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Chapter XIX





In view of the fact that, in conformity with existing Field Service Regulations, which prescribed that the chief surgeon of a field army concern himself only with the broad principles underlying Medical Department administration without maintaining an office of record, the chief surgeon, A. E. F., delegated to the surgeon, line of communications, the immediate charge of medical supplies of the American Expeditionary Forces, and of the further fact that, in the reorganization of the American Expeditionary Forces, in accordance with General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918, the chief surgeon, A. E. F., came to occupy the dual office of chief surgeon, A. E. F. and Services of Supply, it is in the interests of clarity to relate in so far as supplies are concerned, first the office organization of the chief surgeon, A. E. F., then that of the surgeon, line of communications. Following this, consideration will be given to the border questions concerning medical supplies; however, in so doing no effort will be made to differentiate, as controlling influences, the two offices referred to.

Two experienced medical supply officers, having arrived in the American Expeditionary Forces on July 18, 1917, the senior of  these was made the surgeon, line of communications;1 the other, the officer in charge of the medical supply depot which had  been established at Cosne.2 The surgeon, line of communications, had brought with him from the United States a small but especially chosen detachment of Medical Department enlisted men, a part of which he kept with him for his own purposes, the remainder being assigned to the medical depot at Cosne.2

There now was necessity, in the office of the surgeon, line of communications, for not only divisions paralleling those of the office of the chief surgeon, A. E. F., but for additional ones as well. These were the divisions of supply and of transportation, and they were organized accordingly.2

It is necessary here to explain that, at the time in question, the officers of both the chief surgeon, A. E. F., and of the surgeon, line of communications, were not only in Paris but also they were in the same building there; consequently, though they were separate, in effect the separation was to a lesser extent than one would suppose. It was definitely understood, however, that the surgeon, line of communications, in his capacity as such, was directly responsible for all questions pertaining to supply, with the exception of purchases abroad, which will be referred to below. This brought under his control the medical supply depots, and by this his responsibility was made to include distribution as well as procurement.

Initially, the amounts and kinds of medical supplies were prescribed in certain tables which appeared in the Manual for the Medical Department. All


Medical Department units of the American Expeditionary Forces were field units, consequently, medical supplies were initially provided for them3 and in theory were taken by them to France. In this connection, however, two factors influencing the medical supply question of the American Expeditionary Forces must be taken into consideration. It was known from the first that, because of the wide separation of our field of operations from the United States, a more prolonged and a higher quality of hospital treatment of our sick and wounded in France would be necessitated, thus creating the necessity for more and a wider variety of medical supplies than had been contemplated. Furthermore, in view of the fact that there was a shortage in shipping facilities, there was every necessity for obtaining abroad as many articles for our purposes as would, by so doing, obviate the necessity for having them sent from the United States, thus releasing so much tonnage space for other and more urgent purposes.4

The supply situation of course pertained to all supply branches of the American Expeditionary Forces, and to obviate their entering the European markets as purchasers without regulation and coordination, thereby being thrown into competition not only with themselves but with buyers from the Allied armies and the civil population as well, General Pershing, in August, 1917, created a general purchasing board for the American Expeditionary Forces.4 Since each supply department of the American Expeditionary Forces was to be represented upon this board, the chief surgeon, A. E. F., appointed a medical officer, known as medical purchasing officer, to represent him on the general purchasing board.5 In view of the fact that the general purchasing board functioned under general headquarters, A. E. F., the medical purchasing officer consequently was answerable to the chief surgeon, A. E. F., in the performance of his duties, rather than to the surgeon, line of communications, in whom, it may be recalled, was placed the responsibility for procurement as well as the storage and distribution of medical supplies. As it eventuated, however, it was not unusual for the medical purchasing officer to adopt the less time-consuming method of having the surgeon, line of communications, approve his action in so far as purchases were concerned.2 This practice, begun after the removal of the office of the chief surgeon, A. E. F., to Chaumont, and while the office of the surgeon, line of communications, was still in Paris, continued thereafter without objections being made to it.

In November, 1917, the chief surgeon, A. E. F., established in his office at Chaumont a division of supplies.6 It was not his purpose to duplicate the activities of the division of supplies in the office of the surgeon, line of communications, and for that reason the office force of the division of supplies at Chaumont never assumed similar proportions. However, since matters pertaining to medical supplies were constantly being presented to the chief surgeon, necessitating detailed study before being acted on, and other matters of equal importance were occupying the complete attention of all the existing divisions of his office, the necessity for a supply officer could no longer be disregarded.

There was now, that is, about December 1, 1917, a supply division in the chief surgeon's office, A. E. F., whose function was acting upon questions of equipment, supply and transportation, and the division of supply in the office of the surgeon, line of communications, whose function was similar, with the exception that it did not act upon matters of transportation.


In the division of supplies, chief surgeon's office, A. E. F., routine matters, such as approval of the many requisitions for medical supplies that were received from tactical units in the advance section, were looked after. In addition, however, early efforts were made to establish a policy of supply. This necessitated a number of studies, chief among which were those with reference to the general organization project and the priority shipment schedule.

It is not surprising that, with the existence of the two supply divisions, misunderstandings and seeming duplication of effort should arise. The following letter from the surgeon, line of communications, explains his conception of the existing situation:

France, February 14, 1918.

From: The chief surgeon, L. of C.
To: The chief surgeon, G. H. Q., A. E. F.
Subject: Centralization of supply control.

1. Upon several previous occasions I have transferred to you communications illustrating the difficulties and delays inherent in our present system of supply with more or less divided control. I feel it incumbent upon me now to make representation to you concerning the general situation, to submit my recommendations for your consideration, and to request your decision. I do this because I am firmly convinced that the efficient and smooth working of the supply system demands unified control of all issues, and will more and more require it as the demands increase.

2. While the individual instances are not important in themselves, an accumulation of them works confusion in the minds of the officers affected and thus lessens efficiency. A recent instance is this: I received and acted upon a request from the gas officer for purchase for his laboratory. I am informed by Major Card that other copies of the identical communication were referred to you and acted upon-your action differing slightly from mine.

Purchases.-I have upon a number of occasions made purchases in France or England for stock, although this is, under the provision of general orders, placed directly under you. This matter should certainly be centralized, as I have previously written you, and I am convinced that it should be placed in this office.

More and more the purchasing officer has referred direct to this office questions of purchase, although he is immediately under you. This has probably resulted from the proximity of the offices in Paris. But more and more, too, you have been sending communications to Major Card through my office, not only for my information but for action. This I believe to be a tacit recognition of the advantage of the purchasing office being part of mine.

Red Cross.-The present situation is confusing I am sure, not only for me but for the Red Cross as well. A typical instance is the correspondence on mobile laundries referred to me under date of February the 13th.

I am informed that requisitions approved by division surgeons are being sent directly to the Red Cross. Inasmuch as these divisions are also making requisition upon the supply depots under my jurisdiction, there is no way of preventing duplication. This duplication I have attempted to prevent on the line of communications by directing all requisitions to the Red Cross to be sent through my office. Upon receipt they are referred to the supply depot for issue if the stock is available. The Red Cross is not called upon unless our depots can not supply the material.

Divisions.-All requisitions for whatever material should, in my mind, be referred to the depot, and if the material can not be supplied at that point should be referred to my office for suitable action-purchase or reference to the Red Cross, as seems best.

3. While under these suggestions I seem to be taking over a good many of the functions heretofore exercised by you, it is only because I believe that I am thereby relieving you of the details.


4. The needs of the Army as a whole or of any division thereof would be indicated to me, and it would become my duty to supply those needs getting the material from whatever source was available.

     Colonel, Medical Corps, United States Army.
 [First indorsement]
  G. H. Q., A. E. F., C. S. O., France, February 20, 1918.

To Col. F. A. WINTER, M. C., Chief Surgeon's Office,

   U. S. P. O. No. 717, A. E. F., France.

1. It is assumed that the questions raised above will be automatically settled when the supply division, C. S. O., S. O. R., has been reorganized according to plans now contemplated and becomes operative thereunder.

