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ACCESS TO CARE
MEDICAL SUPPLY IN THE WAR AGAINSTTHE EUROPEAN AXIS
Outposts and Supply Routes
By the time the United States entered World War II, specific theaters of operations, commands, and lines of communication already had been established in the interest of national defense, and to implement the program of aid to Britain (map 1). From the point of view of medical supply, these commands came at an inopportune time because their activation, coinciding as it did with the mushrooming of military installations in the United States, widened the gap between availability and requirements for both personnel and materiel.
NORTH ATLANTIC BASES
In September 1940, the United States obtained base sites at several British possessions in the Atlantic (map 2) and Caribbean areas. Although the Lend-Lease Act was not signed until 27 March 1941, U.S. troops began occupying these bases in January of that year.1 Medical service for the arriving troops was initially under the supervision of the Corps of Engineers, who was also responsible for the health of civilian construction workers. Preliminary surveys to determine medical needs were made under the direction of Col. (later Brig. Gen.) Leon A. Fox, MC.
Newfoundland Base Command
The station hospital, Newfoundland Base Command, was activated on 15 January 1941, aboard U.S. Army Transport Edmund B. Alexander. Before sailing from the Brooklyn Port of Embarkation, medical supplies were carefully examined, segregated from nonmedical supplies, and made readily accessible for use upon arrival in Newfoundland.2 Shortly after arrival of the transport at the port of St. John's on 29 January 1941, it was discovered that no cassettes for chest X-rays were available. This situation was quickly remedied by the loan of two such cassettes from health authorities of St. John's.
When the USAT Edmund B. Alexander, which had been serving as the station hospital, Newfoundland Base Command, was ordered back to its base in Brooklyn, N.Y., it became necessary to find temporary accommodations un-
til a permanent hospital could be erected. Accordingly, a large country estate, Northbank, was rented and remodeled to serve as a temporary hospital.
The assembly for a 50-bed hospital, which had arrived before the move to Northbank, remained stacked high on the pier at St. John's because of lack of storage space. Some remodeling of the estate was accomplished by construction of a temporary 25-bed ward, and by 5 June 1941, the station hospital, Newfoundland Base Command, had completed its move into the Northbank estate. Supplies were stored in outhouses and other temporary storage spaces. The hospital moved in December to newly completed barracks at Fort Pepperrell, where it remained until its own building was ready in June 1943. It had been redesignated the 308th Station Hospital in April of that year.
The medical supply unit of the 308th Station Hospital was established as the medical supply depot for the entire Newfoundland Base Command, and eventually supplied four hospitals totaling 450 beds. This supply operation con-
tinued in a dual capacity until 12 August 1942, when it was separated from the hospital and designated the Medical Supply Office, Newfoundland Base Command. This office, which had the function of coordinating the medical supply activities for the entire base command as well as furnishing medical supplies for the station hospital at Fort Pepperrell, was organized into an administrative section, a receiving section, and an issue and shipping section. The inadequate storage facilities at Northbank were replaced in December 1942 with better facilities located at Fort Pepperrell (fig. 36) in the basement of the detachment barracks in the new hospital, and in a permanent warehouse.
Although medical supplies were adequate for most of the Newfoundland Base Command, the system of automatic supply in some instances produced more or less than enough. For example, the surgeon of the station hospital, Newfoundland Air Base (Gander Field), reported overstocking of drug items. On the other hand, shortages soon developed in such vital supplies as utensil sterilizers, water sterilizers, distillation apparatus, and field X-ray equipment, none of which were on automatic supply.3
Because it was originally planned to use Eskimo dogs in tactical training in Newfoundland, great quantities of veterinary supplies and equipment were received and suddenly became surplus when the project was abandoned. The excess supplies were eventually returned to the Zone of Interior when it was realized that they would not be used and were occupying needed storage space.
Base medical supply levels were set at 75 days maximum, plus order and shipping time of 75 days, and levels for each of the other three posts within
the command were 40 days maximum, plus the 75 days' shipping time. Most excesses which had accumulated in the command were occasioned by automatic supply of medical maintenance units, which system was not displaced by requisitioning until 1 December 1943. The ill effects of automatic supply were compounded by the fact that medical maintenance units were designed for combat operations and contained quantities of items that far exceeded the needs of the command. Excesses were periodically reported and consolidated for return to the Zone of Interior.
Initially, all medical supplies were received and distributed by the base medical supply depot, but this was changed later when all requisitions were filled to the extent of available stocks by the depot, and remaining items were extracted to the Boston Port of Embarkation for direct shipment to requisitioning units. The command considered this the most practical method of supply as it eliminated double handling and overstocking. Obversely, the War Department viewed the method as fostering overstockage, particularly at outlying stations, and precluding central control. The command was directed to revise its goals. The new system, inaugurated on 1 January 1945, resulted in requisitions to the port sufficing for stockage of the base depot and for issue to using units.
The command resisted the change to a centralized requisitioning system because it had been able to curtail its medical supply activity to a greater degree than the reduced command strength indicated, dropping from 13 civilian employees in January 1944 to 0 by December of that year when the base depot was inactivated. Moreover, the military personnel assigned to supply had been released, and a substantial portion of the medical warehouse space had been closed out. With the inauguration of central requisitioning, it was necessary to revise the curtailment of supply operations despite the progress that had been made in reduction of forces.
