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Chapter VI

Contents

CHAPTER VI

Medical Supplies Under Lend-Lease

While it was furnishing medical supplies to U.S. Army troops in all parts of the world, the Medical Department had the additional responsibility of providing for the supply needs of numerous countries actively warring against the Axis or in a state of friendly neutrality. The Lend-Lease Act, approved on 11 March 1941, granted authority to sell, exchange, lease, or lend supplies and equipment to any government whose defense the President deemed vital to the defense of the United States. Under this authority, medical supplies valued in excess of $140 million were distributed among more than 30 nations. Although these supplies represented only three-tenths of one percent of the value of all lend-lease shipments, they constituted more than 15 percent of the total value of Medical Department procurement during the same period.1

Accepting War Department responsibility for the administration of the Lend-Lease Act, the Secretary of War authorized the establishment of a Defense Aid Division in the Office of the Under Secretary of War to coordinate War Department activities, to route requests for lend-lease aid to technical committees for screening and recommendations, and to authorize procurement and transfer of the supplies and equipment.2 The technical committees were known as Defense Aid Requirements committees, whose principal function was the determination of material requirements by type, quantity, and destination. Such committees were established late in April or early in May for Ordnance, Chemical Warfare, Signal, Engineers, and Quartermaster Corps. The first medical supplies distributed under lend-lease were procured by the Treasury, and so a Medical Defense Aid Requirements committee was not set up until June. On the level above the War Department, responsibility for administering the act was assigned to the newly-created Division of Defense Aid Reports, Office for Emergency Management, which was superseded in October 1941 by OLLA (Office of Lend-Lease Administration).3

To carry out the determinations of the Defense Aid Medical Requirements Sub-Committee, a Defense Aid subsection, staffed by one officer and four civilian employees, was established in the Finance and Supply Division, SGO (the Surgeon General's Office) to procure and transfer all medical supplies furnished by the War Department under lend-lease.4

1(1) House Document No. 41, 80th Congress, 1st Session, Twenty-Third Report [of the President] to Congress on Lend-Lease Operations, January 1947. (2) See appendix B, p. 569.
2Letter, The Adjutant General to the Chiefs of Arms and Services and the Divisions of the War Department General Staff, 10 Apr. 1941, subject: Procedure Under the Lend-Lease Act.
3(1) Executive Order No. 8751, 2 May 1941. (2) Executive Order No. 8926, 28 Oct. 1941.
4This subsection seems to have been established in July or August 1941. Before that time, the very small lend-lease operations required about 20 percent of the time of one officer. Memorandum, Lt. Col. F. C. Tyng, MC, to Budget Officer for the War Department, 15 July 1941.


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ROLE OF THE MEDICAL DEPARTMENT IN LEND-LEASE

The first implementation of the Lend-Lease Act by the Medical Department involved the supply of 2,000 standard litters, as directed in a memorandum from the Secretary of War to The Surgeon General on 9 April 1941. These litters were transferred from regular depot stocks to the United Kingdom for probable retransfer to Yugoslavia, and the cost was to be charged against the initial lend-lease appropriation. No further demands were made on the Medical Department until July 1941, when Chinese requisitions were received for medical supplies worth $1.2 million during construction of the Burma-Yunnan Railway (fig. 33). At about the same time, the United Kingdom presented requisitions for field equipment valued at $950,000. These two requirements put the Surgeon General's Office in "the Lend-Lease business."5

Development of Procedures

During this early period, storage and issue activities for medical lend-lease were conducted in depot space provided at Shamokin, Pa., Voorheesville, N.Y., and Marietta, Pa. Between July and December 1942, such activities were centered in the Marietta depot. In the latter month, the Sharonville Engineer Depot, Ohio, provided space for lend-lease operations. This installation was succeeded, in August 1943, by the Louisville Medical Depot, Louisville, Ky., which continued until the end of the war as the only depot engaged in international aid activities. The many preliminary activities were, of course, conducted by OLLA, by the Defense Air Division of the Office of the Under Secretary of War, and by the Defense Aid Sub-Section, SGO.6