By direction of the chief surgeon:

A. P. CLARK, Major, Medical Corps.

As is indicated in the indorsement to letter above quoted, at this time plans had been consummated for the removal of the office of the chief surgeon, A. E. F., to headquarters, Services of Supply, there to be combined with the office of the surgeon, line of communications. Subsequently to this combination, effected on March 21, 1918, there was but one division of supplies for the Medical Department;2 however, in view of the interest of the Medical Department in getting its supplies shipped from the United States to France, the chief surgeon, A. E. F., upon the removal of his office to headquarters, Services of Supply, left a medical officer at Chaumont to represent him in the first section of the general staff, general headquarters, A. E. F., since all questions relating to ocean tonnage were handled in that section.7


As previously stated, the policy of buying everything possible in Europe that would effect a saving in ocean tonnage was established early in the American Expeditionary Forces. But in so far as medical supplies were concerned it soon proved that European markets were practically depleted and thus would be unreliable as a possible source of supply.8

Upon the organization of the general purchasing board, and the assignment thereto of a medical purchasing officer, a copy of the Medical Department supply table, as it appeared in the Manual for the Medical Department, was furnished the board, with the view of having the possible European sources of supply canvassed to secure whatever articles were available.2 It soon proved that none of the desirable articles could be obtained in this manner without a replacement of raw material; consequently, though arrangements were made later, through the general purchasing board, to procure such raw material, much of the work of the medical purchasing officer during the fall of 1917 was confined principally to the making of small purchases in Paris to meet the pressing needs of the different professional services of the Medical Department, as well as those of medical officers, and to the procurement of necessities, in small amounts and from time to time, pending the arrival from the United States of similar articles or material.2

After arrangements had been made for the procurement of raw materials, large purchases of such articles as bed frames, mattresses, pillows, sheets, crockery, and tableware were made in England and in France.2


In addition to purchases made by the medical purchasing officer, purchases were made locally by certain officers of the Medical Department, authority therefore being given from time to time by the chief surgeon.2 Thus on December 15, 1917, the surgeon, line of communications, authorized commanding officers of base hospitals to expend Medical Department funds for articles properly chargeable to the funds appropriated to that department.2 Such expenditures were not to exceed $100 per month. On January 28, 1918, division surgeons were empowered by general headquarters, A. E. F., to authorize medical officers under them to make expenditures, chargeable to Medical Department funds, in amounts not to exceed $100.2 On the 14th of the following month, section surgeons were empowered to authorize medical officers in their respective sections to expend not to exceed $250. As hospital centers were established, each hospital center commander was given a like authority.2

This delegation of authority to expend funds was done with the view of giving local Medical Department administrative officers more freedom than had formerly obtained, in so far as the purchase of articles in small amounts was concerned. Much inconvenience had obtained because of the uncertainty of the mail service, requests for articles frequently being delayed long beyond the arising of the urgent need for them, thus forcing the local commander to make emergency purchases, which under Army Regulations necessitated a formal report in each instance.2 The delegated authority to make local purchases, referred to above, obviated the necessity for such formal reports.

In making foreign purchase of technical material for the Medical Department, A. E. F., it proved necessary to delegate much of this to representatives of the services concerned, such as X ray and laboratory.2


All departments were early called upon to make estimates of the storage space that would be required for supplies needed for different numbers of men, and it is interesting to note the relation shown by these estimates to the actual figures later established.

In September, 1917, the surgeon, line of communications, estimated that for 2,000,000 men in France there would be needed 1,200,000 square feet, of which 865,000 was to be at the base ports. At the same time he estimated that for 300,000 there would be required a total of 335,000 square feet.2 Shortly afterwards the following estimates were submitted:2


Square feet

300,000 men, 30 days, at Gievres


1,000,000 men, 30 days, at Gievres


75,000 men, 15 days, at Is-sur-Tille


Additional (uncovered)


1,000,000 men, 15 days, at Is-sur-Tille


Additional (uncovered)


On November 17, 1917, a revised estimate was submitted in tables prepared by the chief engineer, line of communications, for 2,000,000 men in all France of a total of 2,880,000 square feet roofed, with an additional 220,000 unroofed, distributed as follows:2

Base ports, 1,440,000 square feet, roofed, 80,000 square feet, unroofed.
Intermediate section, 1,200,000 square feet, roofed, 80,000 square feet roofed.
Advance area, 240,000 square feet, roofed, 60,000 square feet, unroofed.


At the time of the signing of the armistice, with nearly 2,000,000 men in France, the Medical Department had the following
storage space allotted:2 



Date established

Maximum storage space 
(square feet)


Intermediate medical supply depot No. 3

July 15, 1917



Intermediate medical supply depot No. 2 

Oct. 10, 1917



Advance medical supply depot No. 1

Nov. 18, 1917


Liverpool, England

Medical supply depot

Aug. 7, 1918


Cristo, Italy


July 29, 1918



Field medical supply salvage depot

Dec. 13, 1918


Treves, Germany

Advance medical supply depot No. 2

Dec. 27, 1918



Base storage station

May 1, 1918




Oct. 1, 1918


St. Nazaire

Medical supply depot

July 1, 1918


St. Sulpice

Base storage station

July 6, 1918



Medical supply depot

May 6, 1918




Dec. 21, 1918



Base storage station

July 8, 1918


Le Mans

Medical supply depot

July 20, 1918



The fact that storage space was necessarily always assigned just as pressing need therefor arose prevented the warehousing of supplies in the manner best adapted to issues, and necessitated the constant shifting of supplies from warehouse to warehouse as supplies were received and space allotted.2


As stated above, basic medical supplies were to accompany units going overseas. Such a shipment of supplies was sent at the time the earliest expeditionary forces went to France.9 Anticipating the arrival of these medical supplies in France and appreciating the necessity for securing in advance suitable storage space for them, the chief surgeon laid his plans accordingly. At the time it was understood that, roughly, our lines of communications would extend from the west coast of France (Bordeaux-St. Nazaire-Brest) through Tours, Nevers, Dijon, and Neufchateau to the front.4 Using these lines as a guide for the subsequent distribution of our medical supply units, and the further fact that the Gondrecourt area had been selected for billeting and training the 1st Division,10 Nevers was selected as a choice situation for the establishment of our first medical supply depot. Assurances were given the Medical Department that Nevers would be assigned to it; however, it proved later that Nevers was more suitable to other purposes than those of the Medical Department, in consequence of which another site for the interior location of a medical supply depot had to be selected. This secondarily selected site was Cosne,11 and the recital of this in itself would have little if any present pertinence were it not for the fact that, whereas Nevers was on the main line from the base ports to the front, Cosne was on a secondary railway, and about 20 kilometers northwest of Nevers.

It is proper here to explain that the selection of a site for a medical supply depot so far inland as Cosne was based upon the fact that, because of the submarine warfare, it never could be foretold to which of the base ports convoys


of supplies in bulk from the United States would come. With such supplies as medical supplies, there are many items of which the amount used or the supply on hand is so small that original packages must first be sent to a central depot and there be distributed in smaller bulk to other depots. So, as soon as medical supplies were received at one or another of the several base ports they were shipped in bulk to the medical supply depot where they were sorted, placed in stock, and accounted for. From here they could be distributed as the occasions arose, and though some shipments necessarily had to be made back over the lines toward the base ports for Medical Department activities, the seeming disadvantages of such a method were far outweighed by the advantages of the arrangement adopted.2

As stated above, Cosne was the site for the first medical supply depot. When taken over by the Medical Department, A. E. F., the site consisted of an incomplete aerial bomb depot, being used at the time by the French.2 The relatively few, floorless, and otherwise incomplete buildings available comprised about 50,000 square feet of floor space. Despite the absence of unloading facilities, a lighting system and other requirements of an activity of this size, this place was developed into our first fixed medical supply depot, a full-stock distribution point, and from this the entire Medical Department distribution system was largely elaborated. For a considerable period of time practically all medical supplies were concentrated at and likewise distributed from Cosne, intermediate medical supply depot No. 3.

The original plan was to develop the medical supply depot at Cosne. However, since, as stated above, Cosne was on a secondary railroad and the French avowedly were unable to handle increased shipments therefrom, the original plans for its expansion were abandoned and a substitute was adopted.12

Before further reference is made to the establishment of other medical supply depots, it is essential to state here upon what the supply system of the American Expeditionary Forces as a whole was based.

On August 20, 1917, when there were about 25,000 of our troops in France, General Pershing announced his policy of supply to the chiefs of the various services, American Expeditionary Forces.13 In his memorandum of announcement, with its subsequent additions, there was outlined a definite method of supply procurement, both from the United States by shipment overseas and by purchase in foreign markets. In this it was furthermore specifically set forth by what policy, under procurement, the increment of reserve supplies was to be accumulated. The supplies were divided into the following three classes: Automatic supply for articles regularly consumed so as to permit of an automatic supply; replenishment supply for articles of which specified stocks had to be maintained; and exceptional supply for articles of which no specific stocks had to be established. Furthermore, on September 7, 1917, General Pershing, in a cablegram to The Adjutant General, announced his decision to establish in France reserves of all classes of supplies for 90 days.14 This reserve was based on authorized issues, where such issues were regular, and on active periodic consumption of other articles based on British and French experiences during the war. General Pershing directed the chiefs of the various services, A. E. F., to prepare estimates, for cabling, first, a list of


four months' supplies to accompany each movement of troops from the United States. This provided not only a 90 days' reserve, but, in addition, one month's automatic supply for consumption and emergency. Second, a list showing the amounts which would have to be shipped monthly for each 25,000 men of the American Expeditionary Forces. In terms of days, the 90-day reserve plan provided for 15 days of the reserve to be in the advance section, 30 days in the intermediate section, and 45 days in the base ports.

Now, in accordance with this plan to have 90 days' reserve medical supplies in France, supply depots were established as follows: Base medical depots at each of the ports utilized by American troops; an intermediate depot at Cosne (intermediate medical supply depot No. 3, referred to above); an advance depot at Is-sur-Tille.12

To revert to the Cosne depot: The substitution depot, intermediate medical depot No. 2, was at Gievres, approximately midway between Tours and Nevers (the site originally selected for an intermediate depot) on the main line from the base port St. Nazaire to our front. This depot, established October 20, 1917, was to replace the depot at Cosne as the main issuing depot, the Cosne depot being retained as an auxiliary.2 As the situation developed the depot at Gievres was increased in capacity and utilized largely for shipments of carload lots.2


With the view of having a distributing depot in the advance section advance medical supply depot No. 1 on November 18, 1917, was put into operation at Is-sur-Tille, a place subsequently used as our principal regulating station.15 This depot, an extremely important unit, largely took over the distribution of medical supplies to troops and units in the advance section. It was not, however, until considerably later that this depot was made a full stock unit. Prior to its being made a full stock depot, its activities were confined largely to the supply of medical units on duty with combat organizations.

