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HISTORY OF THE OFFICE OF MEDICAL HISTORY
Okinawa and the Occupation of Japan and Korea
SUPPLYING THE OKINAWA OPERATION
Preparation for the Assault
Even though the fighting continued in the Philippine Islands until late June 1945, plans were concurrently being formulated for an assault on the Ryukyu Islands which guarded the entrance to the home islands of Japan.
The experience gained in previous Pacific operations helped to augment the tables of organization and equipment of units which would be participating in the assault. A listing of medical units and the authorized equipment, although approved, was not perfect, and it became necessary to request additional equipment. These items often did not arrive on schedule. A critical supply problem developed 2 weeks before the Okinawa operation began, when a ship carrying 48,000 requested jungle kits did not appear at Leyte.
Lt. Col. (later Col.) Stephen G. Asbill, VC, Medical Supply Officer, Base K (Leyte), having no alternative but to provide the necessary kits from the 34th Medical Depot at Tacloban, was caught short by requirements for the landing forces going to Lingayen Gulf ahead of schedule. To cover the deficit, Colonel Asbill arranged for a stock of 70,000 jungle kits to be sent from Hollandia to Leyte on a hospital ship.
To support the early landings on Kerema and Okinawa, the bays of six landing ships were equipped with surgical facilities and were staffed with U.S. Navy surgical teams.1
On 27 March 1945, the XXIV Corps, consisting of the 7th and 96th Divisions, and the 77th Division operating separately, left Leyte en route to the Ryukyus. The 77th seized the Kerema Islands group on 30 and 31 March, after which the 7th and 96th, augmented by the 1st and 6th Marine Divisions, assaulted the western shores of Okinawa on 1 April (fig. 140).2
Medical Supply Functions
Because of adequate planning and preparation by Maj. Stanley W. Bullis, MAC, Medical Supply Officer, XXIV Corps, sufficient tonnage space and sup-
plies from Leyte were made available to support the medical supply aspect of the operation. Four landing ships, medium, assigned to the Corps Surgeon, Col. Laurence A. Potter, MC, were sufficient to move the corps medical battalion and corps medical detachments. Adequate tonnage space for medical supplies was set aside on troop transports and on the cargo ships carrying the hospital elements so necessary for the success of the operation. As a result, selected medical units in the assault were able to carry 30 days of supplies instead of the usual 10.
The 726th Medical Supply Team, which accompanied the assault units on L-day (landing day), took over approximately one-half of each unit's 30-day supply, and added it to scheduled resupply increments made up of medical maintenance blocks which had been loaded in the allotted medical cargo space. These two groups of supplies made up the initial stocks of the corps medical dump on the beach (map 51).
The 726th, with separate supply detachments supporting the 7th and 96th Divisions, remained under XXIV Corps control until 16 April (L+15), when its duties were assumed by the 843d Medical Supply Team. The 726th then set up an Army medical supply dump (fig. 141), in support of the Tenth U.S. Army in its toughest fighting. In the midst of this fighting, the unit was able not only to render effective service, but also to construct enough canvas-covered shelters to protect about 25 percent of its stock.
When the 53d Medical Depot Company, consisting of 12 officers, 1 warrant officer, and 120 enlisted men, arrived on Okinawa on 8 May (L+38), the unit proceeded to take over the major task of supplying the XXIV Corps from a depot established in the village of Kadena near the airport. Here they remained until 20 July when they moved to Naha, Okinawa, and established a more permanent depot (map 51).
After the 77th Division successfully drove the Japanese from the nearby island of Ie Shima, a medical supply detachment of one warrant officer and three enlisted men went ashore on 17 April and set up a supply dump on one of the landing beaches. This dump served all personnel of the division on the island. This detachment remained on the island with the garrison force keeping the dump in operation to serve the 77th Division troops (map 51).3
Hospital Assemblies on Okinawa
Hospital unit assemblies for the Okinawa assault were carefully packed, uniformly marked, and included packing lists which facilitated both loading and unpacking. Each unit of the supporting field hospitals was furnished with one 2½-ton and one ¾-ton truck in which to carry prepacked surgical instruments and supplies that could be made available immediately upon landing. Each hospital unit was stored on a separate vessel to provide proper dispersal.
Typical of the movement of unit assemblies during the Okinawa assault was the experience of the 69th Field Hospital. Personnel and six surgical trucks were unloaded on L+1, and the remainder of its equipment and supplies, which had been carefully packed and crated for the operation, was unloaded during the following 7 days. Having learned much from the Leyte campaign, supply organizations preparing unit assemblies packed plenty of plaster of paris, sheet wadding, and all types of sutures. Some difficulty was encountered in getting equipment off the beaches as sufficient transportation was not available (fig. 142). Other than cots, blankets, and tentage, no other major items of equipment were lost. For the first few weeks, the 69th had a serious shortage of blankets as 300 of the 1,200 blankets packed were lost on the beach and in property exchange. To make up for the lack of pillows, blankets were substituted, and sometimes a shock patient needed as many as six or seven blankets.
To have a reserve of equipment for another hospital in an emergency, an effort was made to keep the equipment of one hospital unit intact.
With the exception of plaster of paris bandages and sheet wadding, few other items of supply were scarce.4
Tenth U.S. Army resupply consisted of four different types of medical maintenance units. The Medical Maintenance Unit, Block 1, was designed to supply 3,000 men for 30 days and was landed in the early assault phase. It supplied units providing first- and second-echelon medical service. Fifty of these blocks were originally scheduled to land on L+5, but actually the first ones were unloaded 10 days later, on L+15.
Block 2 consisted of nonexpendable replacement equipment based on SGO (Surgeon General's Office) replacement factors. One block was to be unloaded between L+15 and L+25, but was finally unloaded at L+50. A second Block 2 was scheduled for the eighth resupply.
Block 3, composed of biologicals, supplemented Block 1. Two of these were scheduled for the first resupply, one for the second, and one for the third. However, these blocks landed approximately 10 days later than scheduled.