One difficulty, however, was soon apparent. Since a specific allotment of funds was made to cover each requisition, it was necessary to make numerous suballotments within the Surgeon General's Office and to extend suballotments to each participating procurement and receiving depot so that all costs occurring with each requisition could be charged against the specific allotment. In addition, materials available in regular depot stocks could not be used and subsequently replaced, for the allotments contained a clause declaring that "None of the funds herein allocated may be used to reimburse appropriations of the War Department for the value of materials on hand and used for work herein authorized * * *." It was necessary, also, to maintain the identity of each requisition throughout all stages of procurement, storage, and transfer. On procurement operations alone, this entailed placing as many contracts for the same item as there were requisitions calling for that item. Thus, quantities of an item could not be "lumped" for the efficiency and economy of bulk purchasing. In storage operations, this requirement made it necessary that depot employees segregate, on the basis of requisitions, all supplies received for defense

5(1) Memorandum, The Secretary of War to The Surgeon General, 9 Apr. 1941, subject: Transfer of Defense Articles to the United Kingdom (Lend-Lease Act). (2) Unless otherwise noted, the material in the remainder of this chapter is based on the following April 1946 report: Wilson, R. E.: History of Medical Department Lend-Lease Activities. [Official record.]
6(1) Annual Report, Finance and Supply Services, OTSG, 1942. (2) See appendix B, p. 569.


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FIGURE 33.-Lend-lease medical supplies destined for China are unloaded from an American freighter
at Calcutta, India, 1944.


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aid. Aspirin tablets procured to alleviate headaches in the United Kingdom could not mingle with aspirin tablets purchased to achieve the same end in Russia, lest funds allocated to relieve the suffering of an English soldier should be accidentally diverted to the soothing of migraine beyond the Volga.

Another cumbersome feature of early operating procedure was the type of records it was necessary to establish and maintain, based upon those from defense aid depots, to comply with accounting requirements and to prepare the 14 reports prescribed by the Office for Emergency Management. These reports dealt with distribution of appropriations, allotments, and expenditures; analysis of expenditures; schedule of obligations; statement of defense articles transferred; property, rights, and privileges received from foreign governments; and related matters. The authority requiring these reports, apparently, had not contemplated or recognized the tremendous variety of medical items sooner or later to become involved in lend-lease operations.

Although current information was compiled on International Business Machines, preparation of the required reports became complex and time-consuming as the volume of individual requisitions grew, and quantities of individual items became so large that it was necessary to place several contracts to procure the full quantity. Moreover, since a given item appeared on many requisitions undergoing action simultaneously, extensive analysis was required to supply information on total quantities of that item or groups of related items involved in lend-lease activities at a stated time. To speed the compilation of these reports, a supplementary record was established, the material for which was accumulated by item rather than by requisition. By fall 1942, when it became possible to discontinue this record, approximately 12 full-size file drawers of 12- by 16-inch cards had been accumulated.

Only two countries, the United Kingdom and China, received aid in the form of medical supplies during 1941, and the dollar value of those transferred was small, amounting to only $276,000.7

The entry of the United States into the war had no immediate effect upon lend-lease operations, except that shipments were suspended briefly. This suspension lasted only 2 days for nonstandard items and 4 days for standard items. The first few months of 1942 produced no major changes in procedure; but, as the volume of transfers increased, the methods used to present and establish requirements were elaborated.

Wartime Changes

Lend-lease beneficiary governments, at the beginning of each year, submitted to the Defense Aid Sub-Division, SGO, through the International Division, ASF (Army Service Forces), estimates of total requirements for the forthcoming calendar year; and, from time to time, they filed specifically numbered "spot requisitions" for requirements which were unforeseen and therefore not included in the yearly programs. Both types of requirements

7See appendix B, p. 569.


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were first subjected to a process of "coordination," which involved the identification of each item by reference to the Medical Supply catalog, International Aid nonstandard catalog, and other lists of medical supplies and equipment. After this coordination, the yearly programs were forwarded to the Requirements Division, SGO, for incorporation into the Army Supply Program. Although specific War Production Board clearance on the yearly programs was not required, representatives of that agency were frequently consulted for advice as to availability.

