headquarters, USASOS, was created and USAFIA was inactivated. This was actually nothing more than a change in name; all existing functions and directives remained the same.

Also, on 8 July 1942, the medical supply service was dealt a bitter and almost disastrous blow. The freighter SS Rufus King carrying the assemblages for nine station and three general hospitals-totaling 4,000 beds (17,200 boxes)-broke up on the barrier reef just outside of Brisbane Harbor. Early reports indicated that the ship had broken in half and that, although each half was afloat, the high seas made salvage operations impossible (fig. 103).

Fortunately, the seas subsided, and an Australian salvage crew of more than 200 men aided by U.S. Army Medical Department personnel went to work. Thanks to the skillful and daring efforts of these men more than 85 percent of the supplies aboard were salvaged. Much credit for this feat is also due to the personnel of the Brisbane medical supply depot who worked long hours rehabilitating the wet and damaged equipment. Had this salvage operation failed, it would probably have taken months to get replacements. Meanwhile, medical care would have been hampered as medical personnel waited idly in Australia for their assemblages.

During this early period, there was an incessant demand from U.S. troops for vitamins to supplement the inadequate ration, especially in remote areas. Eventually, it became impossible to satisfy requests. It was pointed out to the command that vitamins were not a substitute for food and that efforts must


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be made to improve the ration. After much pressure, this understanding was finally accepted.10

BUILDUP IN AUSTRALIA

After 5 months of uninterrupted victories, the enemy suffered a severe blow on 8 May 1942 in the Battle of the Coral Sea. As a result, enemy strategy was changed from heavy, overwhelming strikes to piecemeal efforts to gain footholds in New Guinea, the Solomons, and New Hebrides and thus to isolate Australia.

The U.S. strategy during the first year was purely defensive and consisted of trying to stop the advances wherever the Japanese attacked. During this first year, the major effort was directed at buildup of the base in Australia.

Base Section Organization

Because of the rural nature of the Australian mainland, it was decided early that decentralization of supplies would be necessary. Accordingly, the continent was divided into base sections roughly corresponding to the six States of Australia, except for the State of Queensland where two base sections were established because of its size and importance. At the height of the buildup, there were seven Australian base sections in all, with headquarters in Melbourne, Sydney, Perth, Adelaide, Darwin, Brisbane, and Townsville (map 29).

The missions of the base sections were as follows: (1) To operate a service command for the administration of the several base sections, ports, and camps; (2) to receive and assemble all U.S. Army troops, supplies, and equipment arriving in Australia; and (3) to perform such services of supply and administrative functions for combat troops as would enable them to move freely and with a minimum of delay.

Base section commanders were charged with the responsibility for providing administration, quarters, supplies, hospitalization, and evacuation for all U.S. Army troops arriving in, or assigned to, their respective areas. To accomplish this, they were provided with complete staffs, including, of course, base section surgeons.

Early in this organization, a controversy occurred in regard to the degree of control which the base section commanders exercised over the operations of the technical sections of their staffs. It was finally agreed that base section commanders would not interfere with technical operational instructions issued by the chiefs of services to their respective staff officers in the base sections.

10(1) Letter, Col. Lester S. Ostrander, AGD, Adjutant General, Office of the Commanding General, Headquarters, U.S. Army Forces in Australia, to Commanding Officer, Base Section No. 1, 30 May 1942, subject: Inventories of Medical Equipment in Base Sections. (2) Letter, Maj. A. M. Libasci, MC, to Base Section Surgeon, Base Section 4, 22 June 1942, subject: Instructions Reference Requisitioning of Medical Supplies. (3) Check Sheet, Chief of Medical Supply Section, Office of the Chief Surgeon, Headquarters, U.S. Army Forces in Australia, to G-4, Warehousing and Distribution Section, 19 June 1942, subject: Medical Supply Depots Operating in Australia. (4) See footnote 5, p. 406.


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This assured the surgeon complete control of theater stocks wherever they were stored.

As the military situation crystallized, the base sections assumed roles of varying importance. It became obvious that the most ideal sites for staging of troops, for hospitals, and for depots were near the large port cities of Melbourne, Sydney, Brisbane, and Townsville on the east coast. Accordingly, base sections in south and west Australia never reached large size nor importance and were inactivated early. Similarly, Base Section 1 with headquarters in the Darwin area, although strategically important, was never built up because of its extreme inaccessibility over large expanses of waste desert with poor roads.