Lack of storage space throughout France added many difficulties to the medical supply question, but those difficulties were particularly increased by the lack of storage space at base ports and by the insufficient docking facilities at the ports assigned.2 It was appreciated early that a large amount of storage space would be required at base ports, and efforts were made to secure such space. No department could meet this need, however, until construction by the American Expeditionary Forces was accomplished, consequently it was many months before confusion at the docks was eliminated. During this period the Medical Department, as was the case with other departments, sent to the docks representatives whose duty it was to search for and sort out the supplies, and to make shipment of them to the proper depot in the interior.2 Even later when this work was taken over by the Army Transport Service the representatives referred to remained at base ports to assist the Army Transport Service.2 Shipments were received in every available port, many of which, for example, La Pallice, La Rochelle, Rochefort, Les Sable d'Olonne, had no storage space, though usually some temporary shelter was provided. Representatives of the Medical Department supply


division were assigned to duty in each of these ports.2 Supplies were from time to time received in the ports of Cherbourg and Le Havre.2

In the vicinity of St. Nazaire, a large storage depot was established at Montoir.2 Close to Bordeaux, a depot at St. Sulpice was established.2 A depot was established at Miramas, adjacent to Marseille.2 In each of these depots, the Medical Department was allotted space.2 No depot was established at Brest and later when the shipments through that port were considerable, this lack of local storage space necessitated keeping stores without protection against the elements until sufficient railway cars could be provided.2 No depot was established at Le Havre, through which port many of the supplies purchased in England were received.2

The car shortage in France was such that never was it possible to ship promptly from the ports material received from ships.2 Though it was desired by the commanding general, Services of Supply, to establish a system of priority shipment from the base ports, this was not possible until after the establishment of the depots mentioned above. The following letter shows the situation in so far as it concerned the Medical Department:

   France, January 24, 1918.

Memorandum to the commanding general, line of communications:

1. Referring to your memorandum of January 23, subject "priority of shipments from base sections," the following remarks seem pertinent concerning medical supplies.

2. In my opinion the principle is good. Under present conditions at the base, however, I can not see how any classification of medical supplies other than in one group as "medical supplies" can be made, owing to the multiplicity of articles upon the Medical Supply Table and to their varying importance-from articles of absolute necessity for the preservation of life to articles that might be well dispensed with in time of great pressure. This brings up the great importance of having at the base a classification warehouse, referred to in my memorandum of January 19.

3. Under present conditions, should our depots at the front or in the intermediate section need articles of vital necessity, such as gauze, ether, morphine, request upon you for order of priority for such articles would involve an order of priority for all, of all medical supplies, many of which might not be needed, and the importance of many of which would be less than articles supplied by other departments, thus working a hardship upon those other departments.

Colonel, Medical Corps, United States Army.
 [First indorsement]

C. G., L. of C., A. E. F., France, January 24, 1918

To the C. in C., A. S., G. S.

1. Forwarded. I am strongly of the opinion that the Medical Department requires storage space at base sections 1, 2, and 5, in order that some classification of medical supplies may be made in those areas prior to shipments to the intermediate and advance depots. It is also appropriate in maintaining the 45 days' stocks in base areas.

2. The facts set forth in the memorandum from the C. S., L. of C., are decidedly pertinent, and it is easily comprehensible that shipments of important medical supplies to fill existing emergencies would be delayed, unless it were possible to make a separation of these supplies from those of unimportant variety. I believe the matter of storage space for classification at these ports for the Medical Department is a very important consideration.

Major General, National Army.


Because shipping medical supplies from France to England, for the use of our Medical Department units there, proved difficult, arrangements were made to have such supplies shipped directly from the United States.2 This necessitated the establishment in England of a medical supply depot, one being opened in Liverpool on August 7, 1918.2 It functioned under the surgeon, base section No. 3, and was supplied in part through purchases made in Great Britain.2

The need was early felt for medical supply depots in advance of advance medical supply depot No. 1, Is-sur-Tille; the lack of  them was considered not only uneconomical in the maintenance of supply but also a source of real danger to the supplies themselves.2 So long as our tactical divisions operated independently, during which time they were moved from sector to sector, relieving troops of another nation whose equipment differed materially from our own, it was necessary for each division to have available at all times complete equipment, including many things not listed in the field equipment.2 Division surgeons, in order to protect themselves against possible emergencies, overstocked their divisions; when movement of divisions was ordered, they necessarily left behind a good deal of material.2

In an effort to overcome this situation the surgeon, line of communications made the following proposal:

FEBRUARY 11, 1918.

From: The chief surgeon, line of communications.
To: The commanding general, line of communications.
Subject: Storage for Medical Department.

1. I request that the Medical Department be authorized to provide itself with one or more small storage warehouses with capacity of approximately 5,000 square feet each so situated that they can be reached by truck direct from the troops in the field. These storehouses are considered essential to the proper supply of divisions for the following reasons, and I believe that they should be provided at the earliest possible date. No elaborate system of issue is contemplated, simply a dump where the essential articles such as ether, gauze, dressings, morphine, first-aid packages, and standard Red Cross dressings can be stored and issued in emergencies: (a) Is-sur-Tille is too far from the line to be reached by truck, and rail transportation for less than carload lots is necessarily slow. I have from the start been convinced that for Medical Department storage, Is-sur-Tille is not suitable for the most advanced depot. (b) The problems of the Medical Department differ considerably from the other staff departments in that shipments to any one organization are neither so large nor a matter of daily occurrence. (c) Another important reason is the fire risk. Should the Is-sur-Tille depot be wiped out it would be most advantageous if there were small stocks in the front area sufficient to maintain supplies until such time as shipments from Cosne or Gievres could reach that area. (d) Economy: In my judgment if the troops in the field have absolute assurance that supplies can be had promptly when needed they will cut their requisitions to their immediate needs. They will thus not encumber themselves with unnecessary impedimenta.

2. If this recommendation meets with your approval, I request that the paper be referred to the commanding general, Advance Section, for selection of the towns and for leasing of the necessary buildings.

F. A. WINTER, Colonel, Medical Corps.

With the organization of the Paris group and, later, of the First Army, the establishment of army dumps became essential. In
connection with the Medical Department purchasing business in Paris, there had been established previ-


ously in Paris a small medical receiving warehouse; and although this was utilized somewhat in the manner of an army dump, it was not essentially that type of depot. The first army dump established was at Lieusaint,16 and this was organized and administrated for the purpose of supplying combat units in the Paris group and, later, the First Army.

The supply table authorized for an army dump, which in common parlance later became known as the "Lieusaint list," grew out of the establishment of this army dump.16 The original basis of the "Lieusaint list" was the replacements necessary for one combat division for eight days, and the officer in charge of this distribution point was authorized to maintain in storage as many times this amount as there were combatant divisions in his area.16 This practically constituted a stock maximum for his depot. Practically this same system, although with a modified list, was adopted for use in planning the distribution of medical supplies when the offensive operations, directed toward the reduction of the St. Mihiel salient, and later against the Meuse-Argonne area, were in preparation. Gradually, however, a policy was developed of establishing army dumps for which there was authorized a definite fixed stock maximum without reference to the number of combat units to be supplied, but based more upon the number of such dumps established in relationship to the known number of divisions to be employed in the operation. Such dumps, for instance, were established at Toul, Souilly, Vaubecourt, Fleury, and Les Islettes, and in the order named.16


Upon the adoption of the plan of concentrating beds in hospital centers, there was need in each center of more than 5,000 beds for an issuing medical supply depot. The following letter on this subject was submitted to headquarters Services of Supply by the officer in charge of the supply division of the chief surgeon's office:

France, April 23, 1918.

Memorandum for the General Staff:

1. I am informed that the present scheme of construction for hospitalization includes for storage space for medical supplies the following: For each base hospital of 1,000 beds, one 20 by 160 foot building.

I understand that provision for a sorting warehouse for all supplies has been made. This warehouse to be 24 feet of a 50-foot wide building for each 1,000 beds.

2. I am of the opinion that in this matter the needs of the supply division have not been adequately provided for, and I request that the matter be given consideration, not alone from the standpoint of storage for a group of base hospitals, but as part and parcel of the entire scheme of storage and distribution of medical supplies in France.

The following data are pertinent: With a peace-time strength of 100,000 men and with an average morbidity rate of approximately 3 per cent, there were in the United States the following depots: New York supply, St. Louis supply, San Francisco supply, and field medical supply depot, Washington. I am unable to give the combined floor space of these depots.

3. It would therefore seem probable that the needs of a hospital center of 10,000 or 5,000 beds would be sufficiently great to warrant the establishment of not only storage space but of an issuing depot. It has been found by experience that beyond a certain point the amount of work done in an issue room may not be expanded without loss of space and energy and that it is desirable when that point is reached that another issue room be established.


When this becomes necessary no advantage is gained by establishing that second issue room in immediate proximity to the first, and in fact there are many advantages of its establishment elsewhere.

4. The advantages accruing to the service in this matter of an issue depot at the hospital centers are as follows: (1) Lessened fire risk. The disadvantage of having all supplies in a few depots is apparent. (2) Direct shipments. With a depot at the center direct shipment of bulky articles can be made from the ports, avoiding the difficulties and the use of rolling stock incident to transshipment at the main depots. (3) Economy. A full knowledge on the part of the hospital commanders that their emergency needs could be promptly met will unquestionably lead to small requisitions and particularly to an elimination of those articles infrequently used. (4) Embargo. With a depot in the immediate vicinity in times of railroad stress, shipments by the Medical Department can be entirely suspended so far as these centers are concerned.