Bermuda Base Command
Contrasted to the bleakness and cold climate of the Newfoundland Base Command, the Bermuda Base Command, located in a more temperate area, also served as a link in overseas communication and as a defensive post for the hemisphere. Established in April 1941, the Bermuda Base Command experienced problems of supply because of its crowded facilities. Medical supplies were stored in two rooms on the ground floor of the 221st Station Hospital, which occupied the Castle Harbour Hotel.4
In May 1943, the hospital was transferred to a partially completed building at Fort Bell (fig. 37), and supply facilities, similar to those in the previous location, were established.
During 1944, 24 long tons of excess medical supplies were returned to the States. Air-conditioning units were installed in operating rooms, X-ray rooms, and in one recovery room.
The common complaint of the Bermuda Base Command concerning medical supply was that intervals between freight transports prevented prompt filling of their requisitions made to the New York Port of Embarkation. However, as with the other bases and stations servicing the various air routes of communication, emergency medical requirements, supplies, and patients were air delivered to their destination rapidly.
Eastern and Central Canada
Bases located in eastern and central Canada were important links in the North Atlantic Ferry Route. Traffic over this route reached a peak in 1944, when 8,641 aircraft were ferried to Europe.5 Medical facilities in eastern and central Canada ranged from dispensaries at tiny weather stations, such as
Southampton Island, Padloping Island, and River Clyde, to station hospitals at the key ferrying points of The Pas, Fort Churchill, Frobisher Bay, and Goose Bay.
Because of the extreme isolation of most posts in eastern Canada, supplies were shipped by water during the few summer weeks that the shipping lanes were open, or by air in an emergency. Ships sailing from the Boston Port of Embarkation to Goose Bay, Frobisher Bay, and other points carried a 360-day level of expendable supplies as well as a 450-day level for maintenance items found in the 30-day unit for 10,000 men.6 In central Canada, distribution of medical supplies to the isolated weather stations during the summer months was necessary because of the extremely bad weather during the rest of the year. Items contained in these shipments were limited to first aid and emergency treatment essentials and certain drugs needed to treat common ailments.7
The most serious supply problem encountered in eastern and central Canada was that of dealing with surpluses. By March 1944, the 4th Station Hospital at Churchill and the 131st Station Hospital at The Pas were transferred from the theater and replaced by dispensaries. Thus, a surplus of supplies existed for some time.8
During 1945, the anticipated inactivation of the U.S. forces in central Canada caused a flurry of inventorying and adjustment as well as reorganization. The supply policies, despite this hindrance, worked particularly well on Southampton Island, where the post surgeon performed a successful emergency appendectomy only 15 days before the arrival of the ship which was to evacuate supplies and equipment.9
Greenland Base Command
Following an agreement with the recognized Danish Minister in Washington, D.C., U.S. troops landed at the head of Tunugdliarfik Fjord in southern Greenland on 6 July 1941. Included in the first contingent of troops were 2 medical officers and 14 enlisted men of the Medical Department.10
The first medical facility, located at Bluie West No. 1, was a first aid tent. In the interval between the arrival of this group and the completion of the original hospital building in October 1941, the 10-bed, field-type hospital moved from place to place. Upon completion of the building, facilities rose to 20 beds.
The second Greenland post, known as Bluie West No. 8, was established at the head of Sřndre Strřm Fjord about 15 miles north of the Arctic Circle
(maps 1 and 2). Dispensaries were set up under tentage and, by summer 1942, had grown into overcrowded, improvised hospitals. In September, the War Department authorized activation of four numbered station hospitals and construction was begun. Equipment arrived more quickly than the building materials. By the end of 1942, approximately 85 percent of the needed supplies were on hand, but the buildings were not completed for another year.
Medical supplies for the Greenland Base Command came by way of the Boston Port of Embarkation. The supply officer of the 188th Station Hospital (fig. 38) acted informally as the base medical supply officer, supplying outlying posts, absorbing excess stocks, and redistributing stocks as needed at other installations. Equipment and supplies were generally adequate. The automatic shipment of medical maintenance units actually resulted in a surplus of many items, but little or no corrective action was taken by medical supply officers, who lacked time to handle this particular problem. These surpluses had accumulated from the original 6-month supply and resupply items, which had been shipped to each hospital. Not until after discontinuance of automatic shipment in December 1943 did Medical Administrative Corps officers, available only since May 1943, set up the stock records and systematic procedures that enabled the command to institute a monthly requisitioning system and to dispose of excesses.
Few medical supply difficulties were reported during the war despite hardships of the climate and the long winter nights. There was some indication, in fact, that the Surgeon General's Office became overzealous in catering to the needs of this isolated command. It was reported in mid-1943 that 50 to 75 packages per month were being received by airmail parcel post, while freight shipment would have sufficed for the majority.
As a result of excessive requisitioning, and a change in the table of organization of the hospital, a total of 314,600 pounds of surplus medical supplies was returned to the United States in 1944.
Iceland Base Command
In the middle of September 1941, the first contingent of Army troops arrived in Iceland (figs. 39 and 40), reinforcing a Marine task force that had itself reinforced a British garrison in July. Medical supplies, initially, were handled by 2 officers and 25 enlisted men, who set up a depot in two warehouses in Reykjavík. Adequate space (8,000 square feet) was available, but the lack of elevators and the distance from the docks made normal depot operations difficult. Although 6 officers and 75 enlisted men were authorized for supply duty, that number was never reached.
