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ACCESS TO CARE
Europe: Preinvasion Buildup in the United Kingdom
Beginning in May 1941, the U.S. Military Mission to London, called the Special Observer Group, had been quietly and carefully planning the disposition in the United Kingdom of a tentative U.S. troop strength of 87,000 men and their accompanying equipment.
Following Pearl Harbor, the observer group rapidly began to put their formerly secret plans into operation. The projected troop strength rose to 105,000 men with the plan, MAGNET, which called for a much larger U.S. force in northern Ireland to defend against Axis attack. Early in January 1942, U.S. Army Forces in the British Isles replaced the Special Observer Group, thus establishing the first U.S. Army command in the United Kingdom. Shortly thereafter on 26 January, the first contingent of 4,000 U.S. troops debarked at Belfast, northern Ireland. The buildup of a U.S. Air Force in the British Isles began in late February with the establishment of a bomber command (VIII Bomber Command); by mid-June, plans were made for the direct participation of U.S. air units in the war against Germany.
To supply the planned assault, Headquarters, Services of Supply, under the command of Maj. Gen. John C. H. Lee, was activated on 24 May 1942.1
Early Organization of the Supply Division
The Finance and Supply Division (later the Supply Division), Chief Surgeon's Office, ETOUSA (European Theater of Operations, U.S. Army), was established by verbal order of the Chief Surgeon, Col. (later Maj. Gen.) Paul R. Hawley, MC, on 13 June 1942 at 9 North Audley St., London. Lt. Col. (later Col.) Earle G. G. Standlee, MC, was designated chief and purchasing and contracting officer.
Shortly after the Finance and Supply Division was created, it was moved to Ben Hall Farm at Cheltenham, Gloucestershire, about 100 miles west of London, where it shared facilities with several other divisions of the Chief
Surgeon's Office and the other technical services of the Army. Facilities consisted of a group of temporary camouflaged buildings that had been constructed originally to house parts of the British Ministry of War in the event of invasion or the destruction of the London headquarters. The move to Cheltenham hindered operations of the division because most of its transactions with the British War Office were conducted in London; hence, it became necessary to appoint a London liaison officer. The fact that a Chemical Warfare Service officer served as the liaison officer until a Medical Department officer became available was an early symptom of medical supply's basic weakness of inadequate personnel. Originally, the Supply Division consisted of two Medical Corps officers and one enlisted man, but it was later augmented by a few additional officers, of whom several were untrained in medical supply work.
Within 10 months, there was a succession of four division chiefs. After Colonel Standlee was relieved to go to North Africa in the latter part of August 1942, Lt. Col. (later Col.) Clarence E. Higbee, SnC, was chief for a short period before being replaced by Lt. Col. Howard Hogan, MC. In July 1943, Colonel Hogan was replaced by Col. Walter L. Perry, MC. These frequent changes were not conducive to increasing effectiveness.
Early Functions and Purposes
The first task of the Finance and Supply Division was to compute the requirements for Operation BOLERO, the initial plan for the invasion of Europe; this involved considering material available from British and U.S. sources, and acquiring the necessary depot space for storage and issue of medical supplies and equipment. Plans for medical care under BOLERO included a requisition of supplies and equipment needed to build up the United Kingdom as a base, and acquisition of supplies and equipment required for the assault on the Continent. Accordingly, material in the form of bulk stocks (resupply) and unit assemblies to match troop lists, plus reserve stocks, began to arrive in the United Kingdom by mid-1942.2
The Supply Division had barely started the development of BOLERO when it was assigned the difficult task of furnishing medical supplies and equipment for Operation TORCH, the assault on North Africa. This assignment began in August 1942 and lasted until early 1943, when the Zone of Interior absorbed full resupply responsibility. During this period, all combat units, including medical units, embarking for the United Kingdom were furnished basic TOE (table of organization and equipment) equipment and a 15-day initial supply of medical items.
Medical units equipped to meet the sailing schedules for the convoys moving from England to Africa consisted of four 250-bed station hospitals, one
400-bed surgical hospital, three 750-bed evacuation hospitals, one 750-bed station hospital, two 1,000-bed general hospitals, one medical depot company, and 22 medical maintenance units for resupply. To insure accomplishment of this task, the Chief Surgeon established a special Medical Planning Group, consisting of Lt. Col. (later Brig. Gen.) James B. Mason, MC, Lt. Col. (later Col.) Clark B. Meador, MC, and Lt. Col. John Douglas, ADMS (British).
In fulfilling TORCH supply requirements, it was necessary to strip many units, including operating hospitals, of major items of medical equipment and vehicles. In addition, 30 incomplete medical assemblies in depot stocks were disassembled to build the hospitals required to support TORCH. This task was complicated by the fact that the personnel of the only medical depot company (the 1st) in the United Kingdom were dispersed to five different locations; also, the assembly of materiel for TORCH requirements had to be accomplished concurrently with attempts to provide newly arrived hospitals and other medical units with their basic operating equipment. Inexperienced personnel and a scarcity of stock and packing materials magnified supply problems beyond their normal dimensions, and preparations for TORCH were barely completed as the task force embarked.3
Procurement in the European Theater, 1942-43
Procurement of medical materiel from the British was a burden on the economy of Great Britain, whose industrial sections were severely damaged after 3 years of war. The available labor force was predominately older men and women, who, in addition to their jobs in industry, were engaged during off-duty hours in civilian defense activities as ambulance drivers, wardens, policemen, and firemen. Industry was necessarily closely controlled by the government, with the Ministry of Supply responsible for allocation of manufacturing facilities, manpower, and materials.
The Procurement Section, Medical Supply Division, was located in London within the office of the General Purchasing Agent, ETOUSA, which had supervisory responsibility for all procurement from British sources. While this location had some advantages, it hindered close liaison with the Requirements and Requisitions Branch in Cheltenham.
In the first year of American participation in the war, 1942, serious shortages of military supplies, including medical items, persisted in the European theater. Transatlantic shipping facilities were inadequate, and German submarines were taking a heavy toll. As a means of compensating for those serious handicaps, the British agreed to supply U.S. forces in the United Kingdom, wherever possible, through a reciprocal aid program, commonly called Reverse Lend-Lease.
The medical portion of this program was substantial and important. Through construction or use of existing buildings, the British not only made available many hospitals (fig. 67), but also supplied a predetermined list of
basic housekeeping equipment, including such items as beds, bedside tables, and mess equipment. Technical medical equipment for hospitals, furnished partly by the British and partly from the United States, was to be assembled within the ETOUSA medical depot system. Requirements for medical materiel, over and above the initial establishment of fixed hospitals, were computed by the Supply Division, and an additional demand was placed on the Ministry of Supply for those items which could be furnished from British resources. Otherwise, a requisition was sent to the United States. In doubtful items, the demand was duplicated in the U.S. requisition, but was subject to cancellation if the British agreed to accept the demand. This added proviso was a manifestation of the prevailing uncertainty. Since acceptance at either source frequently required several months, prolonged confusion and duplication were common.
Problems in Procurement
Although English was the common language, it was learned gradually through experience that there were essential differences in nomenclature of like items: GI cans were "dustbins" to the British; excelsior was "wood wool"; requisitions were "indents." For almost every item of medical mate-
riel, British and American specifications were at variance. The same drugs often had different names and different unit packaging. Surgical instruments proved to be a problem as the design, weight, and balance were unfamiliar to American surgeons and frequently were unacceptable. Some items were similar enough that they could be carried under the U.S. nomenclature and catalog item number, but the majority had to be specifically identified as British. It was necessary to publish a British-American catalog of equivalents and a list of acceptable British substitutes. These publications were prepared and published by the Supply Division under the guidance of the professional consultants to the Chief Surgeon, ETOUSA.
U.S. materiel requirements often represented fantastic quantities by British standards. As an example, initial U.S. demands for dental burs were greater than the total annual British requirements for civil and military needs. Conversely, some quantities were small compared to British allowances. Furthermore, requirements fluctuated with the continual alteration of plans, which was inevitable in a buildup of BOLERO's magnitude.
In July 1942, large requirements were placed on the British, to be delivered in increments from 1 August 1942 to 1 April 1943. In September and October, further demands were made, with deliveries to be phased from December 1942 to September 1943. Each new demand injected changes into previous ones, creating much confusion. These requirements included not only supplies for hospitals and troops in the United Kingdom, but also many supplies for the North African assault.
In early 1943, the general policy provided that items requiring extensive labor in their production but a small amount of tonnage were to come from the United States, whereas items with little labor and large tonnage were to be procured in the United Kingdom. By mid-1943, U.S. production was in high gear; shipping had increased, submarine sinkings were declining, and a number of items were excess to needs in the United States; hence, lists of these items were sent to the European theater so that United Kingdom procurement could be curtailed. In several instances, it was discovered that the British were securing items from the United States under lend-lease procedures while U.S. forces in the United Kingdom were placing demands on the British for the same items.