The surgeon of each base section organized his staff along functional lines. As the base sections grew in size so did the functions assigned and staff required. The larger bases in Melbourne, Sydney, and Brisbane had individual officers in charge of personnel, supply, hospitalization, evacuation, nursing, dental, and veterinary activities, in addition to the surgeon and a deputy or executive officer. Professional consultants were not available at this stage of organization.11

Medical Supply Organization

The original medical supply plan provided for a base medical supply depot at each of the six main port cities of Melbourne, Sydney, Brisbane, Townsville, Perth, and Adelaide. These depots were to ship to intermediate depots farther inland, which in turn were to supply advance depots or dumps. This decentralization was deemed necessary because of the totally inadequate rail and road net. It had the further advantage of dispersing stocks so that loss to the enemy of one or all of these ports would still leave reserves available elsewhere. Because of later developments, depots were not established in each base section. During the buildup in Australia, the important medical supply depots were located in Melbourne, Sydney, Brisbane, and Townsville.

In addition to personnel of the 9th Medical Supply Depot, a medical supply officer was on the staff of each base section surgeon. These were usually officers of the Medical Corps. Their job was to edit station requisitions, issue supply instructions, coordinate all medical supply activities, work in liaison with the medical supply depot, aid the medical units to eliminate shortages, and render all assistance possible. The base section supply officers worked directly with the theater medical supply officer and implemented his policies and directives. Almost without exception, these untrained officers did a superior job as supply officers.12

Medical Supply Problems During Buildup

The first automatic shipments in the form of medical maintenance units were most useful. However, 6 months later, they had outlived their usefulness

11(1) Medical Department, United States Army, Organization and Administration in World War II. Washington: U.S. Government Printing Office, 1963, pp. 410-431. (2) Memorandum, Col. William L. Wilson, MC, for General Kirk [TSG], 20 Oct. 1943.
12See footnote 9(2), p. 409.


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as a sole means of support for theater stocks. The concept of automatic shipments is good (1) if shipments can be complete with no shortages and (2) if replacement factors are carefully and continuously adjusted so that excesses and shortages do not develop. In the Southwest Pacific Area, neither of these two conditions prevailed, and the result was not good.13

In the first 6 months of operation, the average medical maintenance unit received was rarely more than 50 percent complete. Shortages, obviously, consisted of those items difficult to procure in quantity to meet demands and were always the same items. Almost as bad were the overages that accrued.

During the first few months of the medical buildup, one of the most frustrating problems was that of table of basic allowance shortages. Medical units were being sent overseas with their table of basic allowance assemblages only 50 to 65 percent complete. The Zone of Interior medical depots backordered the shortages to the units, and as the depots received stocks, coded shipments were made piecemeal to the overseas units. Items were packed in broken-lot boxes, making distribution cumbersome.

The 41st and 32d Infantry Divisions, the first divisions to arrive in Australia, had medical equipment which was not well suited for use in jungle warfare. The substitutive equipment program involved some modification of the medical equipment for these divisions so that it could be used in the Tropics. The experience of Dutch officers who had served many years in the Tropics was invaluable in this matter.

Division surgeons redesigned their medical units for more effective utilization in the Tropics. Requisitions were submitted to the medical supply officer who consolidated them and forwarded them to the Zone of Interior for action. Special drugs and items needed to combat jungle diseases were included. A few items were procured locally. This program took months for successful completion. Mainly, the changes made the equipment more easily portable and waterproof.

Practically all TOE medical units had to be redesigned for use in the Southwest Pacific Area. Fixed hospitals of more than 200 beds were impossible to house in any available existing buildings. The 750-bed evacuation hospital was too large to deploy or transport and had to be broken down into three units of 250 beds each. The medical regiment of World War I, designed to support a square division, had to be completely reorganized.

All this changing of design necessitated much swapping and requisitioning of equipment and supplies. The program was extremely important as units could not operate in many instances until they were reorganized. In spite of exploiting all available local resources, in most instances, equipment had to be obtained from the United States.

In addition to the alteration of existing TOE medical units, new types were adapted for use in this unusual theater. The first of these was a 100-bed

13This section is based on a narrative account of medical supply activities in the Southwest Pacific Area prepared for a preliminary draft of this volume by Col. Alphonso M. Libasci, MC, USA (Ret.).