5. It is apparent that, aside from the additional issue room, no greater amount of storage space is involved by these establishments than would be required for storage at the larger depots. If it is thought that this involves further construction and unnecessary storage space for the Medical Department, I recommend that this storage space be provided in lieu of an equal amount of space at Gievres. This space could be later provided at Gievres if conditions warrant it. I am confident that the Medical Department will require the space asked for.

6. I have estimated 10,000 square feet as the minimum that will be necessary for this depot, and I am inclosing an exhibit which is an approximate list of the supplies that will be carried in this depot, with their cubic feet contents. In addition to the actual space occupied by the materials, there would be necessary approximately 2,000 or 2,500 square feet as an issue room.

7. Of the 50-foot wide building, a 24-foot length of which is already authorized for each 1,000 beds, I am informed that the quartermaster desires 20 feet. This would leave for my purposes 200 square feet for each 1,000 beds, a total of 2,000 square feet, which is not sufficient for the Medical Department.

8. I therefore request that this storage building now authorized be increased in size to take care of the needs herein specified.

By direction of the chief surgeon.

Colonel, Medical Corps, United States Army.

APRIL 29, 1918.

Memorandum for the chief of utilities:

1. Forwarded. Request from chief surgeon for the increase in storage area at base hospitals.

2. Approval in general principle granted. Action to be taken in individual cases as supply of labor and materials is available.

By order of the C. G.

Assistant Chief of Staff, G-4.

Hospital center medical supply depots were established, and shortly before the armistice were at the following principal hospital centers:17 Allerey, Bazoilles, Beau Desert, Beaune, Clermont-Ferrand, Commercy, Kerhnon, Langres, Limoges, Mars-Sur-Allier, Mesves, Perigueux, Rimaucourt, Riviera, Savenay, Toul, Vichy, Vittel-Contrexeville.


More and more it became apparent that efficient service in the supply division of the chief surgeon's office was being hindered by the lack of trained personnel and particularly by the lack of sufficient personnel of any kind.2 The


needs of the supply service, though appreciated, could not be met by the personnel division of the chief surgeon's office until such need became absolutely pressing.2 Plans were submitted by the officer in charge of the supply division, chief surgeon's office, calling for personnel in the main supply depots for training purposes far in advance of the establishment of other depots, but these plans, although carried into effect in part, were never put into full execution and the result was that the establishment of large depots necessitated interference with the normal working force of the main depot.2 This occurred repeatedly in intermediate medical supply depot No. 3, Cosne, from which depot a large part of the personnel for Is-sur-Tille, Gievres, Bordeaux, St. Nazaire, and hospital center depots and army parks were supplied.2 From Is-sur-Tille also a considerable number of men were sent to army parks and other depots.2 Certain units, known as medical supply units, and consisting of 3 officers and 45 enlisted men, well selected as a rule, arrived from the United States from time to time, but because of the medical supply situation in France, and because the method of administration and distribution was so entirely different from that which had been taught the members of the units in the United States, it was deemed inadvisable to send them out as units; furthermore, because the need was so pressing that personnel as it became available had to be allotted to a number of depots, at no time could the number of men comprising one of these units be spared for any one depot.2


It was planned also to have officers from the office of the chief surgeon act as medical supply inspectors. It was intended they should inquire into the adequacy of supplies; to instruct in the method of requisitioning; to meet incoming organizations and to advise them of the location of medical supply depots and the methods followed in the American Expeditionary Forces, the local situation, etc., to acquaint new units with the shortage of supplies and the necessity for economy; to supervise the establishment of storerooms at camp hospitals, wherein supplies could adequately be cared for and conserved; to direct the return to the proper depot of excess supplies; to receive criticisms; to make suggestions following investigations, as to the manner in which distribution of supplies could be better accomplished.2 Such personnel it was never possible to obtain.2 Officers of the Sanitary Corps, formerly noncommissioned officers, were thought to be best prepared for this work, but their services were in demand for other purposes and it was difficult to secure them in sufficient numbers even for the purposes of medical supply depots.2


Authority for the employment of civilians by the Medical Department, A. E. F., was issued from the supplies division, chief surgeon's office.2 With the establishment of territorial sections in the American Expeditionary Forces this authority was delegated to section surgeons.2 Many of the early hospital units took over old buildings, oftentimes cut up into many small rooms and therefore unsuited for hospital purposes. The personnel assigned to the units


was insufficient and due to the critical shortage of enlisted personnel, Medical Department, it was impossible to supply reinforcements. Camp hospitals were established in large number with a skeleton personnel from casuals, since these organizations were not provided for in the original Tables of Organization. A liberal policy in the employment of civilians was therefore established by the chief surgeon, A. E. F., and many were employed in lieu of Medical Department personnel not then available.2 The maximum number of civilians employed was 4,273.


A number of small Medical Department units were sent to the American Expeditionary Forces and there functioned partly under the control of the supply division of the chief surgeon's office.2 Chief among them were the motor assembly units, instrument repair units, and optical units.


This plant consisted of a unit of officers and men for assembling and, later, repairing motor ambulances.2 The services of such skilled men were so in demand that they were utilized at the base ports for assembling all motor transportation, and later on were turned over to the Motor Transport Corps.2


An instrument and typewriter repair unit of officers and men was also sent. Preparation for the reception of this unit had been made by the supply division of the chief surgeon's office and it was installed in a building in Paris.2 Later, upon the publication of General Orders, No. 10, G. H. Q., A. E. F., January 6, 1918, which provided for the organization of the salvage service, the typewriter repair men were asked for by the chief quartermaster, and this portion of the unit was turned over to his department.2


Personnel for eight branch shops were also sent to France completely equipped.2 The main shop was established in Paris in connection with the instrument and repair shop; the eight branches were sent to various hospital centers.2 Later, others were established.

The demands on the instrument and optical shops were so great that the original equipment and quarters proved inadequate. These were then moved to a larger building and an X-ray repair unit was organized in the original quarters.2

As no specific provision had been made for the repair of electrical instruments, the X-ray repair shop undertook this work as far as it was possible to do so with the staff available.2

The work of the repair units was by no means confined to repairs, as it was found desirable to alter equipment to meet the needs of military service as well as to build much special apparatus urgently needed in hospital practice.2

During the entire period of their operation these shops were called upon to work to their full capacity.2 They fully demonstrated the wisdom of their selection and the necessity for such auxiliary units for the successful operation of the functions of the medical service.



On September 18, 1917, in compliance with General Pershing's instructions concerning automatic supply, previously referred to, the first list of medical and hospital supplies for automatic shipment from the United States was submitted to general headquarters, A. E. F.2 It was appreciated at the time that there were many inadequacies connected with this list that would necessitate constant correction, for the requirements of the Medical Department, in so far as any one item was concerned, could not readily be anticipated. Furthermore, the multiplicity of articles, together with the varying needs for them, made it practically impossible to anticipate exact amounts required. At the time in question, no great amount of data was available from allied sources; such data as were available had not been given much study.2

On February 1, 1918, the chief surgeon, A. E. F., caused to be revised the automatic supply list that had been prepared in September.2 This was in conformity with the Surgeon General's request. One of the first steps in this revision was a further simplification; this was followed by an effort to determine what articles, because shipped in small original packages, should be shipped overseas every three months rather than monthly, and to determine what articles should be controlled by requisition. As a result, on April 2, 1918, the chief surgeon, A. E. F., submitted a table of articles, subsequently referred to as the automatic supply table.2

Though the principle of automatic supply never was questioned by the Medical Department, A. E. F., so far as the demands of that department were concerned, the automatic supply was not reduced to a working basis, chiefly for the following reasons:2At the time the table was submitted the stock of medical supplies in the American Expeditionary Forces was critically low. Not only was no information available as to the amounts of each article that would be used, but it was vitally essential that a reserve in France be established; consequently, in many instances, amounts specified in the revised automatic supply table were recognizedly excessive. It was not intended to perpetuate this; on the contrary, it was the intention from the first, to modify the automatic supply list from month to month, once an adequate reserve had been established in France. That this was difficult of accomplishment may be shown by the fact that stores ordered from medical supply depots in the United States in one month in amounts based upon strength figures for the American Expeditionary Forces for that month, usually did not reach France for several months thereafter, and were not available for issue for fully an additional month because of the necessity for their shipment to an interior medical supply depot for sorting preparatory to distribution.2 Furthermore, beginning with the spring of 1918, and by reason of military necessity, the troop movement to the American Expeditionary Forces was expanded in a totally unlooked for manner, in consequence of which, when supplies ordered in January and based on the size of the American Expeditionary Forces at that time, were received six months later, they were obviously entirely inadequate.2



Principally with the view of acquiring data that would permit of an intelligent revision of the automatic supply table, a statistical section of the supplies division, chief surgeon's office, was instituted in the early summer of 1918.2

It was the function of this section to tabulate the amounts of supplies received; amounts available at each medical supply depot; the daily movements of railroad cars containing medical supplies; the movement of supplies (both by weight and bulk) into and throughout France; the rate of issue per unit of men under varying conditions.2 With such work it was the intention to so gain a position as to insure estimating accurately the stores required for replacements under any and all conditions presenting. Such an end, unfortunately, never was reached.2