By the end of 1942, the supply system was being effectively operated by 4 officers and 50 enlisted men.11
Besides the main supply depot in Reykjavík (map 2), some supplies were located in an original package storage depot at Yeomanry Camp and in a subdepot at Camp Ontario in the Alafoss subsector. The latter consisted of three 20- by 48-ft. huts, with a total floor space of 2,880 square feet; the package storage warehouse had a floor space of 4,000 square feet. The medical supply was separated into main depot and subdepots to facilitate dispersal of supplies more easily and conveniently.
All medical units maintained a minimum of 90 days' level of supplies, and certain isolated units maintained a level of 120 to 180 days. From the beginning, replacement supplies were acquired by automatic supply of medical maintenance units supplemented by command requisitions. Controlled items were supplied automatically against the command's monthly material reports to the Zone of Interior. By early April 1943, the automatic supply medical maintenance units led to an unbalanced stock position. Supplies such
as quinine and mosquito bars particularly were received in excess, and were returned to the Boston Supply Depot.
The Iceland Base Command reached a peak strength of more than 40,000 troops in May 1943, but the threat to the Western Hemisphere that had led to the occupation had already passed. Troop strength was cut back by 25 percent in August and continued to decline thereafter, with corresponding decreases in the number of hospital beds. The medical supply system was also reorganized, passing to a base depot section of the 20th Medical Depot Com-
pany in August 1943, and in December of the same year, the 300th Medical Composite Platoon.
Medical supply levels did not fall as rapidly as troop strength, in spite of the shipment of almost 2.5 million pounds of surplus items to the United Kingdom during 1943. Further reductions the following year were necessary to achieve the 30 days' operating and 30 days' maintenance supply levels. By the middle of 1944, depots and issue points remained only in Reykjavík and at Keflavik, adjacent to Meeks Field, principal Iceland base of ATC (Air Transport Command).
CARIBBEAN DEFENSE COMMAND
In early December 1941, a total of 66,000 U.S. troops were deployed in the Caribbean area to protect the vital lines of communication from a German submarine threat, and to repel any possible Japanese attempt to attack the Panama Canal. Expansion was rapid during 1942, when the Panama Canal Department alone had more than 68,000 troops. The Puerto Rican and Panama Canal Departments were the major elements for supply until May 1943, when the Antilles Department was formed. The latter's aggregate strength at that time was approximately 55,000, but strength in the Panama Canal Department was then declining.12
Organization for Medical Supply
The medical supply functions of the Caribbean Defense Command (map 3) were carried out primarily at departmental level until May 1943. One reason for this was the need for relatively independent sources of medical supply for each, in view of the possible isolation that might attend sea surface and submarine warfare against shipping. Another factor was implicit in the expansion of the Caribbean Defense Command, which assumed an active role neither department had been equipped in the prewar years to carry out.
It is noteworthy that the problems of medical supply were comparatively greater in the Antilles Department than in the Panama Canal Department. Among others, two primary factors conditioned the difference: first, the Panama Canal Department was much better established in 1939, and second, the extreme dispersion within the Antilles Department was a definite handicap.
Panama Canal Department
In late 1940, the medical supply depot for the Panama Canal Department consisted of 19,000 square feet of storage space at Fort William D. Davis. This space had been adequate for prewar years, but the possibility of the disruption of transportation by air attacks on the Canal Zone necessitated larger facilities. Freight movement within the Panama Canal Zone was best handled
by a single-track railroad or by ship via the canal. Both routes were considered attractive targets. Because of this potential danger, it was decided to disperse stocks for safety and to provide sources of medical supply on both the Pacific and Atlantic sides of the Canal Zone.13
Early in 1942, although there was an acute shortage of nearly all classes of medical supplies, the establishment of the automatic issue of supplies worked out especially well. A few items were found to be in excess, and some were issued in amounts slightly below requirements, but adjustments were made with the medical supply officer at the New Orleans Port of Embarkation.14
On 1 April 1943, a new medical supply warehouse, measuring 40,000 square feet, was completed at Corozal. Thus, two medical supply sections-the Atlantic and Pacific-were functioning simultaneously until 1944, when stock control was transferred from the Atlantic Branch Medical Depot, and the Corozal General Depot became the dominant installation. The Fort Davis Depot simply became a medical warehouse section of the Corozal General Depot.
The outstanding accomplishment of medical supply activities for 1944 was the establishment of rigid stock control procedure, effective on 1 July 1944; all station medical supply functions were placed on a formal accountability basis. After a complete inventory was taken, new stock record cards were initiated, and a requisitioning objective of 165 days was established for the entire department, with a 46-day level set up for the stations. All excesses were returned to the medical sections of the general depots, and all items not required for depot stocks were returned to the Zone of Interior. A total of 124,480 cubic feet of excess material was returned during the period 1 January-11 December 1944. The established stock levels worked ideally and distribution was without interruption.
Well-trained X-ray and dental repair technicians in the department rendered invaluable assistance in the repair of appliances and equipment even though spare parts were not always available.
The most serious problem in Panama was the deterioration of equipment. The struggle against termites, rust, chemical decomposition, and corrosion was continuous because of the high humidity of the area. X-ray films were received improperly packed and, as a result, cloudiness developed on the film. This condition was corrected by the development and use of a "tropical pack film." Metal instruments had to be specially processed, and certain biologicals had to be refrigerated under controlled conditions. Items that were particularly susceptible to the effects of humidity were stored in a "dryroom" constructed for the purpose at the Corozal depot.