Block 4, the standard medical maintenance unit-10,000 men for 30 days-
was not unloaded until the fourth resupply and occurred 10 days later than scheduled. Each resupply subsequent to the fourth for the remainder of the automatic resupply period of 210 days contained eight or more Block 4's, depending on troop strength ashore. By L+180, a sufficient number of these blocks were ordered to build up a 90-day reserve stock.5
Specially equipped LST's (landing ships, tank) acted as floating depots for whole blood, thus assuring timely and adequate delivery.
Ashore, a blood bank was operated by a blood bank detachment under the supervision of the medical supply officer, XXIV Corps. Blood was available as far forward as the collecting stations which supported the infantry regiments. Because of the availability of whole blood in the 7th Division Clearing Station, a soldier who lost portions of all four of his limbs when his vehicle was struck by a landmine was saved.6
Analysis of Supply Operations
Although no critical shortage of medical supplies occurred on Okinawa for any extended period, a number of shortages arose because of increased consumption and inability to unload supplies selectively. When a critical situation seemed imminent, air shipments were used with timely results. Interchange of supplies between Army and Marine supply dumps also helped. Excessive administrative delay did occur, but this was minimized by aggressive action on the part of the medical supply officer.
The general success of medical supply on Okinawa was remarkable, considering that the American casualties on Okinawa were the highest of any Pacific campaign. Also, a significant amount of medical care was rendered to the natives.
Even before the fighting ended on Okinawa, the XXIV Corps was planning for its assignment in the assault on Japan. The corps was busily reequipping and retraining when the war ended. Okinawa was the last ground campaign of World War II.7
PLANNING THE ASSAULT ON JAPAN
Development of Strategy
By June 1945, the recapture of Luzon, the last important large island objective, was assured, and the way to Tokyo had been opened by seizing Okinawa and its neighbor islands.
Gen. Douglas MacArthur, designated Commander in Chief, U.S. Army Forces in the Pacific, in April 1945, was given the responsibility of preparing the final operations against Japan.
Under the code name, Operation OLYMPIC, an invasion of southern Kyushu Island by the Sixth U.S. Army was to begin on 1 November 1945; and 4 months later, Operation CORONET, an assault on the main island of Honshu by the Eighth U.S. Army from the Philippine Islands, the Tenth U.S. Army from Okinawa, and three Marine divisions, was to be followed by the redeployment of the First U.S. Army from Europe.
Early in the spring of 1945, planning began for the occupation of Japan and Korea, control of the Armed Forces and civilian population, and enforcement of the prescribed terms of surrender. It was assumed that Japan might request a cessation of hostilities early in the invasion operations.8
Medical Supply Planning
Medical supply planning for the invasion of Japan began in April 1945, under the direction of Lt. Col. (later Col.) Ryle A. Radke, MC, Surgeon's Office, General Headquarters, Manila, a recent arrival from the Mediterranean by way of Washington.
Two factors complicated planning for medical supply: The prospect of field service in a colder climate and the desire to improve the service of medical units by adding certain items of equipment which had been proved invaluable. After careful study, lists of additional equipment were prepared, submitted, and approved as special changes to supplement the War Department tables of organization and equipment. Complete reequipment of all units on the troop list was initiated.
To insure delivery of adequate supplies to the invasion beaches early in the operation, all units were required to carry supplies for 30 days. An additional balanced stock of 15 days was carried in division dumps and by separate medical supply units. Stocks were held in reserve on Okinawa and at Manila to be drawn upon for emergency airdrops or for movement to any beachhead by water. Balanced stocks were loaded on ships to be used for later resupply.
An adequate supply of whole blood on the beaches of Japan was to be guaranteed by providing a mobile refrigerator holding 200 pints of blood for each corps to be landed on D-day. In addition, each field and evacuation hospital was instructed to carry an initial stock of 100 pints of blood. For fast resupply, the Navy was to provide four mobile distribution units on LST's which would accompany the assault echelons. Further supply of blood was to be airshipped daily from the Navy whole-blood distribution center on Guam.
Medical supply plans were based largely on previous operations, especially Leyte and Luzon. Although the medical maintenance unit would provide essentials during combat, many sorely needed items had been omitted. Using block-loaded ships from the Zone of Interior and new medical maintenance
units based on theater experience and consumption studies made by the Supply Division, medical supply blocks were designed.
Medical Supply Block 1 was designed to supply 25,000 men for 30 days during combat operations. Block 2 consisted of 6,800 items, including spare parts and optical supplies, and was computed on the basis of War Department table of organization replacement factors. Block 2 was designed to supply 100,000 men for 30 days for fixed-hospital maintenance, and to provide a balanced stock which would permit organizations to requisition items either lost or damaged in combat. These requisitions were submitted by the Medical Supply Division, Office of the Surgeon, U.S. Army Services of Supply, to the Zone of Interior in May 1945.
Medical supplies for Operation OLYMPIC were to be moved into the target areas in three blocks loaded on standard cargo ships. Twenty-eight ships, coded as BOOM, were to carry Block 1 medical supplies. Thirty-five ships, coded as CROW, were to carry Block 2 supplies. Resupply ships were coded as PLUM, with each vessel scheduled to carry supplies for 40,000 men for 30 days. Because of Japan's early surrender, these plans were never put to a test. However, after careful evaluation of the supply plan for OLYMPIC, the Stock Control Division, SGO, found that Block 2 greatly exceeded any known or anticipated requirements, while Block 1 was reasonable and realistic. Revisions and recommendations of the Stock Control Division were accepted by the theater. The quantities of approximately half of the items in Block 2 were revised, with 70 percent of the revisions being downward. Theoretically, these supplies were to cover Operations OLYMPIC and CORONET until the theater could be established on a requisitioning basis. The theater was to requisition for the blocks desired on a prearranged plan. Of the original 35 for Block 2, 16 were canceled, leaving a balance of 19.9
Support for Operations in Japan
Logistical support for operations against the Japanese home islands were to be carried out by Base X (Manila), Base M (San Fernando), Base R (Batangas), Base K (Leyte), and Base S (Cebu). The major reserve of medical supplies and equipment was to be held at Base X (map 52).