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mobile station hospital. In early 1942, the enemy was making such rapid advances in the islands north of Australia that it was feared that the continent of Australia would be invaded. If so, war would be fought in wide open country where mobility would be of prime importance. The medical service had nothing to meet this threat. The 750-bed evacuation hospital required 27 Australian freight cars to move, necessitating two trains. Obviously, something else was needed. Thus, work was begun early in 1942 on a mobile hospital with van units mounted on truck chasses. The unit was to function as a station hospital, using ward tents, but was capable of moving over open country if necessary. If buildings were available, it could function as a fixed hospital.14

Much time and effort were devoted to this project. However, progress was slow, and by the time the mobile hospital was ready, the need no longer existed. Australia was never invaded, and the unit was never used as such. Its use in New Guinea was out of the question because of the lack of roads. However, the project was not a total loss as some of the functional vans were later used in New Guinea as fixed units; for example, laundry, generator, and sterilizing units, but on a very limited basis.

The other type of hospital specifically designed for the needs of the theater was the portable surgical hospital. This unit, born of necessity, was designed to fill the need for definitive surgery as close to the front as possible. Hand carries of even less than a mile to airstrip evacuation points over jungle trails were hazardous, time consuming, and often fatal to the seriously wounded (fig. 104).

General Carroll fathered the entire idea of the portable surgical hospital. As originally conceived by him and his professional staff, it would be a hospital that could be carried on the backs of men. When General Carroll first described his ideas, most of the staff were not ready for such a radical and hitherto unheard of concept as carrying a hospital on the backs of its operators! Ultimately, it was designed so that the personnel of 3 officers and 25 enlisted men actually carried the entire hospital on their backs or on litters. The men were handpicked from among the finest and best conditioned in the theater medical services.

Of these units, 36 were assembled from resources within the theater by (1) levying on the larger hospitals both for personnel and for equipment and (2) procuring available items locally. The portable surgical hospitals were an unqualified success in the New Guinea jungles. Later, the concept of total portability was modified and more equipment was added. They were used very effectively in amphibious operations and by the Air Forces to move to remote areas to provide hospitalization.

During early 1942, it was decided to design a so-called jungle kit to be issued to each individual soldier. As finally developed, this kit consisted of a small pouch to be carried on the belt. Components varied from time to time,

14A more detailed discussion will be found in Daboll, Warren W.: The Medical Department. The Medical Services in the Asiatic Theater. United States Army in World War II. The Technical Services. (In preparation.]


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FIGURE 104.-The transportation of supplies and equipment of a portable surgical hospital, Australia, 1942.

but they basically consisted of antimalarials, water purification tablets, salt tablets, skin disinfectant, insect repellant, vitamins, and so forth. After the kit had been designed and tried, specifications were sent to the United States for its manufacture and procurement in large numbers. The jungle kit was useful and became a standard item of issue (fig. 105).

Jeep litter brackets were developed to adapt jeeps to carry three litters to displace long hand carries. These were extremely useful in forward areas where trails existed. As in all other local procurement endeavors, the Australian military and civilian authorities cooperated fully. Along these same lines


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FIGURE 105.-Improvised medical jungle kit made from available material for use in rough jungle combat.

when the threat of enemy invasion was real, plans had been made to convert existing civilian van-type trucks and buses to carry litters. Again, special brackets were designed.

It became obvious quite early in the war that it was poor logic to use glaring white dressings in the jungle where all else was so carefully camouflaged. Accordingly, recommendations concerning the feasibility of dyeing a certain percentage of dressings jungle green were forwarded to the United States. Eventually, the recommendation was accepted. However, the dressings were dyed olive drab instead of green.

When equipment for the portable surgical hospitals was being designed, it was found that the U.S. Army forces had nothing that could be used for a lightweight, portable field sterilizer. The Australians had a small, aluminum, pressure-cooker-type sterilizer weighing 30 pounds with special 9-inch drums that just suited the purpose. This was adopted and procured in quantity. In addition, to obviate the necessity for sterilized dressings in the field in advance areas, dressings were furnished already sterile and sealed in tinplated disposable drums. Three types were available: Basic operating unit, dressings, and gowns. The drums once opened were used as containers in the forward areas.

The weight of the standard litters precluded their use in the portable surgical hospitals. The first such hospitals carried lightweight poles and spreader bars that could be fitted into the loops of cot canvases. This litter weighed 11


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pounds complete. Later, sleeves of light canvas, measuring 24 inches in diameter and 84 inches in length with double seams and mattress covers, narrowed by a seam to a width of 24 inches, were fitted over cut poles of various sizes. These were tried and found practical.

The requirements of the theater for lightness, protection against moisture, and ease of portability were never fully met by the Zone of Interior. Much repacking was done in the theater for supplies sent to New Guinea. Many solutions, drugs, and dressings (other than those in waxed containers) were repacked in salvaged cans obtained from hospital pharmacies. The supply of good containers with tight-fitting tops was limited in Australia. Rectangular cans with hinged tops of 1- and 2-quart size and of coated, painted, heavy steelplate were designed and purchased in quantity. Plastic containers would have been ideal. The Japanese used plastic extensively.