Spot requisitions were subjected to a detailed analysis upon receipt to determine the cost, the delivery schedule, and the exact quantities of critical raw materials required. The Medical Sub-Committee of the International Supply Committee discussed the requisitions and made its recommendations to the parent committee. When a requisition was thus approved, the International Division, ASF, forwarded to the Medical Department the authority to procure and transfer the medical supplies and equipment. Purchase authorizations were then prepared and sent to the appropriate procurement office, which made contracts for the required supplies. Deliveries from the contractors were made to the defense aid depot and, there, were warehoused by requisition numbers so that the identity of materials procured against each requisition could be maintained throughout the successive stages of procurement, storage, and issue. When all the material for a given requisition had been delivered, or a sufficient portion thereof to warrant a shipment, the depot notified the Surgeon General's Office, and, upon receipt of the shipping instructions requested from the foreign government, the depot was directed to proceed with the shipment.8

During the spring of 1942, because of the increasing volume and urgency of lend-lease requirements, efforts were begun to simplify procedures throughout the War Department. One notable result was a gradual liberalization of accounting requirements. The specific fund allocation, which required the segregation of requisitions, was eliminated; in its place, Master Procurement Authorities were substituted which were applicable to the requirements of all foreign governments approved at one time. Residues of previous fund allotments were converted into Undistributed Allocation Balance and applied to new defense aid needs. Use of surplus Army stocks was permitted, and provision was made to reimburse War Department funds. In addition, the Medical Department was authorized to include lend-lease requirements in its budget estimates, thus permitting the economic and efficient lumping and scheduling of procurement.

As the year 1942 progressed, the Medical Department was presented with spot requisitions involving large quantities of urgently needed supplies, but it was receiving few long-range programs from foreign governments on which to plan and procure against future needs. In the meantime, the Burma Road had fallen, and transport into the interior of China was at a virtual standstill. As a result, supplies procured for the Chinese account were "backing up"

8In 1942, the International Supply Committee superseded the Defense Aid Requirements committees.


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in the defense aid depot to such an extent that warehousing by individual requisitions became physically impossible. At this point, authority was obtained to adopt more feasible methods of procedure.

In August 1942, the International Division, SGO, successor to the Defense Aid Sub-Division, recommended to the International Division, ASF, a new procedure for lend-lease medical operations. The Medical Department desired authority to establish a large stockpile of miscellaneous medical supplies, upon which it could draw in filling the spot requisitions of foreign governments. The proposal was approved in September 1942, and the procurement of approximately $60 million worth of medical supplies was promptly initiated. In compiling a list of materials for this stockpile, Medical Department officers were guided by requisitions previously received from foreign governments and by qualified technical opinion as to what would be required in the future.9 In addition to new procurement, all materials previously procured against individual requisitions, but not yet shipped, were consolidated and placed in the unobligated stockpile, withdrawals from which were effected only by assignments receiving the approval of the Munitions Assignment Committee (Ground). This new procedure produced an important change in procurement procedure. In the future, it became possible to accumulate requisitions and to negotiate bulk contracts for the total quantities of all items needed. The new stockpile, moreover, introduced a large measure of flexibility into all Medical Department supply operations, for numerous urgent and unforeseen needs of U.S. troops were met by drawing upon this accumulation of supplies.

MILITARY AND CIVILIAN LEND-LEASE REQUIREMENTS

As early as the fall of 1942, efforts were made to distinguish between civilian and military lend-lease requirements. From the inception of the program, all requests for medical supplies had been accepted for action by the War Department and treated as military requirements, without regard to the eventual military or civilian use. This permitted the application of military priority ratings to the procurement of materials for civilian use abroad, while civilian needs in the United States received a much lower priority. After lengthy discussions between the War Department and OLLA, the latter issued an order directing that, after 1 January 1943, the two types of requirements be distinguished and treated separately. To implement this directive, the International Division, SGO, supplied figures on all unfilled requirements for medical supplies (except British requirements) and also reported stocks on hand and quantities due in from outstanding contracts.

9One of the supply officers later declared that the list was based on "sheer guess as to what was likely to be called for in the future." Such uninhibited frankness in official reports is rare enough to merit serious and thoughtful consideration. In the present instance, however, it appears that an excess of candor has performed a disservice to truth. Possessing more than a year's experience in supplying the needs of foreign governments, defense aid officers could base their estimates on something far more substantial than guesses. See memorandum, Lt. Col. F. C. Little, MAC, Director, International Division, to Administrative Assistant to the Chief, Supply Service, 28 July 1945, subject: Request for Specific Instances of Surplus.