Late in 1943, deliveries of technical medical materiel from British sources dropped off appreciably because of increased labor shortages and increasing British needs to equip their own forces for D-day. Fortunately, shipments from the United States were constantly increasing during the latter part of the year.4
Approximately 75 percent of the total tonnage of medical supplies received by U.S. forces in the United Kingdom came from British sources in 1942, with only 25 percent from the United States. During 1943, almost 56 percent of total tonnage received, including program C (housekeeping) items, came from the British (table 2).
In retrospect, procurement of British medical materiel served a useful purpose in 1942 and 1943 when U.S. production was slowly getting underway and shipping was scarce. Moreover, it was helpful in supplying housekeeping equipment before D-day for fixed hospitals in the United Kingdom. Program C items, which were nontechnical, remained fairly stable, so that detailed specifications were relatively unimportant. Deliveries were usually made directly to hospital sites, thus avoiding depot workload; and the items were bulky, which resulted in the saving of ocean cargo space.
Because requirements and specifications changed frequently and deliveries made to depots came in all sizes of containers, production delays were frequent, and recordkeeping was difficult. Lack of personnel in the procurement section of the Supply Division also added to the problems.5
MEDICAL SUPPLY DEPOTS
With relatively few exceptions, U.S. depots in the United Kingdom were general depots, designated by the letter G, followed by a number, 1 to 100, and jointly occupied by more than one technical service. The commander of each general depot was a Quartermaster Corps officer, and the officer in charge of the medical section was known as the medical supply officer. Medical depots were designated by the letter M, followed by a number from 400 to 499.
Depots in the United Kingdom were located generally in existing buildings made available by the British. The medical section of Depot G-20 was
located in a brewery while Depot M-401 at Witney was located in a barnlike structure on the grounds of a blanket-weaving mill. Adaptation of the TOE depot company with a fixed allowance of officer and enlisted personnel to these depots of varying capacities presented a serious problem. The only type of unit available in the European theater for this purpose was the medical depot company, organized under TOE 8-661 of 1 April 1942, consisting of 16 officers and 227 enlisted men.
Depot Units and Operational Sites
The first medical supply installation in the United Kingdom was established in May 1942 at Belfast by a section of the 8th Medical Depot Company. In December 1942, this unit became the medical section of Depot G-10.
The first complete TOE medical supply unit in the United Kingdom was the 1st Medical Depot Company, which arrived in England on 13 July 1942. Additional depot companies did not arrive in the theater for more than a year. During the interim, the scattered medical depots in England were operated by cadres of personnel from the 1st Medical Depot Company, augmented by attached officers and enlisted men. This situation was not conducive to good morale. As promotions for officers and enlisted men were based primarily on TOE authorizations, only a few were awarded. During this period, some depots had as many as 100 officers and enlisted men in a casual status attached for duty.
During 1942, five medical sections of general depots (fig. 68) were established in England (table 3), with emphasis on dispersion because of the danger from air attacks.
1Redesignated M-410M on 23 December 1943, originally G-10-1
established on 18 May 1942.
Immediately following their activation, the sections were saddled with the mounting of Operation TORCH. Depot G-45 at Thatcham had the major responsibility, functioning as the primary assembly and distribution depot for medical supplies. The other four depots assisted by building unit assemblies and 22 medical maintenance units for Operation TORCH. The workload for the issue of 15 days' accompanying supplies to each unit was distributed among the five depots. Despite the extremely heavy workload, the task was completed in the allotted time.
Until the summer of 1943, the North African theater, as the more active combat theater, had a priority on shipments from the United States. However, establishment of depots in the United Kingdom (map 11) in preparation for Operation OVERLOAD continued. During 1943, 10 new depots were established and their medical sections were set up by five new medical depot companies-the 6th, 11th, 13th, 15th, and 16th (table 3). The 1st Medical Depot Company, which had borne the brunt of operating the depots, was gradually relieved by the newly arrived units, and was withdrawn early in 1944 to prepare for its role in support of the First U.S. Army.
With the exception of Depot M-400 at Reading, which was a repair and spare parts depot, and Depot G-45 at Thatcham, which had an assembly mission, all depots during 1942 and 1943 were responsible for distributing supplies to units in assigned geographic areas. Many had, in addition, other missions, such as receiving shipments directly from ports of entry and from
British procurement, manufacturing unit assemblies, and storing reserve stocks.6
Inadequacy of storage space, inexperienced personnel, and the general lack of knowledge of medical supply operations in the early days in the United Kingdom can be illustrated by describing the operations of the medical section of Depot G-35 at Bristol. The depot was established on 12 August 1942 in a five-story chocolate factory with about 63,000 square feet of space and two antiquated elevators, which were frequently out of service. The railhead was about 4 miles from the depot, necessitating movement of stocks by
truck through the crowded city streets of Bristol. The depot reworked unit assemblies (fig. 31, p. 136) received from the United States, filling shortages with items received from British procurement. In October and November 1942, a 750-bed evacuation hospital, a 1,000-bed general hospital, and a 250-bed station hospital were assembled and shipped in support of Operation TORCH. WO (jg.) Lewis H. Williams wrote in 1944 of his earlier experiences:
Lt. Stohl placed me in charge of assembling this unit and the only things I had to help me was one Basic Equipment List and a prayer. Believe me, I needed both of them, as no one in the Medical Section at that time had any idea of the procedure used in assembling a Hospital, and no one even knew what an assembled Hospital looked like.
In February 1943, the depot's mission was to supply units in the area. About the same time, it acquired 90,000 square feet of space in a nearby four-story building (with a single elevator), which necessitated the physical movement of considerable stock. Early in February 1943, the first depot inventory was taken and a stock record system was inaugurated.
By June 1943, the depot was supplying 40 units in its area in addition to packing unit assemblies. During the year, it built, to varying degrees of completion, several medical maintenance units and final reserve units, one 1,000-bed general hospital, and two 750-bed evacuation hospitals. During October and November 1943, the depot was receiving and processing from 700 to 800 requisitions a month. Before November 1943, if a requisition could not be filled, the requesting unit was instructed to requisition again at a later date. In November 1943, a system of back orders was established and by February 1944, more than 5,000 back orders had accumulated.
Personnel were assigned as casuals to the depot from various units. Changes were frequent, as evidenced by the seven medical supply officers assigned from July 1942 until March 1944. With each change came new methods and procedures. Although the strength fluctuated, there was a gradual buildup; by 31 December 1943, 5 officers, 94 enlisted men, and 91 British civilians were on duty. Maj. (later Lt. Col.) Charles I. Winegard, MSC, on becoming medical supply officer in March 1944, wrote:
* * * It was organized confusion * * * There was no depot organization-it seemed as everyone was doing what he chose to do. Responsibilities were not defined. The stock record section was undermanned and thru lack of knowledge of procedures were causing themselves a great amount of confusion and overwork. The Shipping Section was located on the top or 4th floor * * * requiring all shipments to be moved to the top floor, assembled, and held there until shipped or called for, when they had to be taken to the ground floor.
In spite of all its difficulties, Depot G-35 performed valuable work in supporting Operation TORCH, in equipping units, in furnishing supplies in operating hospitals, and in manufacturing assemblies. Basically, its difficulties, like those of the system as a whole before March 1944, stemmed from the necessity of operating with inexperienced and, for the most part, inadequately trained personnel.7
EARLY PREPARATIONS FOR OPERATION OVERLORD
During 1942 and early 1943, plans for invasion of the Continent from the United Kingdom base were rather nebulous. By the summer of 1943, with the North African and Italian campaigns well under way, the plans for the invasion of the European Continent-code name OVERLORD-acquired a noticeable firmness. Medical plans called for the use of the U.K. base not only for mounting the operation and for supply during the first few months, but also for considerable fixed hospital support throughout the campaign.
As mentioned previously, the British were to furnish U.S. forces with 105 fixed hospital plants to house 94,000 beds, complete with housekeeping equipment and some technical equipment. The Supply Division was responsible for equipping these installations and the medical units arriving from the United States and for maintenance support of all fixed and mobile units.
During the last half of 1943, OVERLORD buildup gained momentum as supplies and equipment were being shipped in increasing quantities from the Zone of Interior to the United Kingdom. Under the preshipment plan, medical units deployed from the United States arrived with only basic equipment, which consisted of just that equipment necessary for unit housekeeping and local sick call; for example, mess equipment, some office equipment and medical kits, and one Medical Department chest No. 2.