The standard Zone of Interior medical maintenance unit was not adaptable for use either in Australia or in New Guinea; therefore, extensive modifications were made within the theater. The modified medical maintenance unit was streamlined to a weight of 7 to 9 tons, instead of the original 15 to 20 tons. The unit was stripped of most nonmedical items such as housekeeping items-mops, brooms, kitchenware, wax, and so forth-of all dental and veterinary instruments, and of most laboratory glassware. The unit was also modified quantitatively, using actual theater experience for maintenance factors.

Medical Supply in New Guinea

The establishment of U.S. Army bases in New Guinea, essential because of its strategic location as a jumping-off place for offensive action against Japan, was a slow and painful process. At times, the postcombat buildup was even more frustrating than the acquisition had been. The first U.S. Army troops arrived on 28 April 1942. Within a year, the organizational structure included the U.S. Advance Base at Port Moresby, with subbases at Milne Bay, Oro Bay, and Goodenough Island (map 30).

The medical supply organization in New Guinea paralleled that on the mainland of Australia. Each base surgeon was provided with a medical supply officer who had to be an aggressive provider of equipment needed by hospital units to fill out their table of basic allowance shortages and provide such equipment as lanterns, generators, and ice cream making machines. For approximately the first year, supply to New Guinea was from Australia. Lateral supply within New Guinea was nonexistent except by a few fast supply boats (fig. 106). As a result, once supplies were dumped into a base port, they remained in that base indefinitely if not used. Thus, it was extremely important that the initial distribution be made accurately and reliably. Needless to say, this idea was never achieved.

Regularly scheduled runs from Australia were out of the question. Medical supplies were loaded on whatever ships became available and whenever space was allotted. On such a catch-as-catch-can basis, things indeed would


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MAP 30.-Bases in Papua, New Guinea, 1942-43.

have reached a sorry state had it not been for the two expedients aggressively followed through: (1) A very liberal interpretation of day level and (2) the use of regularly scheduled runs of the intratheater hospital ships to carry cargo forward on return trips to New Guinea.

It became obvious early in the development of the New Guinea bases that the authorized 30-day levels and later 60-day levels of supply would not be adequate in the face of the shipping uncertainties. Therefore, it was decided to raise these levels as it would not involve very large shipping tonnages or warehouse space. Accordingly, more realistic levels were set up, and conditions improved materially.15

Early Medical Supply Facilities in Port Moresby

Storage facilities at Port Moresby were practically nonexistent before January 1943. The medical supply depot occupied several small buildings on Ela Beach, the principal dock area 1 mile from the downtown headquarters. Two of these buildings were used for storage and loose-issue operations. Although there were no space, tonnage, or occupancy reports at that time, it was estimated that the total gross space was no more than 4,000 square feet with approximately 80 tons of medical supplies on hand. Any excess amounts of supplies were covered by tarpaulins in open storage.

15(1) U.S. Army Services of Supply Bases in New Guinea. [Official record.] (2) Memorandum, Col. William L. Wilson, MC, Lt. Col. Charles G. Gruber, SnC, and Maj. Tolbert H. Belcher, MAC, for Commanding General, U.S. Army Services of Supply, Southwest Pacific Area, through the Surgeon, 27 Sept. 1943, subject: Determination of Maintenance Factors and Rates of Consumption and Expenditures.


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FIGURE 106.-Troops loading on an Australian corvette for transfer to New Guinea.

Security storage was, by necessity, improvised. Ethyl alcohol and whisky were stored in a small, detached building of not more than 200 square feet. Original packs of narcotics and other security-type items were stored in an old Army field safe. Refrigerated storage consisted of three or four kerosene-operated refrigerators of the regular household type.

The receiving operations were always accomplished in an open area. Large shipments, if delivered from dockside at a rate which would permit tally-in as received, had to be stored in the open until the receiving crew could segregate the items and remove them to storage. Shortage of personnel and lack of adequate facilities often caused supplies to be merely offloaded and stacked to contain the entire shipment within available space.16

Early Medical Supply Depot Operation

The 3d Medical Supply Depot, commanded by Maj. (later Col.) Stephen G. Asbill, VC, with all of its organizational equipment arrived at Brisbane (p. 406) in December 1942 (fig. 107). Less than 1 month after its

16Quarterly Reports, Headquarters, Office of the Surgeon, U.S. Advanced Base [New Guinea], 1 Oct. 1942-31 Mar. 1943.