Preplanning in the closing days of World War II produced two outstanding accomplishments: 24-hour-a-day emergency supply service to redeployment
troops passing through the canal, en route to Pacific theaters; and complete and prompt delivery of all such emergency requisitions to the ship by medical section transportation and personnel through use of advanced requisitions on the States.
The closing of the Atlantic Branch Medical Depot at Fort William D. Davis on 5 September 1945 caused the transfer of the supplies and equipment to the Corozal General Depot. This move released 40,800 square feet of warehouse space located in two buildings. Equipment and certain personnel were released as well. During 1945, 13,286 cubic feet of excess supplies were returned to the Zone of Interior, and 1,819 cubic feet were disposed of through lend-lease.
The medical section of the Puerto Rican General Depot was activated on 1 September 1940 and functioned through the Medical Supply Office, port of San Juan, P.R., until 2 October 1940, when it was moved to Fort Buchanan and assigned 50,000 square feet of storage space. From a staff of 1 officer, 5 enlisted men, and 6 civilians in 1940, the organization expanded by 1943 to include 3 officers and 13 enlisted men.15
Trinidad Base Command
The Medical Supply Section of the Trinidad Base Command was first established in May 1941. As the sector grew and other bases were established, this became a large facility.
By December 1942, a medical section was established in the Trinidad General Depot, from which medical supplies for the whole sector were handled. Housed in new warehouses in the Fort Read area, the depot reached its peak of requisitioning in mid-1943, and by fall of that year, excess stocks were being returned to the United States.16
Reorganization of the Medical Supply System
After the Antilles Department17 was created in 1943, the medical supply system underwent a complete reorganization, brought about by the changing tactical situation and the improvement of shipping schedules. There were several major changes in supply organization and procedure. Requisitions for medical installations in Jamaica and Cuba were submitted directly to the New Orleans Port of Embarkation. All classes of medical supplies were ordered on a monthly basis instead of periodically as needed. The supply organization was divided into the Trinidad Sector and Base Command, and the Puerto Rican Sector.
The stock record system for all stations in the Antilles Department was changed in 1943 by the incorporation of a department surgeon's office memorandum with the stock control manual. New practices for maintaining a stock level were also introduced.
Disposal of excess stock was handled well by circulating a list of items throughout the department. Extracted items were shipped without reimbursement. A total of 232 tons of excess items was shipped out in November 1943, and 86 more tons were reported ready for shipment in December. In January 1944, new stock levels were established for the Trinidad Sector and Base Command and for the Puerto Rican Sector, and arrangements were made to transfer surplus material to the Navy or to the Public Health Service.
The Optical Repair Team Type No. 1, formerly located at Waller Field, Trinidad, was moved to the Antilles General Depot in May 1944. This unit began handling requests for lenses which had previously been referred to the Zone of Interior. In addition, the facilities and services of the optical repair team were made available to the U.S. Navy and Coast Guard. In 1944, more than 1,700 requests were handled by the team.
The main responsibility for supplying the island outposts of the Antilles Department rested with the Trinidad General Depot, which was redesignated Sub-Depot, Antilles General Depot, in April 1944. This depot supplied the St. Lucia Base Command, British Guiana Base Command, French Guiana, the Trinidad Base Command, and Surinam (including Zanderij Field). The use of this subdepot greatly reduced time in filling requisitions.
As of 31 December 1944, 2,164 tons of excess medical supplies were returned to the Zone of Interior.
Repair facilities for Medical Department equipment in the Antilles Department were not satisfactory before 1945. The medical section of Antilles General Depot No. 1, Puerto Rico, had been using civilian personnel, but low civilian ratings hampered the hiring of adequate personnel. The situation was similar in the area served by the medical section of Antilles General Depot No. 2, Trinidad. Repair could be accomplished only on minor items; often, complete replacement was necessary on units and assemblies which became unserviceable and could not be repaired locally.
An effort was made in late 1944 to establish a medical repair section which would accomplish third and fourth echelon maintenance. Enlisted men were sent to the St. Louis Medical Maintenance School, St. Louis, Mo., for training. As a result, the repair situation improved in 1945 when four enlisted men returned from the course and began putting their newly acquired knowledge to work.
The inception of the Green Project necessitated the following: air redeployment of combat troops from the European and Mediterranean theaters to the United States for transshipment to the Pacific during May 1945, and the attendant necessity for immediate additional supplies and equipment for Trinidad and British Guiana to meet the influx of new personnel of ATC and the Antilles Department. To cooperate with other services in conserving airlift
space for supplies required from the Zone of Interior, medical stocks in Puerto Rico were used to meet shipping requirements for the initial phase, this to the point of depleting many items of depot stock.
Subsequently, requisitions were transmitted to the New Orleans Port of Embarkation for later phases of supply for the Green Project, and supplies were sent to the medical sections of Puerto Rico and Trinidad. As a result of advance shipping from the port, and because newly arrived personnel transported with them additional expendable supplies, an overstockage resulted in both depots. To readjust this situation, a requisitioning procedure was established between both depots, obviating the necessity for requisitioning on the New Orleans Port of Embarkation and reducing overages to a balanced level.