The intent and theory behind this supply procedure were logical, but the method of execution left much to be desired. Upon debarkation, units were immediately shuttled from the U.K. port to their destinations before their basic equipment could be unloaded. To circumvent this problem of delay, port assemblies, consisting of one Medical Department chest No. 1, one Medical Department chest No. 2 (fig. 69), one small blanket set, one splint set, and two litters, were stocked as assemblies at ports of debarkation for issue to each medical treatment unit. These assemblies enabled medical units to provide emergency medical care for their own personnel and for personnel of surrounding units upon reaching their destination. The original equipment of the units was forwarded by the port medical supply representative as soon as it was discharged from the ship, and upon delivery and issue of full TOE, recipients turned in their port assemblies. This procedure was frequently complicated, however, when all or portions of the equipment became lost in transit, particularly if units had included personal items.8
Shipment of Unit Assemblies
Unit assemblies for many units were to be shipped from the United States under the preshipment plan. Because most assemblies shipped from the
United States before 1944 were incomplete in varying degrees, this did not work out in practice. Many split shipments, in which parts of an assembly were placed in the holds of different ships, frequently arrived in the United Kingdom at widely separated ports. Often on arrival, parts of assemblies were then shipped to different depots. Complete assemblies and split shipments, arriving in the United Kingdom, frequently were not recognized by the U.K. depots as components of unit assemblies. This led to component items being picked up on depot stock records and stored as bulk stock. Receipts of T/E (table of equipment) equipment for tactical units, the components of X-ray sets, and minor assemblies were treated similarly, meaning that components were placed in depot stock for issue. Stock status records and requirements computations suffered as a consequence. This failure was directly related to unfamiliarity of supply officers with the marking and composition of unit assemblies and to the complex shipping documents.
Entreaties to curtail split shipments were made to ZI ports and to the Surgeon General's Office by cables and letters wherein the causes and problems were outlined. Reassurances were offered, but improvement was slow and
sporadic. Maj. Abraham Freedman, MC, who had spent 5 weeks in the United Kingdom as liaison officer from the Port Medical Supply Division, New York Port of Embarkation, recommended in his report of 22 March 1944 that assemblies and sets should be bulk stowed in one hatch rather than being dispersed throughout the ship. With the approval of the deputy port commander, as of 31 March 1944, this recommendation was put into effect, thus enabling the theater to handle each hospital expeditiously at the port of debarkation.9
From the experience of the North African campaign, it was learned that the use of colored markings on shipping containers led to the mixing of medical bulk stocks with unit assembly components, which resulted in the loss of assembly identity. This procedure was eliminated on unit assemblies, and a specific design was imprinted in the assigned color. This exception solved only one of the many problems concerning the unit assembly. It did not provide the rigid controls required for a unit assembly to remain intact from point of origin to eventual destination.
Documentation for all shipments, including unit assemblies, was supposed to be airmailed from the ZI port of embarkation so as to arrive in the United Kingdom well in advance of the shipment dissemination to depots scheduled to receive the shipment. Tardy shipping documents, coupled with the fact that all component parts of a unit assembly rarely arrived at the receiving depot at one time, made it difficult to keep an assembly segregated and intact within the depot, upon receipt. All of these factors allowed loose controls and led to reassembly of equipment for each medical unit; this was an unanticipated workload.
Depot stock records, moreover, were grossly inaccurate, not only as to basic on-hand or inventory figures, but also as to the due-in and due-out figures. This situation, in turn, meant that the consolidated theater stock records in the Chief Surgeon's Office were also erroneous.10
Equipping First U.S. Army Units
The Commanding General, First U.S. Army, had been designated as commander of U.S. forces for the Normandy assault. In September 1943, Col. (later Brig. Gen.) John A. Rogers, MC (fig. 70), Surgeon of the First U.S. Army, arrived in the United Kingdom with the advance party which included his deputy, Lt. Col. (later Col.) James Snyder, MC, and the medical supply officer, Capt. (later Lt. Col.) Kenneth E. Richards, MAC.
Shortly thereafter, the advance section was joined by additional staff members from the United States and by a small combat-experienced cadre from North Africa. This cadre included Lt. Col. (later Col.) William H. Amspacher, MC, who became the Surgeon's operations officer. The Surgeon,
with his staff, immediately tackled their herculean assignment. Problems encountered in North Africa were carefully reviewed, and consideration was given to detailed planning, to adjustments for inexperience, and to the adequacy of requirements estimates.
With this approach, the First U.S. Army Surgeon's point of reference was anticipated casualties under assault conditions rather than troop strength, with medical units being assigned greater missions than contemplated under the unit tables of organization and equipment. From a supply standpoint, this procedure permitted translation of estimated casualties into materiel requirements. The First U.S. Army developed augmentation lists of items, by types of units, for incorporation into the organic equipment of First U.S. Army medical units, including equipment of other technical services; for example, Engineer generators, Quartermaster tentage, and similar items. Although these augmentation lists were made final late in 1943, items were constantly added or deleted as specific units underwent mission or organizational changes. Changes in assigned missions, changes in commanding officers, or augmentation of professional capabilities greatly influenced materiel requirements.
The original augmentation lists and their justification with materiel requirements were submitted to appropriate technical services. In those instances where requirements were approved but were not available in the United
Kingdom, the technical service had to institute a special project to ship the item requirements from the Zone of Interior. The First U.S. Army, in estimating its needs, solicited the assistance of General Hawley and his consultant staff.
Concurrently, all tactical medical units in the United Kingdom were furnishing medical service to neighboring units and participating in maneuvers and training exercises which resulted in the consumption, loss, or damage of supplies and equipment. Units, therefore, were constantly submitting requisitions to maintain their mandatory 100 percent state of readiness. Although the quantities were unusually small, the requisitions increased the line-item workload at depots, virtually saturating the budding U.K. medical depot system. This further diminished the depots' ability to cope with T/E and augmentation requisitions, with the equipping of hospitals in the United Kingdom, and with the assembly and reassembly program for OVERLORD.
The inability to obtain firm and reliable information on the status of its requisitions for organization and maintenance materiel was a great concern to the First U.S. Army. Confronted with the responsibility of reporting the state of readiness of medical supply to support an invasion timetable, the Surgeon, First U.S. Army, frequently discussed the contingencies with General Hawley, thus maintaining excellent overall knowledge of ability to support combat.11
MOUNTING CONCERN OVER SUPPLY
The apprehensions of General Hawley regarding the medical supply situation began building in the fall of 1942. In a letter of 3 November to The Surgeon General, the medical supply situation was pronounced critical.12 Because of the unreliability of British sources and the failure of complete units to arrive in the United Kingdom, it became necessary to cannibalize more than 30 hospital assemblies to complete the equipment for 11 hospitals embarking on the North African operation.
Throughout 1943, General Hawley frequently corresponded with The Surgeon General about the U.K. medical supply operations. The problem of supplying the First U.S. Army in addition to local units forced General Hawley in December 1943 to state in a letter to Maj. Gen. Norman T. Kirk, The Surgeon General, that the desperate situation was almost beyond hope. It was certain that correspondence would never reconcile the differences between the Surgeon General's Office's recapitulation of shipments to the European theater and the quantities his supply division had recorded as received in the theater. He had pointed out that if his difficulties were not rooted in the ZI system, then they had to be in the ports, in his own supply organizations, or possibly in a combination of the three. Basically, General
Hawley's problems stemmed from an insufficiency of qualified supply personnel, lack of stock, and inadequate systems and procedures.13
In January 1944, The Surgeon General decided that a team should visit the United Kingdom to survey the medical supply system. Headed by Col. Tracy S. Voorhees, JAGD, Director, Control Division, the team included Lt. Col. Bryan C. T. Fenton, MC (fig. 71), Chief, Issue Branch; Lt. Col. (later Col.) Leonard H. Beers, MAC, Chief, Stock Control Branch, who were all from the Surgeon General's Office; and Mr. Herman C. Hangen, consultant to The Surgeon General. Major Freedman, of the New York Port of Embarkation, accompanied the team to survey U.K. port activities. The team, with orders for temporary duty for 60 days, arrived in London on 27 January 1944, and proceeded to visit the supply division office in Cheltenham the next day.
After spending 2 days in Cheltenham studying each supply function and evaluating the personnel handling each operation, the team visited the depots at Taunton and Bristol and the First U.S. Army Headquarters at Bristol on the following 2 days. Colonel Voorhees then returned to London for consultations while the others visited depots, hospitals, and ports.
On 6 February, the team reassembled in London to determine a course of action as it was evident that recommendations for drastic changes had to be made. The group realized that they could be subject to severe criticism for making such recommendations after spending only a few days in the theater; however, it was clear that if more time was spent in verifying conclusions, it probably would be too late to remedy the situation. Therefore, a meeting was arranged for the morning of 8 February, when Colonel Voorhees and Mr. Hangen reported orally, from penciled notes, to General Hawley on the conclusions made by the team over the weekend. The proposals were not experimental as the supply condition in the theater closely paralleled those in the Surgeon General's Office and the U.S. depots 15 months earlier. The recommendations were patterned on the systems that had proved successful in the United States.
The first of the three recommendations concerned measures to lighten depot workloads. About 50 percent of depot work was expended in building assemblies and filling shortages of previously built assemblies, resulting in a neglected distribution function. Insufficient stocks did not permit a depot to
assemble more than 75 percent of the materiel required for a hospital unit. Back orders on components for unit assemblies were piling up and units were unable to obtain essential hospital equipment. Colonel Voorhees recommended that unit assemblies totaling 37,000 beds be shipped complete from the United States, thus relieving theater depots of a substantial workload and also providing more completely equipped hospital assemblies. This number of beds, together with those already assembled in the United Kingdom, would fully equip all hospital installations required in the United Kingdom by 1 May 1944 and those hospital units scheduled for movement to the Continent shortly after the invasion.