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FIGURE 107.-Interior view of a medical supply warehouse in Brisbane, Australia.

arrival in the theater, the 1st Storage and Issue Platoon, comprising 3 officers and 42 enlisted men, sailed for Port Moresby. Upon arriving on 8 January 1943, it relieved a small detachment of the 9th Medical Supply Depot which had been operating in support of combat elements.

A plan to further deploy the 1st Storage and Issue Platoon by sending one officer and five enlisted men to set up a supply point at Milne Bay and another officer and five enlisted men to do the same at Oro Bay caused a split in the platoon which had been formed to operate as a unit. After a trial period at both Milne Bay and Oro Bay, it became apparent that more personnel and equipment were needed to operate effectively.17

MEDICAL SUPPLY IN THE SOUTH PACIFIC

Organization and Purpose

To protect the lines of communication to New Zealand and Australia and to prepare a counteroffensive against the Japanese forces, Army garrisons were established shortly after the Pearl Harbor attack at Auckland, New Zealand; New Caledonia; Efate, Espíritu Santo, and Fijis in the New

17Annual Reports, 3d Medical Depot Company, 1943-44.


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Hebrides Islands; Tongatabu in the Tonga Islands; Bora Bora; and Tongareva and Aitutaki in the Cook Islands. The South Pacific Area was organized in April 1942, and by July, more than 60,000 troops were in the command.

Estimate of the Situation

Lacking firsthand information on conditions in the area, Maj. Gen. (later Lt. Gen.) Millard F. Harmon, commanding general of all U.S. Army Forces in the South Pacific Area, and several officers had made frequent trips northward to Espíritu Santo and to Guadalcanal in the Solomons to inspect at close range the installations there. Everywhere he went, General Harmon was struck with the shortages in materiel and the inadequacy of facilities. Both General Harmon and Brig. Gen. (later Maj. Gen.) Robert G. Breene, Assistant Chief of Staff for Supply and Evacuation, G-4, realized the many problems in maintaining a steady flow of men and materiel into the area because of the many widely separated island bases.

One of the most serious problems was the shortage of shipping. Unlike a continental theater of operations with debarkation facilities, road nets, and railways, the South Pacific Area, except for New Zealand, had almost no communications or industrial development. In the entire area, only Auckland and Suva in the Fijis had usable terminal installations, and of these, only Auckland could be considered adequate.

Before bases could accommodate large shipments of either troops or supplies, it was necessary to construct harbor and dock facilities. Many islands possessed only the most primitive facilities, or none at all. Roads, warehouses, and storage space so necessary to the operation of a large supply base were nonexistent. To aggravate this situation, there was a notable lack of service personnel of all branches to handle specialized equipment. The original task forces that were hurriedly sent to the South Pacific Area contained a disproportionately high percentage of combat troops who had to be utilized to effect minimum logistical support at each base. This shortage of service elements prevented the construction of adequate facilities for the handling and safeguarding of supplies and resulted in a high degree of waste.

Services of Supply Established

Under normal conditions, the command control of supply of the U.S. Army Forces in the South Pacific Area probably could have been handled through the medium of a G-4 section in General Harmon's headquarters. With the geographic peculiarities of the area and the necessity for close integration with U.S. Navy and Allied supply agencies, however, it was determined that a different type of organization would be required. General Harmon believed that it would have to be large in size, highly executive in character, and headed by a general officer directly under his own command. After studying many plans submitted by his staff, General Harmon established, on 10 November


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1942, Headquarters, SOSSPA (Services of Supply, South Pacific Area), with General Breene commanding. The original intention of the War Department was to establish the headquarters for the U.S. Army Forces of the South Pacific Area in Auckland. General Harmon, however, chose to locate his advance echelon at Nouméa, New Caledonia, to be close to the scene of operations and the theater commander.

Initial Problems in Medical Supply

No table of organization medical supply units were sent to the South Pacific Area during the first year of the war, and no officer trained in medical supply was assigned to the staff of the Chief Surgeon, Col. (later Brig. Gen.) Earl Maxwell, MC, USAF. Shortly before Headquarters, SOSSPA, was organized in Auckland, 1st Lt. (later Lt. Col.) Joseph C. Thompson, MAC, was transferred from the 43d Infantry Division to Headquarters, USAFISPA (U.S. Army Forces in the South Pacific Area), and assigned duties as the theater medical supply officer. At the time that the headquarters moved from Auckland to Nouméa some 45 days later, the medical supply staff in the surgeon's office consisted of Lieutenant Thompson and one sergeant; all files of this office were carried in one briefcase. Nevertheless, this organization immediately took steps to organize an orderly system. In the absence of table of organization supply units, provisional units were organized at Nouméa, Efate, and Suva by drawing personnel from medical units at these bases. Smaller provisional supply detachments were established at Espíritu Santo and Auckland map (31). The first mission of these provisional units was to call in all medical supplies (principally medical maintenance units) in the hands of the various task forces to establish central medical depots.