By August 1945, Base K was handling only from 25 to 30 percent of the theater supplies while Base X was handling 40 to 50 percent. Estimated medical depot storage requirements for each base were computed in June 1945, based on 17 pounds of medical supplies per square foot. Calculations for storage included some space for unit assemblies as well as for bulk stocks. Base X was the largest depot, 630,000 square feet of hardstand and 365,000 square feet of covered storage; Base S was the smallest, with 110,000 square feet closed and 50,000 feet open.10
Redeployment of Medical Supply Units
After the successful conclusion of the war in Europe on 8 May 1945, the tempo of the Pacific war increased. Staging of redeployed units in the Philippines was planned at newly expanded bases. Over 50,000 hospital beds were programed for the Philippines. Thus, various types of hospital assemblies and other unit supplies for these redeployed units were received and stored in dispersed locations. Earlier lack of sound packing, crating, and documentation of supplies was resolved in later shipments.11
Plans were made in early 1945 for the redeployment of eight medical depot companies from the European Theater of Operations, U.S. Army.
REORGANIZATION OF THE MEDICAL SUPPLY SYSTEM
Organization and Change
U.S. Army Forces, Pacific, which supplanted and absorbed U.S. Army Forces in the Far East in April 1945, was without a medical supply division until 21 August, after the war was over. Before that date, policy direction at headquarters on supply matters was exercised by Col. Paul I. Robinson, MC, deputy to Brig. Gen. (later Maj. Gen.) Guy B. Denit, the Theater Surgeon.
During the period of island-to-island warfare, the Theater Surgeon's Office had been limited in size to meet the requirements of a mobile and flexible organization and to better coordinate supervision of medical components of the various echelons. On 7 June 1945, a logistical command, AFWESPAC (Army Forces, Western Pacific), was organized and thereafter assumed all supply responsibilities in the Pacific. The new command, which replaced the older Services of Supply organization, was also responsible for supplying the Sixth and the Eighth U.S. Armies, and the U.S. Far East Air Forces.
The medical supply units in the Pacific were widely dispersed and were staffed by veterans of the Pacific campaigns who were long overdue for rotation to the United States. A few keymen were retained in the theater, but, overall, experienced medical supply personnel were in critical demand during the last months of 1945. When plans were being made for Operations OLYMPIC and CORONET, it had been obvious that staff personnel would have to be provided from existing Pacific supply depots which were already understaffed. To prevent loss of key depot personnel through misassignment, liaison was established with replacement depots.
The establishment of Army Forces, Western Pacific, did nothing to enlarge the Medical Supply Division, which was already inadequate for its growing responsibilities. The 17th Medical Supply Depot on New Caledonia continued to provide the manpower for the theater stock control mission as
a component of the Technical Services. Under the direction of Maj. (later Lt. Col.) John W. Fieting, MAC, effective stock control practices were established which had been tested and proved in the Zone of Interior. A theater stock control applicable to all technical services was developed later by Major Fieting while he was on loan to G-4 (Assistant Chief of Staff, G-4 Logistics) Section, AFWESPAC.12
The computation and recomputation of statistics and reports by manual means was a trying task, alleviated only when electric accounting machines were installed in the Stock Control Division of the Theater Surgeon's Office. These machines proved invaluable in determining theater levels upon which to base surplus property disposal actions.
The study of replacement factors on selected items, begun in November 1944, was continued. On the basis of this experience, revised factors were submitted to the San Francisco, Calif., Port of Embarkation for approval. Used thereafter in computing requisitioning factors, a definite improvement in theater stock levels was brought about.
By mid-1945, the limited transportation facilities from New Guinea had improved. Shipments of stocks were made to the Philippines, thus reducing the necessity for requisitioning on the United States, except for future operational requirements.
Col. John A. Worrell, MC, formerly commanding officer of the Toledo Medical Depot, was sent on a tour of New Guinea bases in May 1945 to insure that priority items were shipped from New Guinea according to need, and that approved packing, crating, and documentation practices were being followed. The job of moving material forward accomplished by the depots was commendable despite limited facilities and materials. The packing and crating job, however, was done by hospital personnel and was far from adequate. To avoid resupplying and reequipping hospital units moving forward, depot personnel supervised and assisted in packing and crating.
By June 1945, with the stabilization of military operations, it became advisable to place Army supply points on a requisitioning basis. This policy curtailed many of the shortages and excesses at the consuming level which had resulted under the automatic supply procedure.
Establishment of the Depot Operations Branch
In the summer of 1945, the Depot Operations Branch was established in the Medical Supply Division, with the mission of preparing plans and policies for the storage and issue of medical supplies and equipment; computing storage requirements; allocating personnel; and inspecting packing, crating, and marking methods, and depot stock control and inventory procedures. By
September 1945, an inspection team was sent out from the branch to check the accuracy of current stock status reports. This team was invaluable in improving the overall efficiency and economy of the supply service within the Western Pacific theater.
An Equipment, Maintenance, and Repair Section was also established within the Depot Operations Branch during the period. There had been considerable deterioration of combat equipment, and although emphasis was placed on the importance of first- and second-echelon maintenance, numerous items of unserviceable equipment needed care because spare parts were not available. To alleviate this problem, Base X was designated as the key depot for storage of spare parts and of replacement parts which were rapidly supplied by air. Bases K and X were designated as the central fourth- and fifth-echelon repair shops, which made possible the successful completion of the rehabilitation and reequipment program for projected operations. The subsequent conversion from combat to occupation needs under Operation BLACKLIST and the readjustment of personnel to the United States made the shortage of trained maintenance personnel even more critical.13
PHILIPPINE ISLANDS BASE SECTIONS
Organizational Changes and Problems
All Philippine Islands bases encountered the same general problems in establishing and operating their respective medical supply systems. Poor storage facilities and insufficient depot personnel were common. Indigenous personnel were not suitable for stock control and stock selection. Depots had to borrow personnel from neighboring medical units to operate around the clock at peak efficiency during the periods of receiving supplies and outfitting units for Operation BLACKLIST. At the same time, large quantities of stocks were being received, exceeding assigned storage space and forcing relocation. In the early days of 1945, replacement supplies were mainly medical maintenance units, but they were gradually replaced by line-item requisitions to balance stocks. When shipments from the United States arrived before the receipt of shipping documents, tallying-in of the incoming property was delayed. This was particularly irritating as stocks had to be stored according to ships' deliveries pending receipt of the shipping documents.