One of the difficulties connected with this work was the fact that there were available neither figures on the amount of supplies required by each unit of men for a given period, nor the relation of weight to bulk for the medical supplies that would be required for the American Expeditionary Forces.2 As a matter of fact, during the entire history of the Medical Department, A. E. F., initial supply formed a large part of the requirements, this in itself making the bulk of overseas shipments assume larger proportions to the weight than would have been true later after the movement of troops stabilized. The disproportion of bulk to weight was more marked as regards Medical Department supplies than was true of other branches, a fact that required repeated explanations. What led to such queries was the situation with the British. Though efforts were made to compare their  Medical Department with ours, in so far as the relationship of bulk and weight of supplies is concerned, this could not be done because our Medical Department was importing bulky, permanent equipment through the necessity of a prolonged hospitalization of our sick and injured in France.2 The British, on the other hand, elaborately equipped their hospitals only in Great Britain to which their sick and wounded could be readily transported.2

Though, as stated above, the work of the statistical section did not, and could not, reach desired results by reason of its late establishment, nevertheless it proved of great value and formed the basis of the later estimates of Medical Department tonnage required.2 Also, this section provided the data upon which subsequent revisions in the automatic supply table were made, and upon which shipments of medical supplies from the United States were increased, decreased, or suspended.2

Essentially this scheme of distribution involved the use of several echelons. From front to rear they were as follows:16 Divisional medical supply unit; army park medical supply dump (for each corps); army medical supply depots (for each army); Services of Supply depots (advance and base).

Toward the end of hostilities the manner of distribution from the supply echelons at the base to those in the most forward areas had been worked out with exceeding care. The plan of distribution, as evolved, was an elaboration of the policies under which the units previously had been functioning, but it


was better balanced, and all echelons were much more clearly defined. This was also true as regards the important technique of filling the requests for supplies of forward units from the unit next in the rear.16


The officer in charge of the divisional medical supply unit normally indicated the need of all organizations in his particular division upon a consolidated requisition, which, after passing through the office of the division surgeon and that of G-1, was forwarded for filling to an army park.16 Often the division medical supply officer was far removed from the division surgeon and the division staff generally, and as a result numerous requisitions had to be sent to the nearest army park in a most informal manner and without any visa or approval. This was recognized as a necessity, and such contingencies were provided for by authorizing the park personnel to honor such emergency calls. It was found in practice that such authorizations increased the confidence of those in the forward areas and that the end result was a better and closer cooperation of all concerned.16

The logical medical stock for army parks included only articles of combat equipment and supplies and trench stores, and divisional units would naturally requisition only such articles, but in the early developmental days of the corps echelon it was found necessary to carry limited replacements at these parks, for such units as mobile and evacuation hospitals. It was very soon learned, however, that this produced a useless dispersion of equipment which it was difficult to obtain, and quickly rendered immobile the army park medical supply dumps-units, which of necessity, must remain mobile. It therefore became the policy to confine articles on the fixed stock maximum of such parks to those of combat material and trench stores. Just as soon as this decision was made it necessitated the establishment of a new echelon, inasmuch as large hospitals in the advance zone would now be required to replenish their stock from a new advance supply unit.16

It was therefore contemplated immediately to establish (and sites were actually selected) full-stock army advance medical supply depots on a basis of one per army.16 This unit, although carrying a complete stock, carried its articles, in so far as quantity was concerned, upon a very limited time basis. The functions, then, of this larger unit would be primarily to fill the calls of the army parks and secondarily to fill requisitions from medical units in the advance zone. The latter was obviated as far as possible by distribution from the rear through "controlled stores" in other depots.16



As medical supplies began to arrive in France in amounts larger than the immediate needs therefore, it became possible to begin the stocking of depots other than that maintained at Cosne.2

At first only articles of which there was a supply more than sufficient to meet the immediate needs were stocked in the base storage stations, all others being sent to the depots in the intermediate section to maintain the stock there.2 Later as supplies began to come in larger amounts, more and more


articles and larger and larger amounts were retained in the base storage stations.2 A typical instance is that of beds and bedding, in fact of all initial equipment except the highly technical equipment that needed especially trained labor for its care and selection. It was impossible to distribute such material if for no other reason than the lack of available technical personnel to provide for its care in all the depots.

Because of the harbor facilities at Brest, shipment of supplies from the United States to France, assumed large proportions in so far as that port was concerned, and, as previously mentioned, the fact that there were no facilities for storage made it necessary to ship out as cars could be provided. Practically all the supplies received at Brest had to be routed to Gievres which acted therefore as a reservoir for that port.2 Is-sur-Tille needs were supplied from Miramas to the fullest extent possible.2

As fast as the medical supply depots were built and became available, they were stocked with such articles as were in France in sufficient quantity to warrant distribution.2 While the desirability of having completely stocked depots was appreciated, as matter of fact, it never became quite possible to accomplish this.2 Though there was an abundance of such material as gauze and bandages, never at any time was there a sufficient amount of surgical instruments to permit stocking more than a few depots with them. It was felt that the depot should be stocked in the following sequence: First, intermediate medical depot No. 3, Cosne, which was then the main distributing depot; advance medical depot No. 1, Is-sur-Tille, a distributing depot for the advance area; the supply depots in the various sections; finally the hospital center depots. Necessity of the decentralization of issues was early appreciated, but complete decentralization could never be effected because of the absence of sufficient stock of several important items, and it was not until shortly before the armistice began that the medical stock was sufficient to permit its distribution to these depots.2

At first it was the practice of local district surgeons to secure from the docks such articles as were needed in their areas, making report thereof to the surgeon, line of communications.2 This practice was permitted in view of the shortages in medical supplies at the ports and in view of the long delay in shipping to and from the depots in the intermediate section; but in order that equal distribution might be made, that accounting could be effected with the view of gaining knowledge of stocks available in France and, finally, that unnecessary rail transportation might be prevented, on July 1, 1918, the policy of "controlled stores" was established.2 Thereafter, all supplies entering a base port were immediately under control of the representative of the supply division, chief surgeon's office, A. E. F., and were shipped in accordance with his instructions, or placed in storage subject only to the order of the chief surgeon, A. E. F.2 In each of the base sections a local supply depot was established whence issues could be made upon the approval of the section surgeon, but issues from the controlled stores were not under his jurisdiction.2 Reports of all receipts and issues from controlled stores were made to the office of the chief surgeon. Here they were tabulated daily, thus permitting the condition of stock in France and in each depot to be known at all times.



From organizations.-Requisitions were submitted to the chief surgeon, in one copy only;2 upon approval, they were forwarded to the proper depot. This method was established with the view of eliminating so far as possible all paper work and of issuing so far as possible all supplies asked for.2 However, the fact that there was no duplicate requisition on file barred any possible checking against previous requisitions from an organization; every requisition was therefore acted on solely upon its face. Later, with the object in view of further expediting action upon requisitions, these were ordered sent from organizations direct to the depot. The officer in charge of the depot was designated assistant to the chief surgeon and was given authority to modify requisitions, but instructed to make such modifications largely upon the basis of the stock on hand.2 Though this delegated authority placed upon the officer in charge of the depot the burden of responsibility for modifying requisitions, not ordinarily his, it was necessary in view of the many shortages in the stock in the early days.2

From supply depots and hospital center depots.-Requests from hospital center depots and from supply depots were sent to the chief surgeon, A. E. F., in whose office extracts were made according to the availability of stock and to the railroad situation; shipments were made from the most available point.2 This permitted shipments to be made in carload lots direct from the ports to the requisitioner, thus conserving labor and time in the loading and unloading of cars and also the saving of cars. Frequently shipments were made direct from the docks.


In so far as accountability at the depots for goods received from the United States is concerned, it was early demonstrated that either accountability must be abandoned or the needs of the American Expeditionary Forces must be neglected.2 Frequently invoices of medical supplies would be received from each of the several depots in the United States, bearing the same numbers. Since packages were numbered serially at each such depot, a shipment of supplies from the United States, when received at a depot in the American Expeditionary Forces, would contain not only not all of the supplies invoiced on one invoice, but several packages bearing the same number, thus making it impossible to determine from which depot the supplies were shipped and to which invoice they should be credited. Many supplies were received in France marked for special units and no invoices were furnished. Frequently these found their way into the medical supply depot and because the storage space was so inadequate there they were placed in stock and issued.2 Supplies marked "Replacement supplies-division" were received and likewise placed in stock. In a similar way supplies received from European sources arrived at the depots. Partial shipments were made on purchase orders. It was therefore determined that accountability at the depots would be for those supplies actually received.2

Maintaining any system of accountability at the front proving impractical, General Orders, No. 74, G. H. Q., A. E. F., December 13, 1917, provided for the cessation of all accountability there.



The system of payment from medical and hospital funds by a central disbursing officer upon an approved voucher proved to be full of difficulties.2 Payment for laundry work done for moving organizations, payment for civilian employees who demanded payment weekly, payment for purchases made in emergency in small amounts, sometimes by a moving command, all theoretically had to be vouchered on Form 330, M. D., approved, submitted to the disbursing officer and paid by check. In order to obviate this difficulty the chief surgeon authorized the payment of such accounts in cash from hospital funds, making upon Form 330 a certificate to that effect, following which reimbursement would be made.2 Such a system was required in the absence of actual cash being made available to officers commanding Medical Department formations.