With the exception of Auckland, Nouméa, and Suva, warehouses or other storage facilities were nonexistent, and storage of supplies was necessarily in tentage or in open storage covered by salvaged tents or whatever canvas was available. Because of high humidity and exceedingly heavy rainfall, supplies at many bases were lost or deteriorated beyond use as a result of this lack of proper storage facilities. Labels became unreadable or fell off the containers entirely, leaving no choice but to destroy the contents. Metal components of equipment became rusted or corroded, and fungus grew on certain optical items.

Inexperienced supply personnel assembled from other units frequently distorted the supply levels available at each base. All bases received medical maintenance units and, in general, were able to maintain adequate supply levels. Drugs for the most part were available although false indications of shortages existed in certain bases due to the personal preferences of many medical officers who were not accustomed to using substitutes. There were, however, some items of special benefit in this area which were left out of the medical maintenance units or were included in inadequate quantities. This was especially noticeable in the many vitamin products and in most of the newer sulfanilamides, but to a lesser degree in the arsenicals. Clinic equipment, such as instru-


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MAP 31.-South Pacific supply points, 1942.


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ments for the eyes, ears, nose, and throat, and replacements of surgical equipment were very short. Special technical equipment such as microscopes and ophthalmoscopes was not sufficiently plentiful in the early stages.

Few of the medical organizations shipped to the South Pacific Area were able to function without changes in their organization and equipment. The very nature of the theater-numerous small islands widely separated from each other and varying in climate from the Temperate Zone of New Zealand to the tropical areas of the Solomon Islands-made these changes mandatory. Revisions varying from minor items in some units to almost complete reorganization in others were necessary. In many instances, a hospital would be the only medical complement in a task force isolated by hundreds of miles. It, therefore, became necessary for this hospital to function as a collecting company, a clearing company, a general hospital, and, in some instances, as the task force surgeon's office. The most serious handicap in this situation was the lack of adequate equipment. Many times, evacuation hospitals were required to function as station or general hospitals, and medical field units such as battalions or regiments were forced to operate hospitals. This required provisional reorganization and equipping of these units.

To compound these problems, units arrived in the area without parts of their essential table of basic allowance equipment while many items were lost on the docks or beaches due to limited control of unloading facilities. If an item was hauled to the wrong unit, there was little or no chance of subsequently locating it. The small medical depots established on the various islands did not have sufficient stock or, in many cases, no stock at all of the items necessary to replace shortages. Other difficulties were encountered when the equipment was placed on different ships than the personnel. Many times, the personnel were diverted to one island and the equipment arrived at another; due to lack of intratheater shipping, the final marrying-up of the unit and its equipment sometimes was never accomplished.

Among the first medical supply installations to arrive in this theater was one section of the advance depot platoon of the 10th Medical Supply Depot. This organization originally arrived in Auckland on 22 November 1942 and was soon transferred to Espíritu Santo. One section of the advance depot platoon of the 17th Medical Supply Depot was activated on New Caledonia from personnel available within the command (fig. 108). A small detachment designated as Medical Detachment No. 1 (Supply) was established at Suva. These were the only officially organized supply units located in this theater in the initial phase of its operation.

Medical Supply Levels

The supply facilities on Fiji, New Caledonia, and Efate, as well as the smaller supply points at Espíritu Santo and Auckland, were receiving automatic medical maintenance units and were able to maintain their supply levels between 100 and 200 days. Frequently, these levels varied because units which


425

FIGURE 108.-U.S. Army medical supply depot in New Caledonia, 1942.

had lost all their equipment had to be resupplied. Also, it was hard to calculate exact supply levels because of certain shortages and excesses.18

Stock Control

The geographic conditions peculiar to the South Pacific Area and the shortage of supervisory personnel in the headquarters element required that decentralization be the keynote for medical supply in the area. The advantage of centrally located issuing points was recognized, but their establishment in this theater was clearly impracticable because of the chronic shortage of personnel and intratheater shipping at the outset. As a result, until January 1944, most supplies were shipped in the form of medical maintenance units from the San Francisco Port of Embarkation directly to the island where they would be consumed. Requisitions were transmitted to the

18(1) See footnotes 2(3), p. 397; and 14, p. 414. (2) Annual Report, Surgeon, South Pacific Area, 1942.