Refrigeration was also a problem, and improvisation or reliance on other sources for refrigerator space were the common alternatives in most bases.
As of 1 July 1945, strict accountability was placed in effect within the Philippines, necessitating the initiation of prescribed inventory and accounting procedures. The large exodus of units in August under Operation BLACKLIST required the preparation and issue of substantial amounts of equipment and replacement supplies. As strengths in the bases receded, hospitals and other medical units began turning in their excess supplies, equipment, and unit
assemblies to the depots, which were caught in a squeeze between the increased workload and the postwar personnel reductions.14
Manila Base Depot Systems
By August 1945, the Greater Manila area contained one of the largest medical depot systems developed in the Pacific area during the war. As part of the base development plan, 365,000 square feet of covered storage and 635,000 square feet of hardstand for medical supplies and equipment was being constructed in five separate areas during June, July, and August.
From the time that Manila was occupied until the assumption of logistical support by Base X, the medical depot, located in a Manila schoolhouse, was operated by the 15th Medical Supply Platoon (Aviation), a Sixth U.S. Army unit. When the 49th Medical Depot Company arrived in Manila, it took over the issue point from the 15th which returned to combat duties.
With the increase of receiving and shipping activities, additional storage facilities of a variety of conditions and locations were allocated as well as desirable hardstand located at the North Harbor Beach area and the South Beach area of Manila. DUKW's (amphibious trucks, 2½-ton cargo) were used to haul supplies from the ships backlogged in Manila Bay, to the supply storage areas faster than the depot crews could tally in and stock them (fig. 143). Fortunately, the use of abundant civilian labor and the dry season facilitated this operation. In the meantime, a former Philippines customs warehouse in the port area replaced the schoolhouse. This new warehouse, with 90,000 square feet of covered space, became the nucleus for local storage and issue, relieving added storage problems which had stemmed from the poor packaging of material shipped from New Guinea bases.
As soon as pierside unloading was available, the North Harbor Beach dump was reduced to use as dead storage space for bulky, slow-moving items. Additional bulk-storage space was acquired on North Bay Boulevard; however, lack of materials for handling equipment hampered operations.
During June 1945, the depot was expanded by constructing a 26,000-sq.-ft. prefabricated warehouse adjacent to the issue depot, and six warehouses, totaling 200,000 square feet, at Quezon City (fig. 144). Adjacent to the Quezon City warehouses was 104,000 square feet of hardstand, and an additional 140,000 square feet of hardstand was acquired when one-half of the Zablan airstrip was taken over. The widely scattered locations of warehouse and storage areas presented problems which would not have been encountered if the depot had all been under one roof (map 53).
All issues were made from an issue warehouse where the master locator and stock records systems were maintained. Paperwork in the outlying agencies was kept to a minimum to control and expedite movement of stocks.
A medical supply liaison section of the depot directed delivery of medical supplies from the ships to the proper dump or to the warehouse furnishing the depot with advance notice of supplies to be received. A locator service on stray medical shipments was also maintained by the medical supply liaison section.
Additional personnel from various other medical depot companies were used by the 49th because its own were insufficiently trained. Soon the policy was established to have the outlying area units operated by separate detachments. The depot system of Manila was utilized to train new units on their arrival in the theater. To permit the administrative operation of these many groups, the 5261st Medical Depot Group (Provisional) was organized. This resulted in more effective administrative control of the numerous depot companies which were operating the medical depots and assured a continuity of effort in supporting the numerous hospitals and equipping the units mounting for Japan.
As of 15 October 1945, the issue depot was operated by the 49th Medical Depot Company; the bulk-storage warehouse in the Quezon City area was
operated by a detachment of the 61st Medical Depot Company; the South Beach dump, Depot No. 4, was operated by the 67th Medical Depot Company; and the Zablan Bulk Storage Depot, Depot No. 6, was run by the 48th Medical Depot Company which had been redeployed from Germany (map 53).
Until the responsibility reverted to the Philippines Commonwealth Government, medical supplies for civilian relief of the Philippine Islands were received, stored, and issued by the 77th Medical Base Depot Company which used the 36,000-sq.-ft. Studebaker automobile distributing agency building.
The tonnage received and shipped by the medical supply depots in Manila from the beginning of operation is given in table 8.
Amounts of supplies shipped do not include the innumerable issues to organizations drawing their supplies locally. While the first 3 months of operation consisted of receipt, storage, and routine issue, June, July, and August found the depots with the additional load of reequipping units for a forthcoming operation.
Following V-J Day, additional problems emerged, such as receipt, reconditioning, and storage of equipment being turned in by inactivating organizations; supply of occupation forces by shipments from Base X and other bases; and determination and disposal of excesses.
Maintenance and Repair
To meet the need for repair, a maintenance section of the 49th Medical Depot Company was established in the issue depot (fig. 145). At the beginning of its operation, repairs had to be accomplished by cannibalization of items because of an inadequate stock of spare parts. Fortunately, the workload was light until redeployed units began to arrive in the area. Consequently, maintenance sections of the other depot companies were combined to pool their supplies, equipment, and personnel, and Manila was designated the key depot for spare parts. While spare parts continued to arrive automatically, many parts could not be used because they were of a different manufacture than the end-item for which they were required.