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In the meantime, the foreign governments filed all new requirements for calendar year 1943 with OLLA, through the International Division, ASF, and all requirements thus filed were separated into civilian and military categories. OLLA considered as 100 percent military all unfilled 1942 requirements and the 1943 requirements for Russia, China, Latin American nations, and the British forces in the field. Other British programs, as submitted by various parts of the Empire, were divided on a percentage basis. All other requirements were classified as 100 percent civilian. Stocks on hand and quantities due in from procurement were to be applied first against military requirements, with the residues to be used to satisfy civilian requirements. This comprehensive statement of requirements and assets, known as the "OLLA Control Books," was finally presented to the International Division, SGO, in March 1943. A detailed review of these books revealed some 1943 programs had not been carefully screened and that quantities obviously designed for civilian use were included as military requirements. In addition, procurement authorizations, so frequently departed from programed requirements, were forwarded at such sporadic intervals and were amended so often that, by summer 1943, not more than 25 percent of that year's requirements for medical supplies had been placed under contract. Had it not been for the stockpile authorized during the previous year, only a thin trickle of lend-lease medical supplies could have been shipped during 1943.

This unsatisfactory state of affairs provoked renewed discussions between the War Department and OLLA, and culminated in a new agreement, defining in detail the functions and responsibilities of the various lend-lease agencies.10 In effect, OLLA was eliminated from the processing of military requirements. Its responsibility was confined to presenting civilian requirements and ordering shipment of the supplies as they became available. The International Division, SGO, was to procure military requirements and maintain any records needed to exercise this control. This change produced a distinct improvement, but important difficulties still remained. OLLA continued to issue procurement authorizations sporadically and, in some instances, for only a small part of the total civilian requirements for which approved programs had been received. The Inventory Control Branch had to deduct lend-lease civilian requirements which came up in a "buy position" under the automatic stock control procedures in effect. This cumbersome extra step was eliminated in November 1943, when the Surgeon General's Office received from the International Division, ASF, a "blanket" procurement authorization applicable to all programed civilian requirements not previously authorized for procurement.11

In the meantime, the OLLA Control Books had become obsolete, and a strong need was felt for a reliable and current record of total lend-lease re-

10Procedure for Handling Lend-Lease Medical Supplies, 11 Aug. 1943. [Official record.]
11Memorandum, Col. George Olmsted, GSC, Chief, Requirements and Assignment Branch, International Division, to Office of The Surgeon General (attention: Lt. Col. [Charles] Garside), OTSG, 23 Nov. 1943, subject: Lend-Lease Civilian Requirements for 1943 and 1944.


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quirements. Accordingly, all known requirements, including spot requisitions and yearly programs, were submitted to the Machine Records Branch, SGO, for tabulation. The result was a consolidated listing by item, divided into 1943 and 1944 requirements, subdivided into military and civilian accounts, and coded to indicate the unfilled requirements for each item by each foreign government. This listing was then subjected to a comprehensive and detailed review by OLLA, by the International Division, ASF, and by the British Ministry of Supply Mission to eliminate any unjustified requirements. By fall 1943, the electric accounting machine listing had been thoroughly screened; and, with subsequent additions, it provided a reliable guide to lend-lease requirements during the remainder of the war.

REORGANIZATION AND REALINEMENT OF RESPONSIBILITIES

During 1943, a general reorganization of the Supply Service, SGO, eliminated duplication of functions pertaining to lend-lease and realined the International Division in its relationship with other divisions and branches.

Procedure relating to lend-lease procurement was developed in May 1943. Foreign government spot requisitions were received, analyzed, and processed by the Coordination and Analysis Branch, with assistance of the Distribution and Procurement Divisions. Availability of critical raw material and the effect on the Army Supply Program were determined by the Production Scheduling Branch of the Materiel Office, ASF. After coordination with the Distribution Division regarding the availability of surplus stock, purchase requisitions were prepared by the Procurement Division, and issue requisitions were prepared by the Distribution Division.