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port for items not contained in the medical maintenance units or for inadequate quantities in them.

Because of the widely separated island bases and shortage of transportation, frequent inspection trips for supervision by Headquarters, SOSSPA, were not possible. Therefore, all depots were placed under the administrative control of the island base, and in many cases, each island base had different ideas concerning the control of these supply installations. On one of the infrequent inspection trips, however, Captain Thompson noticed that, in addition to some shortages, excesses were accumulating on certain items in the medical maintenance unit. For example, on Guadalcanal, the supplies of blood plasma, intravenous fluids, morphine Syrettes, and antidiarrheal drugs were inadequate while cotton, glycerin, castor oil, ether, ammoniated mercury, and salicylic acid had built up huge excesses.

Trips to the other island bases in this area confirmed that certain items supplied in the medical maintenance unit were accumulating large excesses, but the filing of reports proved an inadequate remedy. After considerable correspondence between the theater, the San Francisco Port of Embarkation, and the Surgeon General's Office, only token relief was received, and some excesses continued to accumulate.

The smaller and more eastern islands of the South Pacific Area (Tongareva, Bora Bora, Aitutaki, and Tongatabu) were placed on a requisition basis in 1943. This was at the suggestion of the San Francisco Port of Embarkation because these islands were occupied by only one medical installation and usually small task forces, and it was unsatisfactory to supply them through the medium of fractions of a medical maintenance unit.19

Optical Activities

In the fall of 1942, one of the major medical supply problems of the South Pacific Area was that of replacement and fabrication of spectacles. Generally, prescriptions for spectacles were received at the medical supply section of the surgeon's office, Headquarters, SOSSPA, and forwarded directly to the Joint Purchasing Board in New Zealand, where arrangements had been made for the fabrication of spectacles by civilian facilities. It soon became evident that the demand far exceeded the New Zealand capability and that optical-repair sections of medical supply depots were needed in the South Pacific Area.

The first such unit was the optical-repair section of the incomplete 17th Medical Supply Depot in New Caledonia. This unit was established late in 1942 from personnel available to the command. Through the cooperation of G-1 Division, Personnel, War Department General Staff, records of many units were screened, and men with optician's background were located. A noncommissioned officer who was a bandsman assigned to one of the bands

19Essential Technical Medical Data, South Pacific Area, U.S. Army, initial report, dated 17 Sept. 1943.


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in the Americal Division was found by this survey. It was soon discovered that he possessed an ideal background in optical repair and fabrication and was subsequently commissioned a second lieutenant in the Medical Administrative Corps, becoming the first optical-repair officer in the South Pacific Area. The depot, its equipment augmented by a spherical surfacer, was soon repairing or fabricating an average of 800 pairs of spectacles each month.

The base platoon of the 11th Medical Supply Depot which arrived in the theater in August 1943 included the personnel but not the equipment of an optical-repair section. When the platoon rejoined its parent unit in the European theater, these personnel were utilized to augment the already existing optical-repair shop, and additional equipment was requisitioned. When the equipment arrived, however, it was shipped to Guadalcanal, and personnel were transferred there to operate an optical-repair shop.20

Maintenance and Repair

Before the arrival of the base platoon of the 11th Medical Supply Depot, there were no maintenance and repair facilities within the theater other than those organized provisionally on various island bases. For the first time, two trained enlisted instrument repairmen were available for utilization. However, lack of spare parts, particularly for sterilizers and X-ray equipment, greatly limited their utilization.

The lack of intratheater shipping also limited the ability to return items to this one source for repair, and many times, it was more practicable to send repairmen to a forward base than to return the equipment to the depot.21

MEDICAL SUPPLY ACTIVITIES IN ALASKA DURING THE DEFENSE PERIOD

Prewar Expansion of U.S. Forces

Early in 1940, the strategic significance of Alaska22 was recognized, and by late June, additional troops were dispatched to Fort Richardson, near Anchorage. The 1940 augmentation consisted of one battalion of infantry, a field artillery battery, an engineer company, a quartermaster detachment, and an ordnance detachment. Medical support came from 10 enlisted men who comprised the medical detachment of the 4th Infantry Division and 20 enlisted men from Fort Missoula, Mont., and Letterman General Hospital, San Francisco. Three Medical Corps officers and one Dental Corps officer had been scheduled to accompany the group, but only the dental officer received orders

20See footnote 17, p. 420.
21Essential Technical Medical Data, South Pacific Area, U.S. Army, for February 1944, dated 7 Mar. 1944.
22This section on medical supply activities in Alaska during the defense period is based on McNeil, Gordon H.: History of the Medical Department in Alaska in World War II (1946). [Official record.]