SOUTH ATLANTIC THEATER
Early in June 1942, a Special Headquarters Staff of the South Atlantic Wing, ATC, was established at Georgetown, British Guiana. This unit was the forerunner of U.S. Army Forces, South Atlantic, which was activated on 24 November 1942 (map 1).
The principal mission of U.S. Army Forces, South Atlantic, was to establish, operate, maintain, and support all ATC activities, to cooperate with the Brazilian Armed Forces in the defense of north and northeast Brazil, and to defend Ascension Island where U.S. Force Composite 8012 had been deployed in March 1942.18
Between July and December 1942, medical supplies were obtained by requisitions submitted directly to the Surgeon, ATC, in Washington, D.C., filled by the Medical Supply Section at Wright Field, Dayton, Ohio, and airshipped to the station where the requisition originated. Authority had been granted to obtain supplementary supplies by requisition from the Trinidad Sector and Base Command; however, supplies available at Trinidad were limited and delays of 4 to 5 months occurred when requisitions had to be extracted by the Trinidad Supply Section to the New Orleans Port of Embarkation.19
Until supply personnel were assigned to the theater in late December 1942, Lt. Col. George E. Leone, MC, Theater Surgeon (fig. 41), personally prepared requisitions, and in anticipation of an expanding command, medical maintenance units were ordered. To supplement the requisitions coming through regular channels, permission was granted to purchase medical supplies locally. Although no major items of technical equipment were available in Recife, a fair quantity of drugs, chemicals, small sterilizers, and minor equipment was purchased there.
Preliminary plans were made to establish a medical supply section within the Recife General Depot, with the proposed hospitals at Natal and Belém serving as subdistribution points for supplies which would be requisitioned from the New Orleans Port of Embarkation.
By 1 February 1943, medical depot personnel had arrived and had set up a small general depot at Belém, staffed by one officer and one enlisted man. The medical section of the general depot at Recife, was manned by two officers and two enlisted men.
The Belém depot was originally intended to function also as the supply point for medical activities at Amapá and Săo Luíz. However, because the actual volume of traffic with these base dispensaries was so small, it was clearly more efficient to supply them from the 193d Station Hospital at Belém. In November 1943, the medical section of the Belém depot was inactivated.
In contrast, the medical section of the Recife General Depot was assigned 200 square feet in warehouse No. 14, in the Recife dock area. With expanding activities and increasing responsibilities, the allotted space proved inadequate. The medical section moved first to an adjoining warehouse and, by early 1944, to a garage in downtown Recife. By late 1944, more space again was needed, and the section was expanded an additional 7,500 square feet, including a built-in bank vault for alcohol and narcotics. This enabled the entire medical supply section to be under one roof.
The mission of the medical section of the Recife General Depot, after November 1943 when the Belém depot closed, was to furnish medical supplies and equipment to all U.S. Army installations in Brazil. This included station
hospitals at Recife, Natal, Belém, and Ascension Island (assumed in February 1944), and base dispensaries at Amapá, Săo Luíz, Fortaleza, Fernando de Noronha, Bahia, and Rio de Janeiro. The Recife depot was also responsible for supplying U.S. Army transports which docked at ports of the command, and for supplying U.S. military commissions in Paraguay and Uruguay. A close liaison was maintained between the depot medical supply officer, Maj. John J. Ryder, MAC, and the officer in charge of the U.S. naval medical storehouse in Recife.
The Recife depot furnished the Brazilian Army with a limited amount of material under lend-lease according to the availability of requested items in excess stocks.
Development of penicillin resulted in a flood of requests from various sources. A policy was adopted to furnish penicillin only to military patients except in extreme emergency with the approval by the Commanding General or Chief of Staff necessary. When more penicillin became available to the civilian population in 1945, the Surgeon's Office published information regarding the purchase of penicillin from commercial sources.
Early in the war, there was no command system of accountability for supplies and equipment; however, depot supply officers kept accurate property records, and stock record accounts were kept in all stations. Formal accountability was established in October 1943. Because of the accuracy of the medical supply officers, or base surgeons who served as supply officers in some instances, the problem of initiating stock record accounts according to instructions was minimal.
Although a formal directive establishing inventory stock control procedures for all supply services was not published by theater headquarters until late 1944, these procedures had been followed before that date. The medical supply section at Recife maintained a 45-day minimum level of supplies, plus a 30-day operating level. Some difficulties were encountered in establishing a proper requisitioning objective for the depot, but by raising the objective slightly, adequate stocks were maintained despite shipping delays.
Before February 1944, routine supplies were requisitioned from the Trinidad Sector and Base Command, and nonroutine items were obtained from the New Orleans Port of Embarkation. As of 1 February 1944, Trinidad was eliminated as an intermediate supply point. Vaccines, biologicals, and emergency supplies were shipped by airfreight from Miami, while other supplies and equipment were shipped by water from New Orleans. Air shipments were received within 2 to 4 weeks after requisitioning while shipments by water were received within 110 days. In an emergency, supplies could be received in as few as 5 to 8 days.
Until mid-1944, procurement of sufficient supplies and equipment to meet the needs of a rapidly expanding command was a major problem. Until initial stocks were supplemented by medical maintenance units, reliance was placed on the local market. Biweekly rounds of the local drug companies and surgical and dental supply houses were made by a medical officer of the Recife depot.