Electric accounting machines installed in the medical lend-lease depot eliminated the necessity for sending copies of receiving reports from the lend-lease depot to the International Division for maintaining stock records.

As the procurement districts assumed responsibility for compiling statistics for the monthly progress reports, the International Division was able to eliminate processing of procurement authorizations to the Machine Records Section as well as copies of contracts.

Responsibility for preparation of fiscal reports (DDA Forms) was transferred to the Fiscal Division, and preparation of notices of availability pertaining to shipping instructions and maintaining liaison with foreign government shipping agencies were decentralized to the lend-lease depot.12

By fall 1943, the Supply Service had formulated and adopted a new system of inventory control which was extended to apply to all lend-lease requirements. Under this routine, total lend-lease requirements for a 6-month period were reflected in the monthly Delivery Needs report. Where indicated, the

12Supply Service Memorandum No. 30, 18 May 1943, subject: Procedure Relating to Lend-Lease Procurement.


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Inventory Control Branch initiated interdepot transfers into segregated military and civilian stock accounts in the lend-lease medical depot. Also, new procurement was initiated in the event of an overall stock shortage against total requirements.

Efficient operation of this system apparently was incompatible with OLLA's practice of issuing procurement authorizations sporadically and in some instances, for only partial quantities of total programed requirements. For a time, therefore, the Inventory Control Branch had to make special provision for the deduction of any lend-lease civilian requirements which came up in a "buy" position under the otherwise automatic procedures in effect. Since lend-lease civilian requirements involved the entire range of items procured by the Medical Department, this cumbersome extra step imposed a real burden on the International Division and on the procurement offices because special procurement authorization had to be initiated for the nonstandard civilian requirements.

The situation was corrected in part in December 1943, with a "blanket" procurement authorization applicable to all programed civilian requirements not previously authorized for procurement. This blanket authorization was issued by the International Division, ASF,13 upon authorization in turn from FEA (Foreign Economic Administration), which superseded OLLA in September 1943.

Two problems in civilian lend-lease procurement still remained to be corrected. The first of these involved the fact that numerous civilian requirements for items previously allocated under the bid system, and items in short supply, had been authorized for procurement under the blanket authorization which, as it developed, had never been cleared through the War Production Board. Thus, the Army Medical Purchasing Office often was unable to place contracts for full quantities of certain items programed by FEA and, more seriously, in some instances was criticized and held accountable by the War Production Board for exceeding War Department allocations. No satisfactory solution to this problem was ever reached through discussion or agreement with FEA.

The second problem remaining to be corrected involved accountability for materials procured and delivered against requirements presented, but subsequently canceled, by FEA. This occurred frequently and introduced surpluses. Therefore, the "Procedure for Handling Lend-Lease Medical Supplies," dated 11 August 1943, was amended on 29 March 1944. Following this amendment, an allotment of FEA funds to the War Department for $68.5 million was effected to cover the entire civilian lend-lease program. Funds were made available to The Surgeon General for reimbursement on shipments made for the FEA account. Such other expenses or losses as might be incurred in the handling of procurement, storage, and issue on their behalf, including overshipments, were adjusted periodically against the allotment.

13See footnote 11, p. 161.


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These many changes and developments gradually formed an operating procedure, within the framework of which the obligations of medical lend-lease could be discharged. By spring 1944, this procedure had been so developed that only minor changes were made during the remainder of the war.

The first important duty of the Analysis Branch of the International Division, SGO, was the identification of items requested, the insertion of proper nomenclature and stock number, and the recommendation of substitutes. After this preliminary "screening," the lists were returned to the foreign governments, which then submitted them to the International Division, ASF, as formal programs. Draft requisitions were returned directly to the International Division, ASF, for submission as formal requisitions.

Formal programs and requisitions were screened against "excesses chargeable to Lend-Lease governments" and, if appropriate excesses were not found, were submitted to the Inventory Control Branch, SGO, to determine which items would require new procurement. Items requiring procurement were submitted to the Production Division, ASF, to ascertain the availability of the quantities requested and to provide for allocation if necessary. After total costs were computed and the quantities of controlled materials estimated, the programs and requisitions were returned to the International Division, ASF, with recommendations as to the procurability and suitability of the items requested. When approved by the International Division, ASF, the quantities were added to the Army Supply Program and thus were authorized for purchase.