Similar difficulties were experienced in assembling medical maintenance units. Packing could not be standardized because stocks of components were not complete in any one depot. Proper packing material for waterproofing and easy handling was not available, and the units being packed in the United Kingdom consisted of 70 pounds of packing material and 30 pounds of supplies. It was recommended that the First U.S. Army and the Chief Surgeon's Office agree on the number of standard medical maintenance units needed and have them shipped from the United States. Units shipped from
the United States would be complete, amphibiously packed, and with a larger proportion of the weight in supplies.
A third means of lightening the workload was to relieve depots of the additional tasks caused by British procurement. Many items of British medical equipment and supplies had proved unsatisfactory as substitutes for American products and generally were not acceptable to professional personnel. British items were unlike their American counterparts because voltages differed, units of measure frequently varied, and packing was unsatisfactory. The mission recommended cancellation or postponement of deliveries on British procurement except for those items which were in short supply in the United States. On deliveries of other than shortage items which had to be accepted, it was recommended that storage space should be obtained to hold those supplies in reserve rather than as active operational stock.
Changes in Supply System
The major deficiency in the supply system was the lack of an accurate central stock control system. In numerous instances, one depot was found to have a surplus of an item while another had many back orders. Each depot took a monthly inventory, but, as there were no due-in figures and no uniform cutoff between inventory, issues, and due-ins among the several depots, these inventories were of little value. A weekly report on critical items, whose preparation by the depots required much work, had insufficient data to be of much value. A third report, a daily one on items reaching a minimum quantity, was unreliable as there was little relationship between minimum quantities and current issues.
To correct this condition, installation of a stock control system similar to that used in the Surgeon General's Office was recommended. This recommendation provided for a biweekly stock report from all depots which would be consolidated in the Chief Surgeon's Office. The consolidated stock report would form the basis for computation of quantities to be requisitioned from the United States, to distribute incoming stocks to depots more accurately, and to control stock levels.
In medical supply, many important items on which quantities issued were very small had been widely dispersed upon receipt, making it difficult to locate the item when needed. A key depot system was suggested, whereby certain depots would be given priority on incoming shipments on one or more classes of items. It was decided that dispersion of stocks would be lessened with a maximum of 20 percent of an item stock to be located in one depot.
Another serious deficiency was found in the lack of control of the levels of supplies and equipment maintained in hospitals and field units. Units, having attempted to obtain an item from one depot only to have it placed on back order, frequently went to another depot and secured the item while the original depot furnished the back ordered item when it became available. To overcome this system deficiency, it was proposed that an issue branch of the Sup-
ply Division develop stock levels for hospitals and field units, control requisitioning, and secure returns of excess stock in the hands of units.
All depots needed rewarehousing to save space and to make stock more accessible. There was no standardization of storage methods. Each depot packed according to its own design and there was no knowledge of amphibious packing methods that had been developed in the United States. To correct these conditions, it was recommended that a depot technical control branch be established in the Supply Division to develop standing operating procedures and to supervise all depot operations.
Changes in Organization and Personnel
In neither the Supply Division nor in the depots were there sufficient personnel to handle the workload. Efforts were expended in meeting emergencies without any time remaining to install proper systems and plans. Personnel were unfamiliar with the many improvements that had been made in supply management in the United States during the previous year. To improve the organization, it was suggested that the Supply Division be patterned on the organization in the Surgeon General's Office. This organization would require an additional 15 officers and 44 enlisted men for staffing the Supply Division.14
Approval of Recommendations
General Hawley accepted the proposals in their entirety. A teleprinter conversation with the Surgeon General's Office was arranged for 10 February, and a summary of the facts and conclusions was furnished, together with a request for personnel by name to fill important positions in the supply organization. The Surgeon General's Office agreed to send the personnel, including Col. Silas B. Hays, MC, for Chief of the Supply Division. Colonels Fenton and Beers and Mr. Hangen went to Cheltenham on 14 February and proceeded with the reorganization, pending the arrival of Colonel Hays. Colonel Voorhees and Mr. Hangen returned to Washington in March while Colonels Fenton and Beers remained as permanent members of the Supply Division's staff.15
REORGANIZATION FOR INVASION
On 3 March 1944, Colonel Hays, formerly of the Surgeon General's Office, was designated Chief, Supply Division, Chief Surgeon's Office, ETOUSA. The division had been reorganized into four branches-Administration and Finance, Stock Control, Issue, and Depot Technical Control. The staff was
increased rapidly from 16 to 32 officers while enlisted personnel increased from 47 to 84. Thirteen British civilians also were employed.
In addition to staffing the Supply Division in Cheltenham, two officers-Maj. W. A. King, SnC, and Capt. (later Maj.) Joseph B. Parks, MAC-with four enlisted men were attached to Headquarters, Advance Section, Communications Zone, at Bristol. Their function was establishing stock control procedures for operations on the Continent as the Advance Section assumed jurisdiction of rear areas.16
Depot System Realinement
Under the direction of Maj. Robert R. Kelly, MC, Chief of the Depot Technical Control Branch, four new depot companies (the 63d, 64th, 65th, and 66th) were organized under TOE 8-661, and five depot companies (the 6th, 11th, 13th, 15th, and 16th) were brought up to TOE strength. One company, the 8th, was deactivated. Because of wide dispersion of stocks in small medical depots and medical sections of general depots, it was impossible to employ an entire depot company at one location. As a result, depot companies did not operate as a unit in the United Kingdom, but rather were employed as an administrative headquarters for the assignment and control of their personnel.
Before D-day, there were, in addition to the companies just indicated, the 1st Medical Depot Company which was attached to the First U.S. Army, and four companies (the 30th, 31st, 32d, and 33d), which arrived in April and May 1944, for a total of 14 companies in the United Kingdom.
The 30th and 31st Medical Depot Companies were assigned to the Medical Service, Headquarters, ETOUSA, and designated for Communications Zone operations on the Continent after the invasion was underway. The 32d and 33d Medical Depot Companies were assigned to Third U.S. Army. The 13th Medical Depot Company was also designated for subsequent move to the Continent as soon as U.K. operations permitted. A key depot system was established within the distribution depots in the United Kingdom during March 1944 to overcome excessive dispersion of stocks, expedite the handling of requisitions, eliminate the large quantity of back orders, and drastically reduce extracting of requisitions to the Chief Surgeon's Office. The key depot system effectively accelerated the delivery of available supplies (table 4).
Key depots were given the highest priority for receipt of stocks from the United States. They were stocked to 100 percent of their stock levels before incoming receipts were distributed to non-key depots. Where insufficient stocks were received to fill key depot levels, the items were prorated to each key depot.
Except for assemblies, units and installations requisitioned supplies and equipment from designated area distribution depots, which virtually eliminated "shopping around" from depot to depot. When non-key depots were out of stock, the item was extracted automatically to the key depot for the area. When a key depot was out of stock, a back order was established so that
shipment would be made upon receipt of stocks. Periodically, the Chief Surgeon's Office directed key depots to extract their back orders to other depots where the stock status report indicated that stock was available.17
Medical Depot Manual
To establish uniform operations in all medical depots, a medical depot manual was published by the Chief Surgeon's Office during March 1944. This manual facilitated storage and issue operations and provided the basis for a biweekly stock reporting system, which was the feeder report for compiling the theater consolidated stock status report. Quantities due-in, quantities on hand, and back orders for each item were recorded on depot stock reports. The consolidated report was the basis for determining theater requirements and for preparing and submitting requisitions to the Zone of Interior.18
The authorized theater stock level of 75 days consisted of quantities required for 45 days of operation plus 30 days' stock as a reserve or safety level. At the beginning of March 1944, depot stocks were badly unbalanced; numerous items were on hand on which stock was small or depleted while on others, the quantities exceeded 12 months' requirements.
One major objective of the Voorhees mission was the establishment of modern merchandising procedure to control supplies and balance depot stocks. This requirement was tackled immediately by Colonel Beers, a member of the Voorhees mission. A new system which included the use of electric accounting machines was soon installed. Fortunately, machines for compilation of medical statistics were already in operation at Cheltenham. By being worked extra
shifts, these machines were able to assume the additional load of stock control. An authorized level of supply was established for each item that was to be stocked in the theater with a reorder point. The reorder point was the authorized level of supply for each item plus lagtime (the length of time from the date of the requisition to the Zone of Interior until the supplies were received in a theater depot and available for issue).
A study on the stock position of each item was made each 30 days. When stocks on hand plus due-ins were below the reorder point, a requisition was placed on the New York Port of Embarkation for replenishment in an amount sufficient to bring assets up to the reorder point. Current stock levels, which would permit flexibility and allow adjustments for changing conditions, were established by this method.