Optical Service of Manila Depots
The optical service in Manila began with the operation of the optical section shop, run by the 49th Medical Depot Company (fig. 146). Although the workload was light, difficulty was encountered because of the lack of lenses and of spectacle repair parts, a situation resulting from the procedure established by the Surgeon General's Office. This procedure required that requisitions for lenses and spectacle repair parts be placed for direct delivery to each individual optical unit. Because of the distances between ports and the shipping backlog, optical units were often short of various supplies. The shortage of stock during the early stages of operation was partly overcome by requisi-
tioning repair supplies from portable optical repair units. To prevent continuation of such shortages, a key depot, responsible for establishment of theater levels of optical supplies, and for requisition, storage, and issue to various optical units, was established in Manila. Because of the minimal weight of spectacle repair parts, unit stocks were easily restored by either mail or air shipments. As additional medical depot companies arrived in Manila, their optical repair sections, set up in the issue depot, pooled equipment, supplies, and personnel.
One important aspect of the medical depot was the supply of whole blood to units in the Manila area. The first issue was made on 11 March 1945 by the 15th Medical Supply Platoon (Aviation). There was an average daily issue of 125 pints during March, 160 to 175 pints during April, and 175 pints during the succeeding 3 months. With the cessation of hostilities, the issue of blood dropped to a minimum. Shipments of whole blood from the United States ceased on 15 September 1945.15
Airdrops to American Prisoners of War
On 4 July 1945, in anticipation of the collapse of Japan, plans were made to airdrop essential medical supplies to all American prisoner-of-war camps in Japan and Korea. The Surgeon's Office, AFWESPAC, developed a list of components, and the depot supply service experimented with and developed suitable packaging (fig. 147 A). The project involved 180 drops, each of which contained 42 essential items including concentrated vitamin products, antimalarial drugs, parenteral dextrose solutions, diarrheal remedies, analgesics, and narcotics. The package, limited to 125 pounds, was required to fit into a canvas drop package 14 inches in diameter and 6 feet long. The drops were made on each prisoner-of-war camp together with appropriate medical personnel shortly after V-J Day (fig. 147 B). Because the liberated American prisoners were evacuated so rapidly, the drops were not so beneficial as had been anticipated.16
OCCUPATION OF JAPAN
Operation BLACKLIST Executed
With the sudden and unexpected surrender in August 1945, the block resupply set up for Operations OLYMPIC and CORONET was no longer
FIGURE 147.-A. Parachute airdrop pack opened to show how each item was wrapped in cotton. B. Medical supplies that constituted an airdrop package for American prisoner-of-war camps in Japan and Korea.
needed. Operation OLYMPIC was hastily converted to Operation BLACKLIST, which provided that occupation units would carry medical supplies for 30 days.
In numerous supply conferences held between Colonel Robinson, of AFPAC (United States Army Forces in the Pacific), and the medical supply officers of key bases and armies, it was decided that resupply would be provided by the block-loaded ship. Army Forces, Western Pacific, hastily developed an automatic resupply block consisting of 2,680 items based upon ZI(Zone of Interior) replacement factors for 100,000 men for 30 days. A 500-bed hospital assembly was shipped to Yokohama as an emergency source of equipment and for other unpredictable needs. Upon arrival, this assembly was diverted for utilization by the 42d General Hospital, which was established at St. Luke's International Hospital, Tokyo (fig. 148). An unplanned and welcome source of supplies came from the U.S. Army Hospital Ship Marigold, without the knowledge or requisition of the theater. Apparently, requisitions had been placed in the Zone of Interior by the Surgeon General's Office and loaded out of San Francisco.
By 27 September 1945, 30 days' supply for 100,000 men was stored in the Yokohama Depot which was operated by the 29th Medical Depot Company. Tremendous quantities of litters, blood plasma, plaster of paris bandages, and similar bulky combat type items arriving in block-loaded ships from the Zone of Interior became a disposition problem. When the 43d Infantry Division
and the 1st Cavalry Division departed for the United States, they complicated depot operations further by turning in field equipment.17
Problems of Supply in Japan
Despite the haste with which occupation plans were formulated and executed, medical supply problems were initially minor.
Winter items, such as pajamas and convalescent suits, not required in either New Guinea or the Philippines, were in short supply as the block-loaded ships provided quantities based on replacement factors only. The shortage of temperate-zone items required the supply by emergency requisitions from the United States.18
Considerable pressure was placed on all supply echelons to prevent the buildup of excesses in Japan.
All OLYMPIC requisitions which had not been shipped from the Zone of Interior before Japan surrendered were immediately canceled. It was recommended to the War Department that fully loaded ships awaiting discharge in Japanese waters be returned to the States unless they were carrying essential equipment and supplies required in the occupation area. As this complicated supply computation, it was requested that emergency requisitions be submitted to the Philippines for any supplies not received because of ship diversion.
Beginning on 1 October 1945, replacement factors were computed on ZI rates upon instructions from U.S. Army Forces in the Pacific. Numerous ship diversions occurred from the Philippines to Japan, with many ships containing hospital assemblies from the European and Mediterranean theaters of operation. If these assemblies were delivered to the Philippines, they were unloaded; if received in Japan, they were returned to the United States.19
Postwar Supply System
By 1 January 1946, the medical supply system in Japan was well established. Col. Stephen G. Asbill, VC, was Chief, Medical Supply Division, U.S. Army Service Command, with Capt. Albert Simms, MAC, serving as chief of the Administrative Division. The stock control mission was performed by a separate unit headed by Maj. Cornelius J. Curran, MAC, and was attached to the 29th Medical Depot at Yokohama, the key depot in Japan. The 9th Medical Depot Company, commanded by 1st Lt. Milton A. Kaplan, MAC, arrived at Wakayama (Southern Honshu Island), on 29 September 1945, from Base
M. It was initially assigned to Headquarters, Sixth U.S. Army, and later to I Corps, and it operated depots at Nagoya, Wakayama, and Kōbe (map 54).
The 78th Medical Base Depot Company, commanded by Capt. (later Maj.) Leroy M. Martine, MAC, arrived at Otaru, Hokkaido, on 5 October 1945, with 180 measurement tons of medical maintenance units to supply 20,000 troops in that area. This unit experienced difficulty in protecting its supplies from the freezing temperatures of that location. An improvised structure of approximately 10,500 cubic feet was built from framing and tarpaulins and was heated with gasoline tent stoves.