The final important duty of the Analysis Branch was the maintenance of the International Requirements Record. Compiled monthly by the Machine Records Branch, this record provided current information on gross requirements approved within the calendar year, by item and country, together with cumulative assignments made against these requirements. In addition, it showed a net balance due and the stocks on hand in the lend-lease military and lend-lease civilian accounts. It furnished currently adjusted lend-lease requirements to the Stock Control Division for inclusion in the Consolidated Stock Report and the Army Supply Program; and it afforded a simplified means for recording requested reductions in requirements.

The first duty of the Assignments Branch was registry of requisitions and programs to identify them in the process of assignment and shipment. An SGO shipping order number was given to each new requisition or program, and the number thus given became the permanent file reference for the requirement.

This branch also determined and presented bids for available stock before the medical subcommittee of the Munitions Assignment Committee (Ground). A monthly military International Requirements Record was compiled, which showed the bids of each beneficiary government. At the subcommittee meeting, these bids were routinely approved when stock was available to satisfy all claimants; but, when the supplies were inadequate to meet all unfilled require-


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ments, the subcommittee allocated the available stock on the basis of urgency of need. A copy of the International Requirements Record was transmitted to the Munitions Assignment Committee (Ground), which authorized the transfer of the supplies to the foreign governments.

The Assignments Branch then prepared the necessary shipping orders, posted them to sequence records for permanent cross-reference, and transmitted them to the appropriate depots for action. At every stage of the shipping process, the Assignments Branch received information on the shipments and maintained comprehensive records on them. It was possible, therefore, to respond to inquiries from beneficiary governments without frequent reference to depots and ports.

The foregoing procedure was confined to military lend-lease shipments. The Medical Department had ceased to have any responsibility for civilian lend-lease, except to act as a purchasing agent for FEA. Early in 1944, it became apparent that even this limited responsibility was interfering with duties which were more closely related to the winning of the war. The Foreign Economic Administration had presented to the Medical Department a program involving the purchase of $66 million worth of medical supplies, which were pouring into the depots from contractors' plants with little likelihood that the bulk of it would move out before the end of the war. There was, moreover, reason to believe that relief requirements would grow with the passage of time, that they would continue beyond the war period and would burden the Military Establishment while it was undergoing demobilization. The War Department proposed, therefore, that all responsibility for the procurement, storage, and issue of medical supplies programed by FEA be transferred from The Surgeon General to appropriate civilian agencies not later than 31 December 1944. The general terms of this proposal were promptly accepted by FEA, with reservations as to the time limit, and representatives were named by the agencies involved to formulate plans for the transfer.14 Protracted delays by FEA then ensued, which were finally ended in the fall of 1944. At that time, the War Department forced the issue by announcing that additional civilian requirements necessitating new procurement would not be accepted, and proposing to release one of its medical depots to FEA.

Negotiations were begun promptly, and basic agreements were soon reached. Commencing on 15 October 1944, the shipment of all medical supplies programed by FEA for civilian rehabilitation would be called forward through the Procurement Division, U.S. Treasury Department. Shipments to actual participants in the civilian lend-lease program would be handled, as in the past, on FEA shipping orders. New civilian requirements of any type would be referred to the Treasury Department for procurement although the War Department would screen the requirements and would accept any portion

14(1) Letter, Maj. Gen. Lucius D. Clay, GSC, Director of Materiel, ASF, to the Hon. Leo [T.] Crowley, Foreign Economic Administration, 11 Mar. 1944. (2) Letter, Mr. Leo T. Crowley, Administrator, Foreign Economic Administration, to Maj. Gen. Lucius D. Clay, 23 Mar. 1944.


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that could be filled from excess stocks. The Medical Department would release a suitable depot, complete with equipment and civilian operating personnel, to the Treasury Department as operating agent for FEA.