The theater stock level for each item was computed by using the authorized War Department replacement factor or, when this factor proved inaccurate, a theater replacement factor was computed on the basis of issue experience. To the authorized 75 days' level of supply was added the lagtime factor, averaging 105 days, to establish the reorder point. The reorder point was established at 180 days and the quantitative requirements were computed by using the current troop strength for the requisitioning period. The product of multiplying the average troop strength by the replacement factor was then multiplied by the number of months for which the supplies were being computed to arrive at the reorder-point quantity. Under this system, theoretically, the stock on hand of each item would fluctuate between 45 and 75 days of supply.19
Stock levels for individual depots were based on the total troop strength served by the depot. Before the reorganization, there was no stipulated level of supply for each depot. In March 1944, realinement of stocks within the U.K. depots to conform with the newly established levels under the key depot system was accomplished virtually overnight. Depots submitted current stock reports simultaneously, which were reviewed to determine the necessary interdepot transfers. Transfers were effected by trucks organic to medical units according to an exacting schedule that assured maximum payloads in each direction with a minimum of trucks and time.
Stock adjustments, sustained by accurate inventories plus improved stock control and back-order procedures, quickly eliminated major problems in the inventory control system, except for problems connected with overall stock imbalances. On 1 April 1944, stock status reports indicated that 3,603 items were in the ETOUSA medical supply system. Quantities on hand indicated that 1,473 items (41 percent) were in short supply, 214 items (6 percent) were in good supply, and 1,916 items (53 percent) were in oversupply.
Items in short supply were requisitioned from the United States and priorities were requested for prompt and early shipment. By 1 May 1944, the stock position had changed materially and the buildup of stock levels was underway. Reorganization of the stock control system had provided the Chief Surgeon's Office with the means to determine the stock on hand and the normal requisitioning requirements, and to control distribution of items in short supply. During May 1944, medical supply operations approached a near routine state. In fact, except for a few last minute actions, there was a comparative lull in the Medical Supply Division, Chief Surgeon's Office, during the 10 days immediately preceding the invasion, but the depots were still grinding out the preplanned shipments for the buildup on the Continent.20
Concurrently with the buildup of U.K. stocks in the spring of 1944, planning for maintenance support of continental operations required immediate attention. The Surgeon of the First U.S. Army was responsible for determining requirements for maintenance and replacement supplies for D-day to D+14, including Air Forces medical requirements on the Continent. The Surgeon, Advance Section, Communications Zone, was responsible for D+15 to D+41, with the Surgeon of the Forward Echelon Headquarters, Communications Zone, responsible for D+42 to D+90. Actually, representatives of the Surgeon, First U.S. Army, and the Chief Surgeon, ETOUSA, collaborated in this total work, inasmuch as neither the Advance Section nor the Forward Echelon was staffed with sufficient personnel experienced in stock control and requirements determinations. Computation and requisitioning of maintenance supplies and equipment were particularly difficult as only limited experience data were available for an operation of this type. Estimated battle losses, shipping losses, and normal maintenance based on casualty estimates were necessarily considered in computing requirements.
Following D-day, the European theater was to be involved in a dual logistical effort, with operations in the United Kingdom and those on the Continent being distinctly different in character. Separate maintenance requirements had to be computed for each area. Those for the United Kingdom were largely for fixed medical installations, such as general hospitals, while those for the Continent included the mobile units of the Armies as well as fixed installations in the Communications Zone. It was planned to support operations on the Continent from the United Kingdom for the first 90 days and then to depend largely on direct supply from the United States to continental ports.
Replacement supplies for D-day to D+14 were to consist of automatic shipments on a prescheduled basis from U.K. depots to beaches and ports on the Continent.
Colonel Rogers, of the First U.S. Army, and his staff examined the items in the standard medical maintenance unit in light of anticipated casualties
rather than the supplies required for a stated force strength. It was anticipated that peak casualties would occur during the period when forces were numerically small. Moreover, it was determined that the type A standard medical maintenance unit for 10,000 men for 30 days was inadequate and deficient in various critical items. Additional maintenance lists developed by the First U.S. Army included a divisional assault maintenance unit type D, which had two sections-one containing supplies to care for 1,000 medical casualties and the other having sufficient supplies for 1,000 surgical casualties-and a supplemental D unit containing supplies considered essential but not included, or insufficient in quantities, in the A and D units, to serve both as a supplement and a reserve. Divisional assault supplemental units carried additional quantities of material, such as plaster of paris, sheet wadding, cocoa, instant coffee, and medical gases, as insurance against extreme consumption. Also developed was a type G unit containing supplies for treating 1,000 gas casualties in the event that the enemy used poison gases.
In addition, bulk quantities of equipment were phased in which had not been included in other resupply units. Selection of the items that could possibly benefit the operation through D+30 was made by reviewing medical unit assembly equipment lists and theater augmentation lists. Quantities, to a large degree, were governed by availability and by tonnage allocation. Some portion of each item was scheduled for arrival by D+5, but no attempt was made toward uniformity of each day's shipment. Surprisingly, two of the items that proved most beneficial were washing machines and sewing machines, which were essential in maintaining the supply of linens, such as the towels and drapes for the operating rooms.
Replacement of equipment lost or damaged by troops going ashore was also computed as a maintenance requirement. Except for airborne units, it was estimated that 15 percent of the equipment would be lost on D-day, that troops going ashore by D+4 would lose 8 percent of their equipment, and that by D+10, this factor would level off at a 5 percent loss factor. Airborne replacement requirements were estimated at 100 percent. These estimates proved to be reasonably accurate.
Theater directives placed a responsibility upon the Chief Surgeon to determine and provide automatic shipment of maintenance supplies, based on phased tonnage and priority allocations authorized for medical supplies, and the phased estimate of casualties by type. Requirements for D+15 to D+90 were computed by the Supply Division, Chief Surgeon's Office.
Requirements for D-day to D+90 included 100 type A maintenance units, 114 type D surgical units, and 22 type D medical units. It was intended that all type A maintenance units were to be assembled and shipped from the United States to the United Kingdom, but sufficient quantities did not arrive in time and many had to be built in U.K. depots at the last moment. The D and the G units were assembled in U.K. depots.21
Packing and Crating
The Voorhees mission discovered that the quantity and variety of medical maintenance units included in First U.S. Army requirements for the assault imposed a significant packing and crating requirement. Also, training in the United Kingdom made it imperative that unit personnel open, inspect, become thoroughly familiar with, and repack, the equipment to be used in combat (fig. 72). Because of the concentration of troops in the United Kingdom, OVERLORD medical units supplemented fixed medical facilities by providing dispensary-type medical care to troops in the immediate staging or training areas.
For the reasons just stated, medical units, including small detachments and field and evacuation hospitals, opened their ZI waterproof-packed equipment and supplies. The Voorhees mission realized that an expanded packaging and crating program had to be generated swiftly in the United Kingdom under an experienced officer. Consequently, Capt. (later Maj.) William B. Wagner, MAC, was recommended to The Surgeon General for assignment to the Medical Supply Division in view of his experience in developing the ZI depot packing and crating program.
The ETOUSA packing and crating requirement had two separate facets: first, accomplishment of the workload by depots in packing the maintenance stocks and unit assemblies constructed in U.K. depots for shipment to the Continent; and second, instruction to unit personnel on packing their equipment for an amphibious operation. A scarcity of packing material and a narrow margin of time confronted Captain Wagner upon his arrival in the United Kingdom on 26 February 1944.
An adequate supply of sisal paper, waterproof cement, lumber or boxes, nails, and binding equipment was a prerequisite to waterproofing supplies. Since sisal paper and cement were not available in the United Kingdom, the program had to begin with available substitutes pending the arrival of stocks from the United States. Binding and marking materials and acceptable waterproof paper were available, which, together with hot tar and hot asphalt, served as alternatives. Careful reclamation of ZI fabricated boxes and insulation material, augmented by box shooks and lumber obtained from the Quartermaster Corps, provided the balance of the required material. Some additional material was obtained on the British market.
To afford further protection to individual boxes of supplies, to facilitate handling in transit, and to prevent individual packages from going astray, a skid-loading plan was developed which was patterned after that used in the Mediterranean area. The skid consisted of a platform built from 2-inch lum-
ber to dimensions of 4- by 6-feet, mounted on two 6- by 6-inch skids, which were tapered in sled-runner fashion. A heavy clevis was attached to the front to aid towing. Skid loads were approximately 5 feet high, completely covered with canvas, and banded with one horizontal and three vertical 1½-inch metal bands. Slots were cut in the top of the skid runners to anchor the vertical bands and the load.
Processing Unit Equipment
Units anticipated the need for breaking out their equipment, setting up, dismounting, and repacking for movement during combat. Mobility and the time factor would be particular problems for field and evacuation hospitals. Ordinary merchandise boxes would not suffice for repeated packing of equipment; a reusable container was required. Some units had attempted to improvise by installing hinges and hasps on discarded ammunition cases, rifle cases, and similar boxes. Generally, the improvised containers were heavy, too small, and lacked permanent waterproofing features.
One of the first actions growing out of the Voorhees mission was the dispatch of a cable to the Surgeon General's Office in February 1944 for 10,000 Wherry boxes. Captain Wagner, working with the Wherry Luggage Co., had previously promoted the development of a box that was permanently waterproofed, sturdy, lightweight, and equipped with nonprotruding handles, hasps, and hinges. The container was waterproofed by sealed seams and a combination of hasps and hinges which compressed the lid on four sides against a fixed sponge, plastic, or rubber gasket.