On 20 October 1945, the 80th Medical Base Depot Company, commanded by Capt. F. R. Glascock, MAC, arrived in Yokohama and was attached to the 29th Medical Depot Company.
During October 1945, the Medical Supply Division, AFWESPAC, requested inventories from the various command levels to establish accurate theater on-hand figures. At the same time, medical supply procedures were furnished these commands, since AFWESPAC was to provide logistical support until 1 March 1946, when the Eighth U.S. Army was scheduled to assume responsibility.20
MEDICAL SUPPLY OPERATIONS IN KOREA
Japan's sudden surrender found the staff of the XXIV Corps still planning for the invasion of Japan. The corps was furnished with medical support units necessary to perform its independent operation as an occupation force in Korea, and was designed to support a force of 100,000 men and a military government organization. An initial mission of the corps was recovery, processing, initial care, and evacuation of U.S. prisoners of the Japanese in mainland prison camps.
Medical Supply Responsibilities
Responsibilities of the medical supply officer, XXIV Corps, ranged from supervising medical-supply manufacturing installations which Japan had established in Korea to reestablishing production in a variety of factories in Korea.
Another peculiarity of the supply program was the arrival of assigned hospital units less all personnel except one lieutenant and one corporal. These units were completely equipped, but because of the rotation policies, they had lost all personnel at their points of origin, either in Okinawa, Tinian, or Luzon, or back in Australia or Hawaii. Soon a mountain of unprocessed supplies, equipment assemblages, and paper piled up beside the inadequately staffed 58th Medical Base Depot Company. It was not surprising that it took many months to work out this backlog. Unmanned units were never manned because the planned strength of the occupation force was reduced to 40,000, and so the disparity between supplies and personnel continued to grow.21
Medical supply personnel were called upon to make significant contributions to the medical service in Korea by a number of activities. They outfitted and put into service a hospital train, established supply stores in Korean hospitals, reestablished medical schools, and set up a previously dismantled smallpox vaccine manufacturing laboratory and distributed its product to the civilian population, thereby combating a full-scale epidemic.
The medical supply system was also instrumental in establishing standards for drug purity by promulgating codes of conduct for the drug manufacturing industry.
Early in October, a classical smallpox epidemic began to crop up in the civilian population which had not been vaccinated for 5 years, as the vaccine laboratory near Taegu had been diverted to meet the needs of the Japanese Forces. Through the efforts of Capt. Ernest R. Tinkham, MAC, the laboratory at Seoul was reestablished, and vaccine became available.
In early November, with the recognition of the first U.S. case of smallpox and a serious outbreak of smallpox among civilians, all personnel of the command were ordered revaccinated. A new consignment of vaccine was obtained from Philippine Islands laboratories. Because some cases of smallpox among U.S. personnel remained in evidence, the medical supply officer required high-potency vaccine to be airshipped from California. All members of the command were given this vaccine. From then on, all personnel arriving in Korea were vaccinated aboard ship before debarking.22
Civilian Medical Supply in the Philippines
Supplies for Philippine Islands civil affairs units were received, stored, and distributed by Army medical supply personnel. Relief stocks were distributed proportionately under the operational control of the Sixth and Eighth U.S. Armies. On 1 July 1945, full responsibility for civil affairs supply was transferred to the Eighth U.S. Army to release the Sixth for future operations. The Eighth was responsible for maintaining necessary records to insure that supplies were not over-requisitioned. Issues from Army stocks were made in emergency only if Army stocks were in a favorable position.
With the cessation of hostilities, the supplies for Philippine Islands civil affairs units, which were stored in civil affairs medical depots in Manila and Leyte (fig. 149), were inventoried to determine supplies ready for issue to the civilians of Japan and the Philippines. These supplies were transferred to the Foreign Economic Administration, which turned them over to the Commonwealth of the Philippines Government on 9 October 1945, thus releasing the Army from further responsibility for civilian supply in the Philippines.23
Civil Affairs Supplies in Japan
Late in August 1945, plans for the supply of the civilian population of Japan were begun by Col. (later Brig. Gen.) Crawford F. Sams, MC, surgeon of the Japanese Allied Military Government group and his medical supply staff, in coordination with the AFWESPAC Medical Supply Division. Colo-
nel Sam's group took the position that, because the war was over, civilian requirements should be given priority over military requirements. The Supply Division, on the other hand, believed that, because medical supplies in the theater were Army stocks, only excesses could be applied to civilian requirements and then only after SGO approval. Failure to establish delineation of responsibility between the Allied Military Government and the Eighth U.S. Army was another confusing factor. Since neither group had sufficient personnel, the task fell on the 29th Medical Depot Company at Yokohama.
On 22 September, a medical maintenance unit was shipped to the Hiroshima area, along with as much penicillin and other essentials as could be spared. In response to a request of the Eighth U.S. Army, a full medical depot company was provided to operate the Civilian Aid Program for the Allied Military Government group. Late in September, the SS Tuscon was diverted from the Philippines to Japan. Eleven hundred cases of supplies and a large quantity of relief supplies for the Philippines were segregated in 35,000 square feet of covered storage by the 29th Medical Depot Company. At a later date, Japanese Army stocks were diverted for civilian requirements, and a program to build civil affairs units from excess U.S. Army stocks was started by Army Forces, Western Pacific.24
DISPOSAL OF EXCESSES AND SURPLUS PROPERTY
Organization and Early Work
After V-J Day, advantageous disposition of the huge excesses of medical supplies and equipment became one of the prime missions of the Army Forces, Western Pacific. Early in September 1945, Maj. Raymond F. Linn, MAC, was
designated as the medical member of an AFWESPAC surplus property disposal team which visited New Guinea bases with the objective of delivering all supplies in excess of a 6-month maintenance requirement to the Dutch Government. After inventorying and pricing stocks at these bases, the value was set at $4.8 million.