From the source of supply, whether this was in the United States or in Europe, to the ultimate consumer the distribution of supplies was influenced by the overburdened transportation system.2 Necessarily, the railroads and the ports of embarkation in the United States were congested; equally congested were the ports in France, several of which were illy equipped with docking facilities and cranes. The car shortage in France was great, and embargoes, complete or partial, were of frequent occurrence.2 Differences in the languages added to the difficulties there. For a considerable part of the time lack of storage facilities at the base ports rendered impossible any satisfactory sorting of supplies, and lack of trained personnel to recognize the property of the various departments all combined to delay receipt of supplies at their proper depots.2 Every available means of transportation was used, and this resulted in the splitting of consignments.2 Frequently shipments were made by motor trucks and by canal barge from Havre and from inland points. The use of these various means of transportation at first caused an uncertainty as to whether or not delivery of the supplies would ever be made. With the growth of the American expeditionary Forces, however, a system of convoy was established whereby trains or cars were accompanied by members of the American Expeditionary Forces. This in a large measure corrected the fault.

The result of all the factors outlined above was that the availability for issue of stocks received was much delayed, and that many supplies, even though known to be "somewhere in France," could not be considered as forming part of the reserve.2


It was early appreciated by the supply division of the chief surgeon's office that it lacked information concerning supplies for the American Expeditionary Forces available to supply officers in the Surgeon General's Office.2 In other words, the supply division, chief surgeon's office was groping "in the dark" along certain lines. To remedy this, it was felt that conferees should be interchanged or that written reports should be submitted, but such a plan could not be effective by reason of the lack of adequate personnel.2 On the other hand,


in the light of after events, it is thoroughly appreciated that one egregious error committed in the supply division of the chief surgeon's office was that, though it was known there that the automatic supply table was excessive, this was not made known to the Surgeon General's Office, thus creating a confusion in an activity that should have worked smoothly. Proper liaison would have obviated this.2


Regulations obtaining at the time we entered the World War required that organized voluntary aid for our land forces would, through the American Red Cross, constitute a part of the Medical Department.18 In the American Expeditionary Forces, in conformity with the regulations referred to, the American Red Cross military hospitals which had been established became a part of the Medical Department. However, the American Red Cross was charged by the commander in chief, A. E. F., with many activities entirely unrelated to the Medical Department (for example, civilian relief), and the chief of the American Red Cross in France was, by General Orders, No. 8, H. A. E. F., July 5, 1917, placed on the administrative and technical staff of the commander in chief, A. E. F., independent of the Medical Department. In this independent work, the Red Cross obviously required medical supplies, consequently large quantities were procured.

Since these supplies were freely made available to Medical Department units, the result, so far as these supplies were concerned, was duplication not only of effort but of supplies as well.2 Our Medical Department personnel, being for the most part new and untrained in the methods of obtaining supplies, secured them from whatever source they found most available, and frequently, having no realization of the dangers of shortage of supplies in the world markets duplicated their requisitions and obtained supplies from both the American Red Cross and our medical supply department.2 As an example, there was always a shortage of sheets during the period of hospital expansion.2 The chief surgeon, A. E. F., established the policy of issuing six sheets per bed, and with this arrangement the Medical Department managed to keep just ahead of the demand.2 Meanwhile the American Red Cross in France also had sheets and was being called upon to issue to units other than those for whose supply they had accepted responsibility, including some who had already received their allotment of six.2 This duplication of supply resulted in a shortage in many of our hospitals at a time when these articles were needed. The result of this demand upon the American Red Cross was a financial burden to that organization which it should not have been called upon to bear and which, in fact, its officials had no desire to bear.2

In extenuation, however, it should be stated that, if the personnel of the Medical Department was largely untrained, so, too, much of the Red Cross personnel was equally or more so. But being exceedingly desirous of rendering service and frequently entirely unfamiliar with the normal method of supply, the officials in immediate charge of issuing Red Cross supplies felt that the burden of supplying hospitals was upon them. In some cases they were even unfamiliar with the existence of the Medical Department supply service; as a result, they not only made issues whenever called upon regardless of the fact that the articles


could have and should have been supplied from Army depots but they also failed to convey the information necessary to prevent a repetition of the demand upon them in the future.2 In an effort to meet this situation, after consultation with the chief of the American Red Cross in France, and in full agreement with him, orders were issued by the chief surgeon, A. E. F., permitting issues from the Red Cross only after approval by division, corps, section of army surgeons, or by the chief surgeon, A. E. F.2 As a matter of fact it was believed by the officer in charge of the supply division of the chief surgeon's office and by the American Red Cross officials in Paris that a further restriction would have been better; however, with the extensive unfamiliarity with our medical supply methods that obtained among requisitioning officers, it was felt unsafe to in any manner bar the way to the prompt securing of supplies.2

It is obvious that the purchase by the American Red Cross of articles also purchased by the Medical Department interfered to some extent with markets in Europe and in America. Articles that were available in the United States were shipped on both Medical Department tonnage and Red Cross tonnage and this duplication resulted in an overstocking of such articles in the American Expeditionary Forces.2 This double procurement system did not in any way improve the situation in the American Expeditionary Forces in so far as the articles of which there were still a shortage were concerned, since that shortage resulted largely from the depletion of the markets at home and in Europe.2

Following conferences on the subject with the Red Cross officials, the chief surgeon, on February 11, 1918, initiated a cable to War Department asking that an agreement be reached in the United States with the American Red Cross headquarters, and that the great amount of made-up garments prepared by the women of America be collected by the Red Cross and turned over to the Army to meet their needs, thus permitting the demands upon the manufacturers to be reduced to a like extent.2

Red Cross contributions to the Army were considerable. Not only did this society establish entire hospitals in emergency, but also at all times its entire stock of supplies was made available to the Medical Department.2 It supplied large quantities of front-line parcels made in France, which practically supplanted first-aid packets, and turned over in bulk to our depots and to the hospitals by direct shipment, in pursuance of a program given them by the chief surgeon, A. E. F., enormous quantities of made-up surgical dressings.2 It undertook the production of standard splints and met the need thereof entirely until splints began to arrive from the United States.2 It undertook the production of nitrous oxide and oxygen for the American Expeditionary Forces and established a plant in Paris for that purpose.2 In all of these activities it turned over in large part the products to the Medical Department by which distribution was made.



An act of Congress, dated September 24, 1917, authorized the Comptroller of the Treasury and the Auditor for the War Department to send to the American Expeditionary Forces portions of their organizations for performing there the functions of  their offices. As a result of the establishment of the offices of


the Assistant Comptroller of the Treasury and of the Assistant Auditor for the War Department in France,19 and in accordance with the request of General Pershing, the chiefs of the various War Department bureaus organized units to function in the American Expeditionary Forces in a manner similar to the finance and property divisions of the several departments in the United States. Thus the unit formed in the Medical Department eventually became the finance and accounting division of the chief surgeon's office, A. E. F.20


In availing himself of the authorization referred to above, the Surgeon General had an officer of the Medical Corps ordered to Washington for consultation, and upon arrival directed him to obtain and organize a force sufficient to care for the Medical Department accounts for an army of 2,000,000 men.9 After consultation with the Assistant Auditor for the War Department and with various other departmental authorities this officer modeled his organization on that of the corresponding division of the Surgeon General's Office.9 In order to get men qualified for this work all the large banks as far west as Chicago, and a large number of insurance companies, railroads, and department stores were requested to supply the names of drafted men qualified for service in this group.9 Prompt replies were obtained but, meanwhile, almost all the men named had been assigned to such duties that their transfer was not feasible. Banks were then asked to supply lists of their employees who were about to be called to the colors and from these by induction and enlistment the number desired was obtained. From time to time personnel to a total of 7 officers (including the chief of the division) and 135 men pertaining to this group were sent to France.9 It was purposed, in so far as the men were concerned, that many of them would perform clerical service not only in the office of the chief surgeon, A. E. F., but also at medical supply depots, with division surgeons, and in similar assignments.9

Because of numerous transfers, the enlisted personnel of this unit was further reduced to 37 men. One of the officers was sent to Paris for duty in the bureau of accounts, A. E. F., and one was assigned to duty with the general purchasing board, A. E. F.

On April 1, 1918, when the unit was attached to the office of the chief surgeon, it consisted of 6 officers and 47 men. Gradually other personnel were added until in February, 1919, this division consisted of 10 officers, 132 enlisted men, and 15 French civilians. This was its maximum strength.9


In November, 1917, a temporary office was established at the New York medical supply depot where the plan of organization was developed, and recruits were examined to determine their technical qualifications.9 These men were then sent to Governors Island to be recruited and temporarily quartered. While there they were given some drill and were instructed in their prospective duties. Supplies also were collected at this place and plans made for the details of procedure and work of the detachment abroad.


The first section of the detachment, consisting of 5 officers and 100 men, left the United States on January 4, 1918, and arrived at St. Nazaire on January 17.9 From January 24 to February 13 the group was stationed at Bois, where its organization was perfected.20 Plans of procedure were charted and suggestions worked out for the improvement of the methods of handling money and property accounts of the Medical Department.