The boxes, usually filled with supplies to conserve shipping space, were requisitioned in February and began arriving in the United Kingdom during March. They were distributed immediately to all medical units for the repacking of their equipment and supplies.22
Assembly for Prescheduled Shipment
By 1 May 1944, the maintenance supplies required for D-day to D+15 were assembled and packed on skid loads. All maintenance supplies required for shipment to the Continent before D+60 were amphibiously packed to withstand wave action and 90 days of open storage. Many of these supplies were packed in the Wherry boxes.
A total of 955 skid loads, approximately 725 long tons, was assembled and scheduled for movement from specified depots to designated ports of preloading well in advance of D-day. Included in the skid loads were 30 type A maintenance units, 92 surgical divisional assault units, 22 medical divisional assault units, 30 divisional assault supplementary units, and 10 gas casualty units. An additional 2,400 skid loads of medical supplies were packed by U.K. depots and shipped to the beaches during the first 60 days of the invasion.
Skid loads, although unwieldy and requiring a crane for loading and unloading, provided a means to keep a balanced functional supply unit together during the early days of the invasion. Where there were surgical needles, there were always sutures; administration sets accompanied solutions. Instruments for surgical needs were kept together. Sufficient skids were built for the using units because many loads were eventually broken down, and the individual items were placed in depot stocks on the Continent.23
Medical Tonnage Allocation
In planning the cross-Channel assault, combat elements and weapons commanded top priority in tonnage allocations and dictated the total shipping space that could be assigned to supply support and for the buildup of stock levels on the Continent. The allocation for medical supplies (not including unit equipment) was limited to 100 tons per week during the assault phase.
In early April 1944, G-4, Services of Supply, directed each technical service to submit a schedule showing the weight and cubage to be shipped to the Continent, based on the tonnage allocation for D-day and for each subsequent day to D+30, and identified with the shipping depot. Such information was essential for determination of "goods wagon" requirements, rail shipping routes, traffic control, ship space, berthing of vessels for preloading, and port of return for reloading of vessels. Unfortunately, the G-4 deadline for the technical service schedule came before the Medical Department could effect a final stock check and assign the total assembly skid-loading program to depots. The skid-loading program had been started by the Medical Department before the reporting date, however, and the experience offered an excellent basis for calculating the weight and cubage of daily shipments. The shipping depot was not so easily determined.
Supplementary Means for Assault
The total calculated medical resupply requirements consisted of an average of .333 pounds per man per day up to D+51. The medical supply tonnage allocation priority during the assault phase, however, was considered dangerously close to the estimated requirement, leaving little margin for error. Moreover, Major Richards, the First U.S. Army medical supply officer, was reluctant to assume that all allocated tonnage would arrive on the beaches as scheduled. Some alternate method had to be found to phase in auxiliary maintenance supplies to assure support of the anticipated casualty rate during the first day of the invasion. As a result, new items were developed which greatly aided early medical support.
Mortar shell cases-The mortar shell case medical package designed for the assault troops was comprised of a special waterproofed unit of medical supply which would float and would serve as a life preserver for an individual. A unit consisted of seven specially treated mortar shell cases, each of which
contained several items (fig. 56, p. 234). These units were issued as follows: one unit per infantry battalion, artillery battalion, chemical battalion, engineer battalion, and ranger battalion; two units per divisional collecting company; four units per divisional clearing company; six units per medical battalion (Engineer special brigade). Additionally, units were loaded aboard every conceivable type of vessel moving to the far shore through D+5. Personnel on board were instructed to drop the units on the far shore or overboard close to the shoreline and to rely on the tide to carry them ashore.
Assault vest and maintenance units-The assault vest was merely a hunter's vest that the medical supply officer of the First U.S. Army had had fabricated to increase the carrying capacity of the medical aidman during the initial assault. The many-pocketed vest accommodated small medical items peculiar to the aidman's kit.
The two-man carry maintenance unit was designed to provide a substantial quantity of fast-moving items to the medical units that accompanied various assault forces. The items were packed in boxes that could be carried ashore and overland for a reasonable distance.
The purpose of these little units was to breach unforeseen weakness of the medical units' reserve supplies and to assure availability of the selected items through the first few days of the anticipated confusion. The units proved extremely valuable in the early hours of the assault because of the delay in unloading medical supplies. Many floating mortar cases were found by the advance detachment of the 1st Medical Depot Company in establishing its medical supply dump on D+3.24
Army-Navy exchange units-Designed primarily as automatic resupply of the property exchange items dissipated during the early stages of evacuation to the United Kingdom, each unit consisted of 100 litters, 320 blankets, 4 splint sets, 3 boxes of surgical dressings, and 96 units of normal human plasma. The proposed number of units precluded their movement within the space allotted to Medical Supply, so arrangements were made with the U.S. Navy to place one unit aboard each of the first 100 LST's (landing ships, tank) moving to the Continent. The Medical Supply Division was to find ways and means for delivering the remaining 200 units, which were moved as rapidly as possible on hospital ships and other vessels embarking for the Continent.
Equipping First U.S. Army units with their authorized equipment was the first major task during the buildup period. In February 1944, orders were issued by First U.S. Army Headquarters for a showdown inspection by all units to determine if any shortages of items were authorized by appropriate tables of equipment, tables of basic allowances, or by theater directives. Issue of equipment against unit shortages presented some problems. The heavy telephone traffic, the lack of transportation, and the continued movement of units from the campsite to another in the United Kingdom made it difficult to place available items in the hands of units within a reasonable period of time. To
alleviate this condition, Major Richards arranged for the 1st Medical Depot Company to consolidate the shortage requisitions from all units for presentation to depots and to pick up and deliver the items to the units.
The same method was used by Third U.S. Army's 32d and 33d Medical Depot Companies during April and May 1944. These companies, used as distributing units in southern and central England, received and consolidated requisitions from units within their areas, presented the consolidated requisitions to depots, and picked up and distributed the supplies to the units. This procedure was eminently satisfactory as it reduced the pressure on U.K. depots and eliminated many distribution problems.
Problems Under the Preshipment Plan
The most serious problem on the preshipment plan was the short period between the discharge of the cargo in the theater and the arrival of the unit. The plan was predicated upon the arrival of the equipment at least 30 days in advance of the unit, but changes in tables of equipment, frequent delays in transit, and losses and damage to equipment caused many difficulties. Deficiencies in packing major items of equipment, such as X-ray, were frequently experienced.
Constant reorganization of tables of organization and equipment of units by the War Department was a major problem. Frequently, the equipment was shipped under an old table of equipment while the personnel were organized under a new table. At times, the theater was not aware of the change until the movement order for the unit was received identifying a new table of equipment. This difficulty was eventually corrected by the establishment, with War Department approval, of a list of T/E's, which were applicable in the theater regardless of those listed in the War Department movement order. The Medical Department promoted this method through G-4, Services of Supply.
Another difficulty during this period pertained to War Department publications, including the Army Medical Bulletin, which often listed and highly recommended various new items long before their availability in the theater. The Supply Division and depots were constantly besieged with requisitions for such items, and professional personnel could not understand the reasons for nonavailability of the item in view of the official publication.25
Augmentation Equipment for Units
Issue of field equipment to units was not complete, however, with the furnishing of initial equipment authorized by tables of equipment or tables of basic allowances. Supplementary lists of material for units and provisional units had to be dealt with immediately. For the most part, medical items so authorized were filled from stocks available in the theater.
An authorization for equipment in excess of tables of equipment was established for such units as evacuation and field hospitals, infantry, airborne and armored divisions, convalescent hospitals, engineer combat groups, auxiliary surgical groups, and medical depot companies. As an example, the medical battalion of the Engineer special brigade was authorized X-ray and fluoroscopy units, oxygen therapy apparatus, anesthesia apparatus, and accompanying auxiliary items. As this organization was to be the first medical unit ashore in the assault phase, it needed the essential equipment to provide more definitive medical service.
During a similar landing operation in the Sicily Campaign, a critical need existed for X-ray equipment to determine the presence of shell fragments in wounds, and for inhalation anesthesia. The anticipated isolation of airborne units from the main invasion body was another consideration in furnishing items in excess of allowances to those troops. Hence, mission requirements became a determining factor in augmentation issues and in establishing the need for additional quantities of medical supplies and equipment.26
Arrival of Third and Ninth U.S. Armies
When additional Army headquarters arrived in 1944, the tactical units were reallocated and each Army proceeded to determine its own T/E augmentations according to its mission and the Surgeon's estimate of the situation. To some degree, this was equivalent to designing separate T/E's for the medical units of each Army. Some complications resulted when units were shifted between Armies before D-day, and a transfer of augmentation material was necessary. The three different standards for T/E supplementation supplies necessitated an increased line item stockage in Communications Zone depots.