PROBLEMS OF LEND-LEASE ADMINISTRATION

After extensive negotiations, the Toledo Medical Depot, Toledo, Ohio, was declared surplus and was transferred to the Treasury Department, effective on 1 May 1945.15 During the interim from November 1944 to May 1945, the Medical Department continued to operate the depot, but Treasury Department representatives were assigned to participate in its administration, pending the actual transfer of accountability and title. An extensive assembly program for civilian rehabilitation was continued at Toledo until the end of December 1944. Since the depot was to be transferred to the Treasury Department in May 1945, it became necessary to clear Medical Department stocks from the warehouse areas and to replace them with FEA stocks then in the Louisville Medical Depot. This transfer was first estimated to involve the movement of 1,200 to 1,500 carloads, but a "paper transfer" of stocks greatly reduced the size of the contemplated movement. FEA supplies at Louisville were credited to the Army or military lend-lease accounts while Medical Department supplies at Toledo were transferred to Treasury Department accountability. After these paper transfers were made, the movement of only 800 carloads of supplies completed the transfer and relieved the Medical Department of all responsibility for civilian lend-lease just a few days before the end of hostilities in Europe.16

The administration of lend-lease was a "war baby" without antecedents and, so far as anyone could tell, without hope of posterity. It was born and grew to maturity within the short space of 4 years. For the expansion of the Army and the waging of a war beyond the seas, precedent and experience offered some guide. But lend-lease was without precedent. It was constructed by inexperienced hands to meet pressing and changing needs. The result was an almost continuous establishment, revision, rescission, and reestablishment of offices and policies, in and out of the War Department, which appeared frivolously inconsistent to those at the lower operating levels.

Excessive Foreign Requirements

There is reason to believe that some countries looked upon medical lend-lease as a grab-bag filled with gifts for the needy. In the early days before any distinction between military and civilian requirements was recognized, all lend-lease materials were procured under a military priority. This created in beneficiary governments a strong temptation to fill civilian needs which were un-

15Army Service Forces Circular No. 164, section VI, Installation, 8 May 1945.
16It should be noted, however, that a large quantity of supplies was held at Louisville to maintain an uninterrupted flow of civilian lend-lease shipments. FEA had given assurances that these supplies would be "called forward" before 31 December 1944, but as late as September 1945, approximately 500 tons still remained in the FEA stock account at Louisville.


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FIGURE 34.-Planes at Gali Morgheh Airport, Tehran, Iran, used for air shipment of supplies and equipment from the United States to Russia, 11 April 1944.

connected with military operations. Even after the division of military and civilian requirements, occasional abuses occurred which left the impression that the United States was looked upon as a lush source of material wealth. For example, the U.S.S.R. continued throughout the war to enjoy a 100 percent military classification on all her requirements, receiving tremendous quantities of many items which were designed primarily for civilian use (fig. 34). Objections by the International Division were promptly overridden by higher authority. During 1943, Australia was allowed to classify her artificial teeth requirements as 100 percent military. She asked for, and received, a quantity in excess of total U.S. Army issues for that year. When it is considered that the total population of Australia was somewhat smaller than the U.S. Army, it is probable that the 1943 shipments amply supplied the Australian forces with artificial teeth. However, that country promptly submitted another requisition for the following year's needs, which were estimated at 75 percent of the quantity received in 1943. The second requisition was disapproved on the recommendation of the International Division, SGO.17 The British had a 100 percent military classification for all requirements of X-ray equipment until late in 1944 on the strength of the argument that their distribution system did not permit segregation for military and civilian use. Since much of this equipment was of an elaborate type not essential for military use, the International Division interposed vigorous objections and was finally able, in July 1944, to distinguish civilian from military requirements. At this time, the American X-ray industry had on its books domestic civilian orders 16 months

17Memorandum, Lt. Col. Charles Garside, Director, International Division, OTSG, to Director, International Division, ASF (attention: Col. George Olmsted, GSC), 8 Dec. 1943, subject: "Adjustments" in UK Programs.


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old and commercial export orders antedating Pearl Harbor, while British civilians were enjoying an AA-1 military priority for their X-ray needs.