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in time to get to Seattle, Wash., for the embarkation. Consequently, several hours before personnel boarded ship, a medical officer on duty at the station hospital at Fort Lewis, Wash., was given verbal orders, later confirmed in writing, to proceed to Alaska with the movement; after packing a few personal effects, he joined the medical detachment as its surgeon. Medical supplies and equipment consisted of the following Medical Department chests: Two No. 1, one No. 2, one No. 4, and one No. 60 (dental), together with litters, blankets, and special drugs and supplies.

Organization of Medical Supply Following Pearl Harbor

The medical service of the Alaska Defense Command was organized on 12 December 1941, following the appointment of Lt. Col. (later Col.) Luther R. Moore, MC, as surgeon. The echelons of medical supply in the Alaskan theater originally were, as follows: Unit supply officer, post medical supply officer, and the Overseas Supply Branch, Seattle Port of Embarkation. From the Seattle Port of Embarkation or the Prince Rupert Sub-Port of Embarkation, Prince Rupert, Alaska, units arriving in the theater usually landed fully equipped with supplies for the initial period, plus additions for a special tactical situation. At each station, the post medical supply officer also served as the station hospital medical supply officer. Most items were furnished automatically by the medical maintenance unit. Those authorized items not included were requisitioned directly from the Seattle Port of Embarkation.

Storage of Medical Supplies

The provision of adequate storage facilities was essential because of the climatic conditions. Much loss was sustained at Adak (map 32), where large amounts of supplies were dumped on the wet ground and exposed to the elements because of a lack of storage space. It was often necessary to store medical supplies in tents, which proved unsatisfactory because of wind, rain, and snow.

Once initial construction was completed at new stations, adequate warehouse space became available. Storehouses were generally constructed of wood, either as part of the hospital or as separate huts. The quonset hut was also unsatisfactory because of sagging floors, leaky roofs, and lack of perpendicular walls. Each station hospital was authorized 35 square feet of storage space for each authorized bed.

Weather conditions made it necessary to store freezable supplies in heated buildings, thus requiring constant supervision and maintenance. At Naknek, supplies froze on the shelves despite the fact that the buildings were heated. Tests were conducted in February 1943 to determine the effects of freezing on medical supplies. Results of the tests, which showed most items were not affected, were reported to The Surgeon General.

Heavy rainfall and resulting dampness required additional special consideration for medical supplies and equipment, X-ray films, and plaster of


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MAP 32.-Supply points in Alaska, 1942.

paris bandages; other similar items often deteriorated and became mildewed, thus necessitating that buildings be heated intermittently to reduce dampness.

Dispersion of Supplies

Upon declaration of war, a policy of dispersion of reserve supplies was invoked. Later, all supplies were dispersed in a uniform manner. This dispersion was conducted in various ways. At Fort Richardson (map 32), established in June 1940, pyramidal tents, dugouts, basement rooms, and even the Eklutna Indian School which was located 27 miles from the post, were utilized for storage.

Because of the distance between stations and the lack of dependable transportation, often handicapped by bad weather, the medical maintenance unit proved valuable in supplying inaccessible spots. Ship sailings were irregular, and air service was generally unavailable except for special items. These transportation difficulties made it necessary to improvise during 1942 to make up for the shortage of field equipment.

Lack of a Medical Supply Depot

There was no regularly established medical supply depot in the Alaskan theater. Fort Richardson served as an unofficial depot. Stations possessing ex-


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cesses of critical items and medical chests shipped them to Fort Richardson, where two buildings were designated as warehouses with two officers and eight enlisted men as depot personnel.

The Optical Program in Alaska

In February 1942, to speed up the procurement of Government-issued spectacles, a procedure was inaugurated which equipped five of the larger stations with the necessary equipment and materials. Spectacle order forms were prepared and forwarded to the American Optical Co., at Seattle, and the spectacles were returned by the Seattle General Depot.

This system suffered several defects: (1) Excessive length of time required to fill an order, (2) losses incurred because of movement of personnel, (3) lack of control for procurement, (4) lack of prompt communication on special cases, and (5) lack of trained personnel and equipment in the command. To remedy this problem, traveling optical teams were organized and sent to stations requiring their services. This became a rather complete service in 1942.

The problem of filling prescriptions and providing a prompt supply of spectacles remained until a fixed-optical unit was assigned to Fort Richardson in April 1943. By June, all initial issue, replacement, and repair of spectacles for the entire command was accomplished by that unit.

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