The difficulties experienced in furnishing augmentation equipment to First U.S. Army medical units had some repercussions. Col. (later Brig. Gen.) Thomas D. Hurley, MC, Surgeon, Third U.S. Army, contacted the Supply Division, Chief Surgeon's Office, immediately after his arrival in the United Kingdom with the advance party, on 23 March 1944, expressing anxiety over medical supply. Before his departure from the United States, Colonel Hurley had learned of the Voorhees mission and the heavy supplementation program for First U.S. Army units, which caused him to question the capability of General Hawley's Supply Division to render adequate medical supply support to Third U.S. Army units. It was necessary to assure the Third U.S. Army Surgeon that assets were available and that the Supply Division was ready to support initial issue and supplementary requirements. The same task was performed when Col. William E. Shambora, MC (fig. 73), Surgeon,
Ninth U.S. Army, arrived in the United Kingdom with similar apprehensions.27
Supply of Units Reaches Peak
As preparations continued, all units became supersensitive to supply problems and the Chief Surgeon's Office was flooded with requisitions for shortages. Requisitions were to be funneled through parent organizations in accordance with theater directives. Despite these directives, the requisitions of many units came directly to the Chief Surgeon's Office. Unfortunately, many requisitions were submitted before the units were alerted; then, upon being alerted, units were instructed to hold showdown inspections and submit requisitions for all items not on hand. Duplicate requisitioning resulted when units had not picked up the items at depots before submitting the second requisition. Furthermore, virtually every unit, regardless of size, submitted a number of showdown requisitions before its departure from the United Kingdom. One division submitted 15 showdown requisitions within 18 days.
The significance of these actions can best be exemplified by the fact that U.K. depots were carrying hundreds of items on their shipping floor awaiting pickup. Major Winegard, at Depot G-35, first brought this situation to the attention of the Chief Surgeon's Office, ETOUSA, in late March 1944 by reporting that he had more than 2,000 items awaiting pickup. A policy of early cancellation of all such shipments permitted recovery of many items in short supply.28
Availability of stocks ceased to be a major problem toward the end of May 1944. It was necessary at times, however, to pick up equipment from discharging vessels to fill shortages in organizational equipment for high-priority units. Also, it was necessary occasionally to divert equipment from low-priority units to others of higher priority. The perpetual problem throughout this period was transportation. Rail transport of less than carload lots was impractical. As a consequence, all U.K. depots were instructed to ship to field units by truck and, wherever possible, to have the items picked up by the organization. The First U.S. Army organized trucking companies into distributing units for pickup and delivery of supplies to units after unit transportation had been processed for shipment to the Continent and was not available for this purpose.29
SUPPLY IN FIXED INSTALLATIONS
In fulfilling the supply requirement for new hospitals and bed expansion to meet the anticipated casualty load, it was necessary to resolve two major problems concerning the proper distribution of equipment.
Split shipment of unit equipment when it was loaded on two or more ships in ZI ports and discharged at separate U.K. ports was the first problem. This dilemma had been the subject of much correspondence between the Chief Surgeon, The Surgeon General, and the New York Port of Embarkation. A representative of the port visited the theater with the Voorhees mission to study the problem, which apparently was resolved by the New York port in April, when shipments of unit assemblies began to arrive in the theater intact.
A second problem concerned the retention of all components of the unit assembly in one place for shipment to its destination. This handicap required action within the theater. A study was made of the availability of hospital plant sites, and the plausibility of shipping unit assemblies from U.K. ports directly to operating sites. Except for those assemblies which were to be stored in depots pending transshipment to the Continent, direct shipment of assemblies to operating sites would permit bypassing medical depots which were heavily engaged in preparations for Operation OVERLORD.
Consultations with port commanders at Bristol, Cardiff, Newport, Swansea, Hull, and Liverpool, and with the Transportation Corps established
the feasibility of the plan, and a standing operating procedure was developed, placing the plan in effect. The Chief Surgeon's Office was required to notify port commanders of the identity of the unit assembly and the appropriate destination so that a timely levy could be made on the Transportation Corps for rail transportation. Railroad cars were switched onto quay side so that the unit assembly was discharged directly from ship to car. Each port was staffed with a Medical Administrative Corps officer and several enlisted personnel to assist in maintaining the integrity of each unit assembly.
Because construction of the new hospitals was incomplete, unit assemblies were shipped directly from the ports to the hospital sites and stored there, pending availability of the buildings.
Medical depots sent representatives to the site to tally-in the equipment, check it against shipping documents received from the port, arrange for proper storage and protection of the assembly, and, finally, turn over the equipment to the unit upon its arrival. This procedure operated effectively and in no instance was the opening of the hospital delayed because of lack of medical equipment.
Sixty-eight hospital assemblies were received from the Zone of Interior between 30 March and 25 May 1944, comprising 53,300 hospital beds. These shipments included twenty-nine 1,000-bed general hospital assemblies and eight 750-bed station hospital assemblies required to complete the hospitalization program in the United Kingdom.30
Supply of Air Forces Units
Supply of Air Forces units differed from ground and service units. Dispensaries at Air Forces bases were operated under the direction of the Air Surgeon although all hospitalization of Air Forces personnel was provided by station and general hospitals in Services of Supply. Distribution of medical field equipment and maintenance supplies to Air Forces units was effected by aviation medical supply platoons, which drew their supplies from the U.K. depot system.
Problems between Air Forces authorities and General Hawley over the equal distribution of supplies was the subject of many letters to The Surgeon General during 1943. However, after numerous conferences, stocks in the U.K. depot system reached a reasonable level in mid-April 1944, and there were few difficulties in furnishing support for Air Forces units.31
Special Supply Projects
Furnishing organizational equipment to units, including items in excess of allowances, did not completely fulfill the need for essential equipment
required for the medical care of anticipated casualties on the Continent. The nature of the assault, a combined amphibious and airborne operation, the magnitude of the troop strength, and the anticipated resistance by enemy forces caused planners in the Chief Surgeon's Office and in the First and Third U.S. Armies to request additional equipment for medical support purposes.
A group of projects, established under the direction of G-4 to support operations, were known as PROCO (Projects for Continental Operations) projects, which included medical as well as other technical services equipment required by medical units. These projects included the mounting of X-ray equipment on trucks to provide six mobile X-ray units for support of the First and Third U.S. Armies, the provision of equipment for establishing blood banks in the United Kingdom and on the Continent, and the equipping of vehicles with medical items for mobile surgical units. PROCO requirements for tentage,32 tent stoves, and other items of hospital equipment rose steadily as D-day approached.
SUPPLY POINTS IN MARSHALING AREAS
Advance supply points, operated by detachments of the 66th Medical Depot Company, were established at Dorchester, Totnes, and Plymouth in the Southern Base Section to support units massing for the assault. Three supply points were established also in hospitals at Govilon, Carmarthen, and Rhyd Lafor in the Western Base Section, which played a lesser role in marshaling troops (map 12).
These supply points furnished initial equipment and supplies to camp dispensaries and first aid stations. They also served as resupply points for field hospital's and other medical units in the area. Small quantities of equipment were made available at these points for units passing through the marshaling area. All embarking troops were provided with motion sickness preventive capsules.
The supply points had several postinvasion responsibilities, including storage and issue of penicillin and whole blood to area field hospitals, hospital carriers, and LST's returning to the Continent after discharge of casualties. Dumps for issue of exchange items were established in the proximity of ports and quays.33
ITEMS HAVING SPECIAL SIGNIFICANCE
Although the perplexities in equipping units and fixed installations and in establishing an adequate supply system absorbed the major efforts of the Chief Surgeon's Office and the depots, some individual items, because of their characteristics and importance, required special handling or different procedures. As each item required professional and technical guidance from the consultants to the Chief Surgeon, the procedures varied on the basis of the professional application or item characteristics.
The Chief Surgeon directed that whole blood for treating casualties would be available at all evacuation echelons down to, and including, division clearing stations and that the shipment of this perishable product would be handled through supply channels.
As a result, the First and Third U.S. Armies were authorized to establish whole blood sections in their medical depot companies and to requisition the necessary equipment and personnel.
Plans provided for maintaining a supply of whole blood at the quays and ports for issue to LST's and hospital carriers for shipment to the Continent as well as for use during the evacuation of casualties.
High priority air shipments of whole blood to the Continent were arranged by G-4, Services of Supply, and 4,000 pounds of critical medical supplies were airlifted to the Continent daily (fig. 74). The medical section of Depot G-45, 3 miles from the airfield at Greenham Common and 38 miles from the ETOUSA Blood Bank at Salisbury, was the receiving and shipping agency. 2d Lt. (later Capt.) Robert E. Pryor, MSC, the officer in charge of air shipments, demonstrated initiative and ingenuity, a major contribution in moving many tons of critical medical supplies to forward areas during the early days of invasion and, later, on the Continent.34
In addition to whole blood, the item that had a dramatic impact on the care of casualties was penicillin. Early in 1943, the European theater began receiving small quantities of this antibiotic. A professional controversy ensued
because penicillin had not been tested adequately and its potency period and prophylactic and therapeutic actions were not fully known. Moreover, the lack of experience concerning the proper storage and preservation of penicillin created some problems. During most of the war, it was stored under refrigeration in the belief that this would lengthen its potency period.