Despite a language barrier and a lack of extensive knowledge of drugs, a considerable quantity of X-ray, dental, and laboratory equipment was purchased in Rio de Janeiro and, in March 1943, a general purchasing agency was established there.
Inexpensive spectacles of good quality were readily available in Recife and, as requirements increased, procurement time lapsed. Therefore, arrangements were made to obtain spectacles from a large optical company in Rio de Janeiro. However, because of delay in delivery and poor workmanship, arrangements were made for forwarding spectacle orders to a branch of the American Optical Co. through the medical supply officer at Camp Blanding, Fla.
The problems that occurred in the South Atlantic theater were typical of the type of climate and situation which prevailed. The heat and humidity of Brazil made equipment maintenance difficult. Instruments rusted, and X-ray film often deteriorated beyond use. Cargo received rough handling, and breakage was exceptionally high until packaging methods improved. Despite these difficulties, the medical supply situation improved rapidly because of the efforts of medical supply officers who learned to anticipate problems and to overcome them.
AFRICA-MIDDLE EAST THEATER
The long thread of air communications from Florida to India had its genesis in the route established by the Pan American Airways. Near the end of June 1941, Pan American Airways, in complying with a request from the U.S. Government, had accepted the responsibility of ferrying lend-lease planes to British forces in the Mediterranean and points further east.
In September 1941, President Franklin D. Roosevelt addressed a memorandum to Secretary of War Henry L. Stimson, indicating that arrangements were to be made at the earliest practicable time to establish and operate depots in the Middle East. These depots were for the maintenance and supply of American aircraft and ordnance material furnished to the British in that area. Such arrangements were made, and these establishments became the embryo of USAFIME (U.S. Army Forces in the Middle East). The Persian Gulf Command was born of the U.S. Military Iranian Mission, activated late in 1941 to provide aid to Russia and Great Britain.20
U.S. Army Forces in the Middle East
On 16 October 1941, Maj. (later Col.) Crawford F. Sams, MC (fig. 42), joined the newly created U.S. Military North African Mission as Surgeon. On 29 October, Major Sams presented plans which he had been developing before his departure from Washington; after his arrival in the theater on 22 Novem-
ber 1941, he modified these plans substantially, based on firsthand information.
As additional medical personnel arrived, dispensaries and a 250-bed station hospital were established. Concurrently, arrangements were made to hospitalize civilians employed by American contractors, as well as U.S. military personnel, in British military hospitals until U.S. facilities were completed.
Absence of an organized medical service in the African portion of the aircraft ferrying route presented a serious problem in Malaya and Australia. A medical plan to establish regular medical service along the ferrying routes was prepared by the mission surgeon after consultation with the Chief Medical Officer, Pan American Airways. By 19 June 1942, militarization of the North African Mission was accomplished and American military activities in that region were consolidated into a theater of operations, the U.S. Army Forces in the Middle East.21
This command was considered an active theater of operations, as well as a Service and Supply Command (map 1), reaching its peak strength of more than 66,000 troops in July 1943. The departure of the Ninth Air Force in August 1943 left the residual mission of supply and service. Further decline occurred in December 1943, when the Persian Gulf Command became autono-
mous, having been on a separate requisitioning basis for some time because of its independent mission of supplying Russia.
Medical supply-The medical supply requirements and activities were determined by such factors as hospital bed strength, patient load, and various ancillary medical facilities. On these were based the number of medical unit assemblies required, the resupply and general logistical aspects of a distant command overlapping portions of two continents. Supplies and equipment for dispensaries established in early 1942 were drawn from a 50-bed hospital assembly which had been made available to the command. Maximum hospital bed strength coincided with the peak troop strength in July 1943, with 6,250 fixed beds scattered from Liberia to Tehran.22
On 17 June 1942, civilian personnel arrived in the command to operate the Douglas Aircraft Corp. hospital in Gura, Eritrea. The bulk of medical items to equip this 250-bed hospital, which was to accommodate all American citizens in the area, was furnished by the Medical Department. Shortly thereafter, many hospitals, dispensaries, and other medical units began to move into the command from the United States. Because of the delay in shipping and of shortages of medical material in general, however, several items were either borrowed or obtained from the British on reverse lend-lease to expedite the opening of these U.S. medical care installations. Some local procurement was effected to advantage, also.
Upon arrival of the Advance Depot Platoon, 4th Medical Depot Company, on 1 November 1942, two advance depots were established at Darb El Hagg, Egypt, and Tel Litwinsky, Palestine, with the base depot being at Decamere, Eritrea. Due to the change in the military situation in North Africa at that time, depots in Palestine and Eritrea were consolidated with the advance depot at Darb El Hagg by February 1943. In March, this unit became the Medical Section, Heliopolis Quartermaster Depot, Camp Russell B. Huckstep, Egypt. This medical section included an optical shop for fabrication and repair of spectacles and a medical maintenance and repair shop. Maintenance shop facilities were adequate for the needs of the command as was the optical shop, which had a manufacturing capacity of 1,000 pairs of spectacles per month. During the most active portion of the buildup period, the Ninth Air Service Command operated a medical section in the Advance General Depot at Benghasi, closely supporting combat missions of the Ninth Air Force.