On 25 October 1945, disposition of surplus property was assigned the highest priority by G-4, AFWESPAC. Despite clearly refined relationships between G-4, G-5 (Assistant Chief of Staff, G-5, Civil Affairs), Technical Services, and the Office of the Foreign Liquidation Commission, disposition of surpluses was hampered by the computation of requirements for a War Reserve Stock to be maintained in the Philippines. However, by 2 November, declarations of surpluses had been initiated.25
Closeout of Philippine Islands Bases
Closeout of the Philippine Islands bases came next in the rollup of the rear. The 34th Medical Depot Company experienced typical problems in closing Base K. With only a few experienced officers remaining assigned to the depot and only an inexperienced combination of inexperienced depot enlisted men, enlisted men from a tank destroyer battalion, Filipino civilians, and 325 Japanese prisoners of war, 29,431 measurement tons of supplies were processed for shipment to either Manila, Japan, Korea, or the United States. Packing and crating materials were adequate. However, certain essential items such as stencil machines were not available, and packages had to be marked in freehand.
The disposition of surplus property in the Philippines was a race against time since the tools for accomplishment-manpower and shipping space-were rapidly diminishing. The Supply Division was fortunate to have Maj. (later Lt. Col.) Clarence Retzky, MAC, as stock control officer. Electric accounting machines were used in the repeated computing of levels and the issuing of appropriate disposition instructions.26
UNUSUAL PROBLEMS OF MEDICAL SUPPLY
Loss of Drugs
The loss of biological products as a result of passing expiration dates in the theater was of considerable concern to the AFWESPAC supply service, and plans were developed to provide biologicals within the optimum use to units. Smallpox vaccine with a 3-month expiration date under routine supply processing would be outdated before it was received in the theater. As a result, key depots at Hollandia and Manila were established with stock levels based on consumption studies. All stocks of vaccine were shipped from the United States on class I priority, and shipments within the area were made by air to
insure use before expiration dates. Undoubtedly, a high percentage of "outdated" biologicals were potent and suitable for use. Development of potency determination facilities by theater medical laboratories appeared feasible to permit the salvaging of a large quantity of these products.
The shortage of biological and pharmaceutical sets at medical depots presented a problem which was solved by designating the 19th Medical General Laboratory at Luzon as the central storage and issue agency for these products. Requisitions went directly from hospitals and consuming units to the laboratory. Items not manufactured by the laboratory were requisitioned from the United States for direct delivery to the 19th Medical General Laboratory.
Another factor in efficiency of storage operations and deterioration of supply packaging was the low priority given warehouse construction. The use of newly developed plastic sheeting as an interim measure seemed desirable as canvas tarpaulins were not available for depot use in the quantities required.
Because of the studies of the Schistosomiasis Commission and other laboratory requirements, an unusually large requirement for laboratory animals developed. Australian sources were becoming exhausted, and transportation from the United States was an important consideration. It was decided to establish a breeding colony at the 19th Medical General Laboratory. Four airplane loads of breeding stock were obtained from the United States for direct delivery to Manila. The final shipment of 10,000 white mice, 600 guinea pigs, and 200 hamsters was received on 29 September 1945. Losses en route were negligible. Food pellets were requisitioned from the United States until sources were developed in the Philippines.
Probably the most acute problem of the medical service in the Philippines was the loss of medical supplies by pilferage. Depot areas were not fenced until late 1945, and truck convoys en route from the port area to the numerous depot locations were frequently hijacked. Medical supplies brought fantastic prices on the black market. Pilferage was not confined to the shoplifting tactics experienced in U.S. depots, but consisted of organized armed raids by day and night. As a result of this problem, penicillin was actually in short supply status early in 1946.27
Supply for Other Services
The Army Medical Supply System provided essential medical supplies to the Navy, Army Air Forces, Marines, Royal Australian Air Force, and other services toward the end of the war. In June 1945, 70 tons of supplies were provided the naval station at Subic Bay. In routine procedure, Army medical depots supplied Navy ships in their areas. In November 1945, issues were restricted to requisitions authenticated by appropriate Navy commands. Typical daily-diary entries showed unanticipated requirements for U.S.O. shows, a hearing aid for General Yamashita to enable him to hear his interpreter during the War Trials, and requests for equipment for a Coast Guard dispensary
and for 100,000 Atabrine (quinacrine hydrochloride) tablets for the Royal Australian Air Force.28
GENERAL CONSIDERATIONS AND CONCLUSIONS
The story of medical supply in World War II was one of frequent frustration and confusion which evolved into success.
After the Japanese severely crippled the U.S. Pacific Fleet at Pearl Harbor and followed up by driving U.S. forces from the Philippines, the supply service in the Pacific had to start on a shoestring. The hard lessons learned in those early weeks and months furnished the experience and taught the lessons put to good use in later campaigns, particularly in the invasion of the European Continent.
Numerous errors of judgment made in the period of austerity between World Wars I and II prevented adequate supply planning. Based on the false assumption that the outbreak of the war would be preceded by a formal mobilization day and the equally false assumption that there would be a manpower ceiling of 4 million men, the supply posture was much too rigid, and planning was totally inadequate. Lack of funds and a woefully inadequate reserve of medical supplies and equipment were responsible for the use of obsolete medical kits, chests, and hospital assemblies.
In September 1939, 4 officers and 27 civilians were on duty in the Finance and Supply Division, Office of The Surgeon General. By the time of Pearl Harbor, the division had become one of the 12 major divisions of the Surgeon General's Office with a complement of 16 officers and 201 civilians. As a result of expanding supply needs after Pearl Harbor, many willing but inexperienced supply officers came into the system overnight. It was not until 1943, when formal training for medical supply officers became a part of the course at the St. Louis Medical Depot Maintenance School, that the supply of trained officers began to meet the demand. By bringing in leading businessmen, such as Herman C. Hangen, J. C. Penney Co.; Edward Reynolds, Columbia Gas and Electric Corp., who became chief of Supply Services; and many others from civilian life, adequate leadership for the supply program became a reality.