Not until April 1944 was the supply of penicillin ample to meet requirements; in June 1944, authority was granted to medical units to obtain the item through normal requisitioning procedures. General and evacuation hospitals were authorized stock levels of 100 ampules; station and field hospitals, 50 ampules; and dispensaries, 10 ampules. Plans were established for the automatic daily shipment of 3,000 ampules of penicillin to the Continent beginning on D-day. The daily quantity was increased to 5,000 ampules at D+17.
As the production of penicillin was accelerated in the United States, ETOUSA requirements expanded, as evidenced by the quantities received and requisitioned. A total of 3,500 ampules were received in March 1944, which increased to 15,000 during April and to 30,000 in May. Requisitions were submitted to the Zone of Interior for 550,000 ampules for June delivery and 800,000 ampules for July. On D-day requisitions were submitted to the Zone of Interior for 900,000 ampules for August loading and 1 million vials for September loading.
Because of the meager production of penicillin in the United States in its earlier days, close control on its use was necessary. The Chief Surgeon's Office, on 16 September 1943, issued instructions as to storage, issue, and administration of penicillin, limiting its use to three main groups of cases in which the antibiotic was of greatest value. The cases indicated were those in which life was threatened by an overwhelming infection; those which, though not immediately life-endangering, showed symptoms of acute or chronic infection not curable by usual treatment procedures; and cases of chronic gonorrhea that were resistant to sulfanilamide. For the latter group and for chronic diseases not endangering life, outdated penicillin could be used, but should be so noted on clinical records.
The dramatic effect of penicillin had even diplomatic reverberations. A stock level of 200 ampules was established at the medical section of Depot G-50 for issue to allied embassies and missions. This level was reduced later to 20 ampules as the need was not so great as anticipated.35
Although Army and Air Forces personnel were issued spectacles to correct visual acuity deficiencies before their deployment from the United States, there remained in the United Kingdom a large and increasing workload for replacement and repair of spectacles.
Optical units of the medical depot companies were consolidated in 1943 into the ETOUSA Base Optical Shop at Blackpool. As the buildup of the invasion forces progressed, the spectacle workload increased until June 1944, when a total of 15,000 pairs of spectacles were fabricated, not including approximately 225 pairs per month of bifocal spectacles procured from Theodore Hamblin, Ltd., in England. A total of 40,400 pairs of spectacles were fabricated in the first 5 months of 1944.
During this period, plans were developed to establish a base optical shop on the Continent and one for each medical depot company designated for continental operations. There was to be a mobile optical repair unit in the base platoon and two portable optical units in each of the advance platoons. Experience by the British in North Africa and Italy and by the Fifth U.S. Army in Italy indicated that facilities for repair and maintenance of spectacles should be provided to the Armies as far as possible, preferably in combat division areas.
The 1st, 11th, 13th, 15th, 30th, 31st, 32d, 33d, and 66th Medical Depot Companies each activated one mobile optical unit, consisting of one officer and six enlisted men and two portable optical units of two enlisted men each. The Base Optical Shop was responsible for determining that optical personnel were adequately trained to function under field conditions and that equipment was ready for operations.36
Gas Mask Inserts
Gas mask lens insert fitting cases were stocked by the ETOUSA Base Optical Shop and distributed to station and general hospitals in the United Kingdom designated by the theater chief consultant on ophthalmology to function as centers for fitting of inserts. Personnel requiring lens inserts reported to the nearest fixed hospital with their spectacle prescriptions and their properly fitted lightweight service gas masks for appropriate fittings.37
Supply of artificial eyes was another item that required special procedures. During 1943 and early 1944, artificial glass eyes were procured by sub-
mitting requisitions to the British Ministry of Pensions, with patient fittings arranged at the most convenient optical appliance depot.
In 1944, following the development of the acrylic eye, 13 dental officers were trained in fabrication of the eye and then stationed at 13 general hospitals in Great Britain. The material for acrylic eyes was generally procured from the British through reciprocal aid procedures. The Chief Surgeon issued instructions to all medical facilities that artificial eyes would be available in two types: the glass eye, and the acrylic or plastic eye. Instructions indicated that acrylic eyes were preferred and that patients should be transferred as early as possible after enucleation of the eye to the nearest general hospital that had dental officers trained in the construction of acrylic eyes. In 1944, the Base Optical Shop stocked glass eyes and furnished hospitals with an assortment of eyes from which the medical officer could select the color and size for each patient.38
Because the chief of the Medical Supply Division considered it essential to coordinate all requirements for certain basic nonmedical items from other supply services, 2d Lt. (later Capt.) Russell S. Kribs, MAC, was appointed to coordinate blank form requirements with The Adjutant General. These forms, including emergency medical tags which were placed on casualties, clinical records, and laboratory and X-ray report forms, were essential for proper medical care and evacuation of patients.
Having been informed by Lieutenant Kribs that the stock level of forms was seriously low, The Adjutant General transferred the responsibility for these forms to the catalog and equipment list section of the Medical Supply Division. Those forms not available were sought in the Zone of Interior, and small air shipments were made to temporarily sustain the U.K. operation. Local production of forms was imperative although the section's printing capability was concentrated in two borrowed and badly worn Gestetner Mimeograph machines and a small supply of low grade sulfite Mimeograph paper.
A survey of local procurement sources revealed that neither paper nor time was available to print the thousands of forms required to support continental operations. Lieutenant Kribs' appeal to friends in the Quartermaster section elicited four new Gestetners and a limited amount of paper. Through scrounging efforts and trading of two borrowed Gestetners and other less essential equipment for paper, production rapidly reached the U.K. consumption rate, but there were countless complaints about the quality of the printing and the paper.
To improve the quality of the forms and to increase production, a Multilith offset printer was "borrowed" from the Air Forces, and needed plates
were obtained on a loan basis from the Multigraph Corp. Paper was also obtained from AG Publications in exchange for "machine time."
After shifting of personnel and many minor trials, the initial requirements for medical forms were delivered to the First U.S. Army medical supply officer for distribution 3 days before D-day.39
FIRST U.S. ARMY SCHEME OF SUPPLY IN COMBAT
Increase in Supply Levels
The First U.S. Army Surgeon considered the standard equipment lists for field and evacuation hospitals and the tables of equipment for divisional and smaller medical units as insufficient for those units supporting the early assault because of the chance of temporary isolation. With that in mind, certain hospital expendables were increased from a 10-day to a 15-day level and all other medical units in the assault were raised from a 3-day to a 5-day level. Without a counterbalance, the increased weight and cubage would have violated the shipping allocation for tactical hospitals and exceeded the capacity of organic transportation of all other medical units. Every means to reduce weight and cubage was exploited.40
Resupply plans indicated that from D-day to D+14, 2 days' supply of essential items would be available on the beaches, building up with the various types of maintenance units to 7 days of supply by D+20. In addition, there would be the bulk shipments of critical items on which abnormal consumption rates were expected-litters, blankets, surgical dressings, and other items to be laid down in the LST Army-Navy exchange units. Also, gas casualty maintenance units were to be delivered to the far shore and held in reserve by the 1st Medical Depot Company. If not used, they were to be turned over to Communications Zone depots when the depots arrived on the Continent.41
Plans for Operation OVERLORD
All divisional units were to inform the division medical supply officer of their requirements, and he would consolidate divisional requirements and draw in bulk from the nearest Army medical supply installation, for breakdown and reissue to divisional units. Other units were to draw directly from the nearest medical supply points. Requisitioning was to be on an informal basis, and oral requests would be acceptable. During emergencies, units normally would use their own transportation to pick up medical supplies, but would be
supported by corps, army, and depot transportation where situations warranted such action.
Medical Department items in need of repair and maintenance were to be turned into the base section of the depot. All generators would be maintained by the Engineer maintenance companies.
Captured enemy medical supplies and documents were to be preserved and reported to the Army medical supply officer, who would receive samples of lots of biologicals and vaccines, for use in the care of prisoners of war and German civilians.
Although the blood detachment was attached to the depot company, it would be based with the major medical unit nearest the servicing airstrip. Deliveries of blood were to be made daily, upon receipt of the blood, based on premapped routes, and in quantities commensurate with the casualty load of each medical unit.42
APPROACH OF D-DAY
Except for those depots scheduled for the rearmost phasings, U.K. medical depots had virtually completed the assembly of automatic supply shipments by May 1944. Many prepackaged units of supplies were on their way to southern ports, with some already preloaded aboard ships. By 1 June, the supply points to support embarking troops were established and stocked as preinvasion actions were virtually completed.
General Hawley, in a letter to General Kirk on 3 June 1944, wrote:
We are all set for the kickoff and I, personally, feel as nervous as players usually feel just prior to the whistle. I have just completed a tour of inspection of all of our field hospitals and evacuation hospitals on beaches and hards and all the transit hospitals which will first receive casualties from overseas. The arrangements are everything that I could desire. You would be very pleased to see the fine mobile units and how they are set up for business. We have just barely squeaked through on our supply situation. I shall not, however, breathe really easily about it for another month.
In a relatively short time, the actions taken by the Surgeon General's Office, with their genesis in the Voorhees mission, had transformed medical supply from an understaffed, floundering system in an untenable position, to a proud and well-integrated organization that could detect its problems, and take the necessary and swift corrective action.43