Until October 1943, all items of resupply were shipped automatically in the form of medical maintenance units, and requisitions were submitted to the Charleston Port of Embarkation for supplemental items and emergency requirements. From the beginning of the theater, medical maintenance units representing an estimated 6-month supply for the existing and contemplated force were set up for shipment as a means of establishing the base depot stocks. These medical maintenance units were far from complete, and back-
ordered items followed the original shipments for several months. Available 6-month supplies were initially distributed as follows: Mobile dispensaries received 10 days' supply; Air Force service squadrons, 30 days' supply; and hospitals, 90 days' supply.
U.S. Army Forces in the Middle East, while favoring the use of medical maintenance units during the buildup period, made these several recommendations to the Surgeon General's Office in view of the overages and shortages ascribed to their use: (1) the simultaneous arrival of the first troops with their initial maintenance, subsequent troop shipments to be preceded by their initial maintenance; (2) the nonestablishment of back orders for items short in the medical maintenance units shipped overseas; and (3) shipment of medical maintenance units at regular intervals, with the theater supply officer constantly checking and advising the port medical supply officer of all inadequacies and overages.
Simultaneous shipments were tried in every instance. Initial maintenance preceding the arrival of troops was accomplished occasionally when troop movements could be anticipated with any degree of certainty and supplies could be made available in advance of a movement.
By early 1943, back orders were discontinued on initial maintenance shipped with the units. Monthly shipments of medical maintenance units were considered as basic stocks for the theater and an interim substitute for theater requisitioning. These items, although many were constantly shifting from availability to nonavailability and back again, constituted a cross section of the essential items of supply.
Thus, failure to backorder items for the maintenance units could deprive the theater of many essential items for protracted periods without detection or correction. This was particularly true in the Middle East where the first 6 months' supply of units was shipped as rapidly as shipping space permitted. The theater policy was recognized as having some merit, especially when accumulated back orders arrived 6 months after the original shipment and accompanied the succeeding periods' shipments of maintenance units which included authorized quantities of the items by reason of their sudden availability. This virtually transposed the status of some items from a shortage to an excess position.
There was never discord within the medical supply system on this matter. The paucity of shipping space during the early days and the relatively low priority of nonemergency medical supplies permitted accumulation of medical maintenance units on U.S. docks for prolonged periods, provoking hardships despite the protests of the Surgeon General's Office.
Levels of supply-Because of distances involved between supply points and the limited means of transporting bulk stocks, it was highly desirable that stations carry at least 90 days' stock. This was attempted at the outset, but theater stocks would not permit such an extravagant distribution, and stations necessarily reverted to a 30-day level, with monthly requisitions. As command stocks became more abundant in mid-1943, all stations were authorized to in-
crease levels to 120 days (not to exceed 6 months), and to requisition quarterly. Dispensing with the medical maintenance unit as the primary means of supply, quarterly command requisitions were instituted on the port, based on 210 days of supply including 110 days' shipping time. Commencing with the March 1944 requisition, the War Department directed that command levels would be reduced to 45 days' minimum plus 30 days' operating, or a total of 75 days' maximum level plus shipping time. Stations again reverted to a 30-day level and monthly requisitions. This War Department action provided the Zone of Interior with a better means of meeting accelerated demands in the scattered combat areas.
With unit personnel frequently arriving months ahead of their unit assembly, and with unit assemblies invariably split in transit, all assemblies were shipped to the depot for reprocessing before issue to units. At the outset, unit assemblies had to be improvised by using the limited U.S. stocks available, augmented with British equipment and the limited, but more expensive, locally procured items. The command found that this processing of unit assemblies through the depot had a dual benefit. Initial requirements were met with limited stocks, and a reserve stock was accumulated for reprocessing and reconstructing assemblies, which would conform to actual needs with a saving in material. Despite these benefits, shortages persisted and unit improvisation was necessary.
Persian Gulf Command
Having originated with the Military Iranian Mission in October 1941, and become the Persian Gulf Service Command in August 1942, the Persian Gulf Command was designated a separate theater on 10 December 1943 (map 1).
The first American hospital in the Persian Gulf Areas was the 2d Station Hospital, which began operations on 6 June 1942. This hospital acquired its initial supplies and equipment from various sources.
The Advance Depot Platoon, 7th Medical Supply Depot, arrived at Khorramshahr, Iran, on 25 January 1943 and, 2 weeks later, opened a depot at Ahwaz.23 While the platoon was at Ahwaz, a fire broke out on 21 June 1943, destroying medical supplies valued at $350,000. However, large quantities of medical supplies had just arrived from the United States and these were in Khorramshahr at the time of the fire. The losses at Ahwaz were thus minimized and fortunately did not hinder the flow of supplies to various units and hospitals.24
By September 1943, the depot was preparing to be moved to Khorramshahr, where a subdepot was established as part of the general depot (fig. 43). The move was made in November 1943, after which the unit was redesignated the 22d Medical Depot Company. A 6-month supply of initial maintenance,
comprised of medical maintenance units, was shipped to the Persian Gulf Command. Units retained 3 months' stock and the depot took custody of the other half. As in USAFIME shipments, these medical maintenance units were far from 100 percent complete on the initial shipments and back-ordered shortages followed for several weeks. Additional shortages resulted from poor packaging and rough handling in transit.25
Paralleling the USAFIME experiences, hospital unit assemblies shipped to the Persian Gulf Command were frequently fragmented. In one instance, a field hospital unit which had arrived in December 1942 received the bulk of its unit assembly in periodic shipments and not until 1 May 1943 had sufficient portions been received to set up operations. These imperfections were occasioned by shortages of stocks in the United States and by failure to load all available components of the unit assembly on one vessel. As a result, hospital personnel were either immobilized or placed with British or U.S. functioning hospitals. A hospital was often temporarily improvised by drawing on local
civilian facilities or U.S. and British sources. Materials obtained from the British in the area, under reverse lend-lease, from 1 January 1943 through April 1945 were valued at more than $23,000. A significant portion of these materials were dental supplies and equipment, which were extremely short in the U.S. Army medical supply system.26
During the period of scarcity of equipment and facilities, the ingenuity of the unit personnel was equal to the situation.