After the unit moved to Tours, on February 13, it established its office, and about March 15 began its actual work in rooms assigned to it in barracks No. 66.9

A second section of this group, consisting of 2 officers and 35 men, which had arrived in France on February 9, was broken up, only the officers and 2 enlisted men eventually joining the original unit now at Tours.9

On May 1, 1918, the finance and accounting division became a part of the division of supplies of the chief surgeon's office, A. E. F.9


At first, the division had three chief activities: Money accounting, disbursing, and property accounting.12 As occasion demanded, other functions were added until eventually the division had 15 distinct but related activities and was divided into corresponding sections.20


This section paid French commercial bills, all doubtful vouchers (when found to be legal) which were referred to it by other disbursing officers of the Medical Department, all laundry accounts, and all civilian personnel pay rolls.20 For the month of January, 1919, these disbursements amounted to 844,207.70 francs, representing 573 vouchers. Prior to March 1, 1919, the disbursing officer paid one-third of the total number of Medical Department vouchers settled in France. Before payment the audit checked up duplications. A liaison was established with both the hospitalization division, chief surgeon's office, and the quartermaster department, A. E. F., in matters pertaining to laundry accounts whereby many hospitals through use of near-by quartermaster laundries saved many thousands of dollars. By April 30, 1919, this section had paid 4,593 vouchers. This section made considerable savings by eliminating duplicate payments and by arranging that hospitals use existing facilities instead of purchasing supplies and labor in open market. Records were made of the time elapsing between dates of purchase and dates of payment, and every effort was made to expedite settlements, thus promoting good will on the part of French vendors. Arrangements were made whereby quartermaster disbursing officers at base hospitals and hospital centers might pay accounts of civilians then employed, the Medical Department appropriations to be reimbursed by Treasury transfer. The importance of this provision is borne out by the fact that on November 30, 1918, there were 3,782 French civilians on Medical Department pay rolls. The average amount of purchases made direct by field organizations were made of record, by which many possible expenditures, by certain units which were given to extravagance, were eliminated.



In this section were audited all accounts which already had been paid (except those on civilian pay rolls) by disbursing officers of the Medical Department, A. E. F.20 So far as possible any errors in these accounts were corrected before they were forwarded to the Treasury Department at Washington for final audit. Vouchers were examined to determine whether they were legal, were correct charges against Medical Department funds, conformed to authorization for disbursement, were arithmetically correct, and there was no duplication. The analysis also included such matters as the time interval between delivery of supplies and payment therefor; the size of average purchase; comparison of volume and prices of similar articles purchased by different units. Data thus gained made possible not only an expedition of payments, but also an elimination of unnecessary purchases and an approximate standardization of prices. Because of this careful auditing very few suspensions were made by the Treasury Department in the accounts of Medical Department disbursing officers. By cancellation of erroneous vouchers and by securing the agreement of other departments, A. E. F., to pay items which properly belonged to their appropriations, many millions of dollars were saved to the Medical Department. A cash refund of approximately $15,000  worth of overpayments was received, as a result of detection of overpayments and duplication of vouchers. The value of carefully auditing money vouchers and recording financial data was fully demonstrated when it was necessary finally to submit the accounts of medical disbursing officers to the Assistant Auditor for the War Department. These accounts were in such condition that they could be accepted without causing any difficulty to the disbursing officers.


This section made an index and abstracts of all vouchers before they passed out of the possession of the Medical Department.20 These important abstracts included such data as the name of the vendor, material, price paid, date paid, by whom paid. They were made with the view of facilitating future settlement of claims which previous wars showed would continue to be made for many years.20


This section audited and made abstracts from pay rolls of civilian personnel before the rolls were forwarded to the Treasury.20 The abstracts showed names of civilian employees, authority for employment, when and where employed, when and by whom paid, etc. Prior to payment many erroneous items were eliminated, some refunds were procured, and some payments were transferred to other corps. Also in this section, efforts were made to provide for prompt payments.


This section audited the individual hospital fund statements rendered by the mess officers of the various Medical Department units, maintained a file of custodians of hospital funds, and records covering the amounts due to various hospitals from individual officers for subsistence while they were


patients in hospital.20 At the peak of this work in March, 1919, 691 organizations were rendering monthly statements and the transactions represented by them amounted in one month to approximately 35,000,000 francs.20 Not only were many underpayments and overpayments corrected, but efforts were made also to promote prompt payment of bills rendered by French civilians.12 Deficits were prevented by issuing warnings to those concerned; in some instances, when gross negligence was evident, liquidation was secured from the private funds of officers who were responsible. Arrangements were made for the transfer of food stocks between organizations. The decision of the Comptroller of the Treasury giving the Medical Department the right to retain proceeds from sales of waste, and the right to turn in to the Quartermaster Corps unused food stocks led to relatively large savings; proceeds thus secured from the sale of garbage amounted to several hundred thousand francs.12 One of the activities of this section pertained to the collection of funds from officers for payment of their subsistence while in hospital at the rate of $1 per day.12 Many officers inadvertently overlooked this obligation, but thousands of dollars were saved by carefully following them up.12


This section consisted of a small staff which checked up records when there appeared to be anything irregular, but whose chief duty was instruction in the field of mess officers and hospital fund custodians in technicalities pertaining to these funds, the correction of errors, and the proper execution of disbursing and property papers.20 Constantly in the field, they gave instruction to Medical Department clerks in the preparation of disbursement vouchers, property vouchers and returns;20 also, they assisted very materially in closing money and property accounts of units returning to the United States.12 Always, there were more calls for their services than could be met.20


The work which engaged this section was taken over about September 13, 1918, when the hospital fund in the chief surgeon's office amounted to 18,800 francs.12 Subsequently, this section controlled the central hospital fund, the loan or donation of small amounts to new organizations, the transfer of hospital funds between organizations, the reception of funds from disbanding units, and the closure of balances.20 The fund on May 1, 1919, was over one hundred fifty times what it had been when taken over in the previous September, the item of interest alone amounting to almost as much as the initial central fund.20 By May 9, 1919, it amounted to 2,862,792.31 francs;21 by May 24, it was 3,084,000 francs.22


By means of this section the finance and accounting division maintained close liaison with similar divisions in other departments,  A. E. F., the finance officer, the finance requisition officer, and the officials of the Treasury in the American Expeditionary Forces.20 This contact proved to be of value in keeping abreast of the various developments in financial matters in the American Expeditionary Forces.



Through this section clearance certificates were issued covering money and property accountability.20 In the cases of deceased officers these certificates were issued to the Treasury Department and in the case of others to the officers themselves. This work became considerable during the later history of the finance and accounting division; however, its performance was expedited through advance information concerning organizations or individuals returning to the United States which thus permitted the preparation of clearances even before these were called for. Arrangements were such that these certificates were issued at any hour of the day or night, usually a few minutes after they were requested. Of the total number of clearances issued prior to April 30, 1919 (other than those to deceased officers), only 156 were for parts of the accounts concerned, all other clearances being complete. Officers were assisted in every possible way in placing their accounts in correct form, and every effort was made to create good will among those returning to the United States and to civil life. Only 312 of the many certificates for deceased officers were for partial clearance and practically all of the debits in these cases were for small charges while in hospital.


One section of the finance and accounting division was engaged in compiling data, from all available sources, relative to the hospitalization of allied troups in American hospitals, in converting these data into proper bills, and in submitting them to the governments concerned.20 During the period that this work was being conducted by this section, these bills amounted to $194,084.32. In April, 1919, this work was turned over to the Medical Department representative at Paris in compliance with orders that that officer be charged with the conduct of all financial transactions with foreign governments. Also, this section formulated some of the bills against other departments of the American Expeditionary Forces but this work also was turned over eventually to the Medical Department representative in Paris.


This section compiled monthly, semiannual, and annual financial reports of various kinds, and also certain special reports which were of peculiar value at different times.20 These financial reports, which were rendered to the offices concerned, covered almost every phase of the financial operations of the Medical Department. From statistical data which this division maintained it was possible to trace completely all Medical Department funds from the time they left the United States Treasury until they were expended for material and labor. These records covered the financial transactions of the Medical Department from the inception of the American Expeditionary Forces until April 30, 1919.


This section maintained from 7,500 to 10,000 individual files each of which concerned an accountable or responsible officer.20 During its most strenuous period approximately 3,500 vouchers per week were handled. Invoices,


receipts, and returns were compared; discrepancies noted; certificates were audited, recorded, and filed; a card index for all officers responsible for medical supplies was maintained. The determination of property responsibility was the source of much trouble throughout the entire period of activity of the finance and accounting division, for it was seriously handicapped by the uncertain states of property accountability in that jurisdiction. This was occasioned by confusing orders capable of various interpretations. Before the armistice was signed accountability was especially uncertain, but an attempt was made to require a strict accountability, subject to due consideration of the conditions incident to active warfare. By May 1 returns to that date had been audited. Whenever necessary, statements of differences were drafted and the balance of the returns filed in such a way as to be accessible and to show the final disposition of the case and the authority for this action.


More than 1,000 returns were received and audited by the section engaged in this duty.20 It would have been completely overwhelmed had not Circular No. 68, chief surgeon's office, February 8, 1919, been issued, conformably to existing orders.  This circular limited the officers responsible for Medical Department property to those at base hospitals, supply depots and schools and thus eliminated from such accountability thousands of other officers who would have been required to render returns.


The section in charge of the legal reference library maintained complete files and formulated indices of Army Regulations, general orders, bulletins, and circulars issued by the different headquarters, whether the United States Army or the American Expeditionary Forces, abstracts of statistics and decisions of the Comptroller of the Treasury, the Auditor for the War Department, the Judge Advocate General, etc.20 This section had been organized merely for the use of the finance and accounting division, chief surgeon's office, in settling questions of legality and in keeping up to date different files of orders and decisions, but in addition, copies of its compilations were used by Treasury officials, the advisary board of war risk insurance, the secretary of the general staff, financial bureaus of other departments of the Army, and by various officers of the Medical Department either in the office of the chief surgeon or elsewhere.9 This section was also called upon to draw up contracts.12 Questions were referred to it much as opinions were asked of attorneys in civil life, for the personnel of this section were lawyers in civil life.