To eliminate the merry-go-round procedure used to requisition items, the key depot system was established. Certain depots were responsible for certain
types of supplies and equipment. Efficient depot operations in the United States eliminated hoarding and rushed the requisitioned supplies to their assigned destinations. Storage space expanded from 1 million to 13 million square feet in the course of a year amid a mad rush for depot space. New depots or medical sections were established in Kansas City, Kans., Seattle, Wash., Atlanta, Ga., and Richmond, Va., to handle the expanding need for medical supplies.
Shortly after Pearl Harbor, the MMU (medical maintenance unit), a standard assemblage, comprising about 700 items and weighing 15 tons and intended for automatic supply of 10,000 men for 30 days, was developed.
Designed primarily for use in overseas theaters and forward bases for the initial phases of development, the medical maintenance unit had a primary weakness of inflexibility. Forward echelons often relied on these units for a longer period of time than was intended, with a resulting serious shortage of some items and an oversupply of others.
An even more serious weakness of the medical maintenance unit, particularly in the European theater, was its inability to ship complete units. Split shipments occurred most frequently in the days preceding D-day in Europe.
To compensate for these weaknesses, other types of MMU's with a smaller number of items of less tonnage were developed and used successfully in Sicily and in Italy, as well as in the Pacific.
Maintenance, Repairs, and Spare Parts
The maintenance program of the Supply Division, SGO, was born of necessity. Virtually nonexistent at the beginning of World War II, it became a fully functioning program in all theaters by the end of the war. The servicing of medical equipment was strictly a wartime policy. Maintenance of medical equipment before the war was handled at on-post shops by other technical services or by local manufacturers of the specific equipment. Poor planning for repairs in North Africa precipitated numerous problems with broken X-ray screens, as well as shattered glass tubing and damaged knobs on steam sterilizers. Without an established maintenance program, the repair of broken items was almost nil, and only superb and ingenious Rube Goldberg techniques saved a catastrophe. By the time of the invasion of Europe, some provision for maintenance had been made and, gradually, full operation was reached with the maintenance section's being attached to the base platoons of the medical depots. Well-trained graduates of the St. Louis Medical Depot Maintenance School filled the need for trained technicians.
In the Pacific theaters, medical equipment repair was more difficult because of the lack of trained technicians and the distance between island bases. Late in the war, it was found practical to send two barges outfitted with equipment and staffed with trained personnel on a scheduled round of the various bases to make repairs and dispense spare parts.
During World War II, it was learned that the Medical Department should not depend on manufacturers' shops to maintain equipment in an emergency. Cannibalization of parts or exchange was not a satisfactory solution because of the huge backlog of unserviceable items which developed.
Development of Special Items of Equipment
Perhaps one of the most outstanding contributions of the medical supply service in World War II was the development of artificial (acrylic) eyes, camouflage dressings, jungle kits, aluminum litters, arch supports, and orthopedic braces.
The optical program itself became an important part of operations in the European theater. More specifically, a mobile optical repair unit was on the beaches of Normandy as early as 3 days after D-day.
More than 180,000 pairs of spectacles were repaired from D-day to June 1945, and more than 120,000 pairs of glasses were issued.
Until early 1944, when the new acrylic eye was developed by European theater dental officers, large numbers of artificial (glass) eyes had to be purchased in Italy. The development of the acrylic eye eliminated the problem of source of supply and the necessarily wide assortment of sizes, shapes, and colors which would be required.
To protect the wounded soldier from sniper fire, particularly in the jungle-infested areas of China, Burma, India, and the Pacific, olive-drab camouflage dressing was created and used with care to avoid any probable toxicity which might occur because of the dyes involved.
Another item used successfully in the Pacific was the jungle kit which was adopted after the Guadalcanal Campaign. Varying in size from a small pouch, which was carried on the individual soldier's belt, to a much larger unit carried on the back, the jungle kit contained antimalarial water-purification tablets, salt tablets, skin disinfectants, insect repellants, and vitamins.
Early in the war, it became obvious that in a fluid type of fighting such as in the Pacific and in Italy, it would be necessary to transport both medical equipment and patients over rough terrain in an expeditious yet comfortable manner. Jeep brackets were developed so that a jeep could carry three litters easily from the forward area to the rear. When available, aluminum litters were widely used because of their light weight.
The development of the blood bank and blood plasma made blood a standard item of supply, as it was handled in the European theater and the Pacific as part of the Medical Supply System.
Development of Packaging and Packing
At the beginning of World War II, some of the first shipments sent overseas fell apart, and glass containers shattered. It became necessary to develop better packaging specifications. The handling of loose or mixed issues was par-
ticularly poor at the beginning of the war, and because of the lack of standardization, packing in a variety of containers was in use.
After much experimentation in the North African and Sicilian campaigns, waterproof medical packs weighing 70 pounds were developed and used in the invasion of Italy and led to the use of waterproof boxes in both Europe and the Pacific. As a result of the Voorhees mission to the European theater, an expanded packing and crating program was swiftly and successfully carried out.
With the development of a skid-loading program which had been introduced in the Attu Campaign of April 1943, supplies were moved rapidly from the depot to the field. By using this method, surgical instruments were packed together as were other special items.
One of the greatest boons to unloading of supplies was first used on the beaches of North Africa. The marking of packages and boxes with the color appropriate to the technical service allowed for effective sorting of boxes by natives who could not read the accompanying shipping documents.
Numerous shortcomings, tragedies, handicaps, and errors hindered supply operations. Despite losses which resulted from sinking of ships, poor handling of supplies on the beaches, enemy destruction of depots and medical installations, lack of control of transportation, nonmedical use of medical items, pilferage, and ineffective property exchange, medical supplies were delivered and used in sufficient quality and quantity to allow the effective treatment of the wounded and the noncombatant disabled casualty. The effective use of missions to the various overseas commands helped straighten out some very intolerable and seemingly impossible situations.
As the war came to a close, careful planning, new innovations, and sheer industriousness had made the supply of the Philippines and Okinawa campaigns much more efficient. The massive movement of units and supplies from Europe to the Pacific never was necessary because of the sudden surrender of Japan.