To combat spoilage among vaccines and serums, a satisfactory Dry Ice was manufactured from cylinders of carbon dioxide. Approximately 17 pounds of ice could be produced in 30 minutes from the contents of one 15-gallon cylinder of the gas.
Medical treatment facilities were equally adaptable. As interim measures, operating lamps were made from large metal kitchen mixing bowls; a bicycle pump served to maintain pressure in a steam autoclave; and a French fryer mounted over a plumber's blowtorch made an excellent instrument sterilizer. This becomes more significant when it is realized that the Persian Gulf Command improvisations were without the benefits of a medical maintenance shop. In time, improvised material was largely displaced with standard equipment.
A survey was conducted early in 1943 to determine high mortality of repair parts, and requisitions based on the results of that survey were submitted to the Charleston port. Although at that time hospitals were without assigned repair technicians, many units had personnel who could make repairs. In the Persian Gulf Command, the local engineer and ordnance shops were used freely by personnel in repairing and fabricating medical equipment. Repairable equipment beyond the capability of the Persian Gulf Command was returned to the United States as replacements were requisitioned.27
The shortage of medical supply catalogs in the Persian Gulf Command was alleviated in April 1943 when an overseas medical supply catalog, which provided guidance for requisitioning supplies, was compiled in the Zone of Interior and was made available to all units. The manual included lists of items that comprised the medical maintenance units, final reserve units, and similar lists with identifying catalog numbers, nomenclature, and unit of issue. These were duplicated and distributed to all units in the Persian Gulf Command.
In January 1944, the level of supply for the command was reduced from 210 days to 105 days. Automatic requisitioning was discontinued at this time and thereafter medical supplies and equipment were requisitioned on the basis of table-of-organization-and-equipment authorization and consumption. The reduction of the days' level of supply created overages in certain items, which were augmented by the abolishment of our final medical reserve. Excesses beyond a 6-month supply were declared and properly disposed of.28
The only interruption to the continuous flow of medical supplies to the theater occurred in April 1944, when two vessels loaded with medical equipment were damaged during enemy action. Repairable equipment damaged beyond the capabilities of the repair facilities at hand was returned to the Zone of Interior while unrepairable equipment was disposed of by report of survey.
During April and May 1944, Eastern Command, a tactical command for which the Persian Gulf Command had supply responsibility, was established in Russia. A considerable quantity of supplies and equipment was supplied from Persian Gulf Command stocks. Requisitions for items which could not be furnished were extracted to the Zone of Interior and the equipment was forwarded on receipt in the Persian Gulf Command. When the Eastern Command (fig. 44) was reduced some months later, the equipment was absorbed back into the command stock or declared excess.
An optical repair unit was attached to the Khorramshahr General Depot in June 1944. Before that time, all spectacle prescriptions had been forwarded to USAFIME for processing.
As medical units were transferred from the command in 1944 and 1945, excess items were recovered by the depot and reissued from time to time.
While the Persian Gulf Command was a key supply link to Russia and the Far East, the U.S. Army Forces in Central Africa with headquarters at Accra, Gold Coast, had the primary mission of the construction, operation, and defense of Ferry Command and Air Transport Command installations in Central Africa. Established on 16 June 1942, this command was merged with the U.S. Army Forces in the Middle East on 15 September 1943 and redesignated the West African Service Command (map 1).
The medical supply depot for the entire area was established originally at Accra, but when the command changed, it was placed under the control of the 67th Station Hospital. The second depot, established at Dakar was placed under the control of the 93d Station Hospital.
As in the Caribbean and Persian Gulf Areas, heat and moisture caused many problems. Many surgical instruments, unless coated with grease or stored in dry closets, rusted. Most surgical knife blades and needles packed in glassine paper and cellophane were rusty when opened. No rust was noted on those packed in wax paper.
Emergency lights shorted out within 2 weeks and batteries also deteriorated rapidly. Deterioration also occurred with hydrogen peroxide and X-ray film. Provision for the repair and replacement of parts was limited. To assure the availability of mechanical parts of motors, X-ray tubes, batteries, and oxygen, requisitions were placed well in advance of actual needs.29
Throughout 1944, the medical supply functions of the 93d Station Hospital were normal and receipt of supplies and equipment was satisfactory. Effective on 1 March, supplies were requisitioned monthly on the basis of a 45-day minimum level plus 30-day operating level, or a total of 75 days' maximum level. This, plus the 110-day order and shipping time, constituted the requisitioning objective of 185 days.
The Medical Supply Depot, 67th Station Hospital, also functioned as a base medical supply depot for the West African Service Command, U. S. Army Forces in Liberia, and ATC stations in Nigeria, Gold Coast, and Senegal. A stock record system, maintained since January 1943, was revised in March 1944. Stock levels based on actual consumption were established and the monthly submission of requisitions was put into effect.