With the formation in Paris of the bureau of accounts by General Orders, No. 5, Services of Supply, 1918, and the Finance Bureau, by General Orders, No. 199, G. H. Q., A. E. F., 1918, a member of the finance and accounting division, chief surgeon's office, was in liaison with each of them and was permitted to pass upon many contemplated plans which affected financial operations in which the Medical Department was concerned.20 The cash expenditures


of that department until April 30, 1919, amounted to $15,000,000. By May 8, 1919, the Medical Department had purchased in Europe medical and hospital supplies to a value of $21,084,943.14, exclusive of the cost of 19 hospital trains (approximately $5,166,666.67).20


By March 21, 1919, instructions had been given for the establishment of a central hospital fund in the office of the surgeon, Third Army, and authority had been given that office to give or take from hospital funds of units in the Third Army such sums as might seem proper, to retain in the central fund such portions of hospital funds, of departing units as might seem desirable, to audit hospital fund statements of units in the Third Army and to retain audited statements, to arrange for payment of civilian personnel out of the hospital funds, Third Army, and to audit civilian pay rolls.23


Early in April, 1919, arrangements were made to send important financial and property papers to the United States by regular  courier service, and at the same time a commissioned officer from the finance and accounting division, who was thoroughly acquainted with these various documents and could explain them to the interested departments in the United States.24 A section was established in this division to collect all these Medical Department finance and property papers to be sent back to the United States and to compile a complete index of all communications and other papers which previously had been sent there.


By May 14, 1919, the chief surgeon, A. E. F., approved the discontinuance of the finance division as of June 15 following.20 Small detachments of the office force were to remain in service at Tours, Coblenz, Antwerp, and Washington, while other members of it were to be discharged. The entire division was then preparing copies of all records that might be needed after the originals had been returned to the United States. These copies were to be retained in the chief surgeon's office, A. E. F.20

A small part of the finance and accounting division continued in the chief surgeon's office, to make such disbursements as were necessary and to maintain liaison with fiscal offices in the United States.20 This service continued after the American Expeditionary Forces was succeeded by the American Forces in France and the American Forces in Germany.25

During the period August to November, 1919, the closing months of our activities in France, claims for services rendered or supplies delivered to various hospitals and units throughout France were investigated and vouchers prepared and paid.25 Many of the accounts so paid were of long standing, the original bills apparently having been lost.25 Investigations of these charges were difficult, not only on account of insufficient receipts but also because officers who gave the orders, received the supplies, or engaged the services had returned to the United States.


After November 15, 1919, no further payments were made by the Medical Department, but all vouchers were prepared and submitted to the quartermaster disbursing officer for payment.25 Since the medical disbursing officer ceased to function, a total number of 70 claims for services rendered or supplies delivered (many of these being final settlements covering a series of transactions with the various persons or companies and requiring a complete check of all bills rendered and paid in order to avoid duplication) were investigated and vouchers prepared for submission to the quartermaster for payment.

(July 28, 1917, to July 15, 1919)


Brig. Gen. Francis A. Winter, M. C., chief.
Col. A. P. Clark, M. C., chief.
Col. Norman L. McDiarmid, M. C., chief.
Col. C. C. Whitcomb, M. C., chief.
  Col. Larry B. McAfee, M. C.
  Col. Norman L. McDiarmid, M. C.
  Col. J. R. Mount, M. C.
  Lieut. Col. Harry G. Ford, M. C.
  Maj. John M. Corson, San. Corps.
  Maj. John S. Fielding, San. Corps.
  Maj. Donald B. Inman, San. Corps.
  Maj. Arthur W. Morehouse, San. Corps.
  Maj. Arthur W. Proctor, San. Corps.
  Maj. William G. Soekland, San. Corps.
  Capt. Bertrand Emerson, jr., San. Corps.
  Capt. Thomas W. England, San. Corps.
  Capt. Morey Feder, San. Corps.
  First Lieut. J. R. Shea, San. Corps.
  First Lieut. John Shotwell, San. Corps.


Col. Henry D. Snyder, M. C., chief.
Lieut. Col. W. D. Whitcomb, San. Corps, chief.
  Lieut. Col. W. D. Whitcomb, San. Corps.
  Maj. Henry Aicklen, San. Corps.
  Capt. E. O. Foster, San. Corps.
  First Lieut. Eugene J. Berry, San. Corps.
  First Lieut. Fred W. Eckert, San. Corps.
  First Lieut. Russell W. Goodyear, San. Corps.

(1) Memorandum for the chief of staff, H. A. E. F., from the chief surgeon, A. E. F., July 21, 1917. Subject: War diary. Copy on file, Historical Division, S. G. O.

(2) Report on the activities of the supply division, chief surgeon's office, A. E. F., made to the chief surgeon, A. E. F., May, 1919, by Col. N. L. McDiarmid, M. C. On file, Historical Division, S. G. O.


(3) First indorsement, War Department, Surgeon General's Office, July 25, 1917, to the chief surgeon, A. E. F. Subject: Forwarding medical supplies without requisition. On file, A. G. O., World War Division, chief surgeon's files, 400.314.

(4) Final Report of Gen. John J. Pershing, September 1, 1919.

(5) Memorandum for the chief of staff, H. A. E. F., from the chief surgeon, A. E. F., September 2, 1917. Subject: War diary. Copy on file, Historical Division, S. G. O.

(6) Memorandum for the chief of staff, H. A. E. F., from the chief surgeon, A. E. F., November 25, 1917. Subject: War diary. Copy on file, Historical Division, S. G. O.

(7) Report on activities, medical group, fourth section, general staff, G. H. Q., A. E. F., for the period embracing the beginning and end of American participation in hostilities, December 31, 1918, by Col. S. H. Wadhams, M. C. Copy on file, Historical Division, S. G. O.

(8) Memorandum for the chief of staff, H. A. E. F., from the chief surgeon, A. E. F., October 7, 1917. Subject: War diary. Copy on file, Historical Division, S. G. O.

(9) Historical report to the secretary, general staff, G. H. Q., A. E. F., on the Medical Department, A. E. F., to May 31, 1918, made by the chief surgeon, A. E. F. Copy on file, Historical Division, S. G. O.

(10) Outlines of histories of divisions, U. S. Army, 1917-1919, prepared by the Historical Section, the Army War College. On file, Historical Section, the Army War College.

(11) Report on the activities of the chief surgeon's office, A. E. F., from the arrival of the American Expeditionary Forces in Europe to the armistice, by the chief surgeon, A. E. F., March 20, 1919. On file, Historical Division, S. G. O.

(12) The Medical Department, A. E. F., to November 11, 1918, compiled by Capt. E. O. Foster, S. C., from the chief surgeon's records, A. E. F., under the direction of the chief surgeon, undated. On file, Historical Division, S. G. O.

(13) Memorandum, G. H. Q., A. E. F., August 20, 1917. Subject: Automatic supply. Copy on file, Historical Division, S. G. O.

(14) Cable No. 145-S from General Pershing to The Adjutant General, September 7, 1917.

(15) Report of medical activities, line of communications, A. E. F., during the war period, by Brig. Gen. F. A. Winter, M. D., undated. On file, Historical Division, S. G. O.

(16) Report of activities of G-4-B, medical group, fourth section, general staff, G. H. Q., A. E. F., by Col. S. H. Wadhams,  M. C., December 31, 1918. On file, Historical Division, S. G. O.

(17) Locations of Medical Department units, prepared in the office of the chief surgeon, A. E. F., as of October 17, 1918. Copy on file, Historical Division, S. G. O.

(18) Manual for the Medical Department, U. S. Army, 1916, par. 536.

(19) A handbook of economic agencies of the war of 1917. Monograph No. 3. Prepared in the Historical Branch, War Plans Division, General Staff, 1919.

(20) Report on the activities of the chief surgeon's office, A. E. F., to May 1, 1919, made to the Surgeon General by the chief surgeon, A. E. F. On file, Historical Division, S. G. O.

(21) Letter from the officer in charge, finance and accounting division, chief surgeon's office, A. E. F., to the chief surgeon,  A. E. F., May 12, 1919. Subject: Report for week ending May 9, 1919. On file, Historical Division, S. G. O.

(22) Letter from the chief surgeon, A. E. F., to the chief of staff, A. E. F., May 28, 1919. Subject: War diary for week ending May 24, 1919. Copy on file, Historical Division, S. G. O.

(23) Letter from the officer in charge, finance and accounting division, chief surgeon's office A. E. F., to the chief surgeon,  A. E. F., March 24, 1919. Subject: Report for week ending March 21, 1919. On file, Historical Division, S. G. O.

(24) Letter from the officer in charge, finance and accounting division, chief surgeon's office A. E. F., to the chief surgeon,  A. E. F., April 14, 1919. Subject: Report for week ending April 11, 1919. On file, Historical Division, S. G. O.

(25) Letter from the chief surgeon, American Forces in France, to the commanding general, A. E. F., December 30, 1919. Subject: Report from July 1, to December 30, 1919. Copy on file, Historical Division, S. G. O.