In seeking to obtain lend-lease medical supplies in excess of military requirements, the Republic of Ecuador proved that small nations can nourish large hopes. That country presented a 1943 military program requiring medical supplies and equipment for 50 infantry and 20 cavalry divisions. This ambitious program was disapproved, and plans were made to provide a quantity of medical supplies more directly related to the size of Ecuador's Army-five divisions.18

Differences in Terminology

Another major problem in early lend-lease operations resulted from wide variations in medical practices, customs, and terminology throughout the world. The identification of some items required by the beneficiary governments was extremely difficult because of language barriers, inadequate specifications, and inability of representatives of foreign governments to discuss and agree upon technical interpretations of stated requirements. This was especially troublesome in screening Russian requirements; the Soviet Mission usually insisted upon materials being furnished exactly as requested although the technical description of the desired item was meaningless to American officers and the Russian officials were unable to furnish clarification (fig. 35). When additional information was received which suggested the advisability of substitutes, the Soviet Mission was reluctant to approve the changes. During the last 18 months of lend-lease operations, several competent Russian physicians were assigned to the Soviet Mission. This change produced a distinct improvement although relations were far from perfect at the war's end.

After the items were identified, other difficulties which were related to the variety of medical practices, developed. There were requirements for large quantities of medicines and equipment which were difficult to procure, either because such supplies were obsolete in the United States or because they had never been produced and used in great volume. Very little calomel was used by American troops, but tremendous quantities were procured and shipped to foreign governments. Although widely used in the United States, insulin was employed in far greater quantities abroad. In X-ray equipment, the same problem was encountered. On one occasion, the Russian Government requested 3,000 X-ray tubes of a type which had not been manufactured in the United States for 25 years. Since it was obviously impractical to tool up a factory to

18Memorandum, Lt. Col. Charles Garside, Director, International Division, OTSG, to Director, International Division ASF, ASP (attention: Col. George Olmsted, GSC), 30 Sept. 1943, subject: Ecuador 1943 Military Program. In discussing the abuses of medical lend-lease, the author has been aware that the maintenance of civilian health and well-being is related to military operations and that it is sometimes difficult to distinguish between military and civilian use. But even after the fullest allowances are made, it is apparent that large quantities of lend-lease medical supplies were diverted to uses which were only faintly connected with military operations.


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FIGURE 35.-U.S. ship lined up at Khorramshahr docks in the Persian Gulf Command ready to discharge supplies and equipment. Although such convoys carried supplies for U.S. forces in the command, the bulk of cargo was lend-lease material for Russia.

produce these obsolete tubes, a new type was shipped which, it was thought, could be used in the Russian machines.19

In the Medical Department supply catalog, approximately 7,000 standard items were listed, but even this collection of medical supplies and equipment was inadequate to cover the needs of lend-lease governments. It became necessary to compile an "International Aid Non-standard Catalog," consisting of items employed for medical purposes but not standard with, and not used by, the Medical Department.

The whole problem was pointedly summarized by Lt. Col. Francis C. Tyng, MC, in October 1942. "After all," he wrote to Brig. Gen. Paul R. Hawley, "the United States is the last remaining bastion of medical supply and it must supply all the Allies in the world, but it cannot continue to fill the unconscionable demands of the Allies and at the same time leave anything for

19Address, Brig. Gen. Edward Reynolds to Medical Department officers assembled at Walter Reed General Hospital, 19 Sept. 1945, subject: Medical Supply Problems of World War II. [Official record.]


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our own armed forces, to say nothing of our civilians. You can easily see that we are heading into a catastrophic situation."20

OTHER RELIEF ACTIVITIES

In addition to the administration of lend-lease medical supply activities, the International Aid Division also handled medical supply activities for the Russian War Relief Society and for the American Red Cross. In August 1944, the latter function was transferred to the Liaison Branch, Purchases Division.

Activities on behalf of Russian War Relief and the American Red Cross involved accounting of special funds provided for the purpose, with the consequent necessity of maintaining the identity of separate requisitions throughout the stages of procurement, storage, and issue. Medical supplies in the common lend-lease stockpile were not authorized to fill these two agencies' requirements. Use of Army stocks excess to current requirements, however, was provided; specifically, requisitions in these categories were forwarded through the Liaison Branch to the Stock Control Division for stock transfers or procurement as necessary. Reimbursement from funds allocated to the War Department (for Red Cross shipments) or from funds on special deposit with the War Department Finance Officer (for Russian War Relief shipments) was obtained by the Fiscal Division, SGO, on the basis of actual shipping documents.

20Letter, Lt. Col. F. C. Tyng, MC, to Brig. Gen. Paul R. Hawley, 18 Oct. 1942.

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