History

Medical Supply

In its proper sense, therefore, the art of waris the art of making use of the given means in combat.-CLAUSEWITZ.

THE MEDICAL SUPPLY FUNCTION

During the past 10 years, the medical supplysystem has changed extensively. These changes resulted in greater flexibilityand a corresponding increase in the ability to meet changing tactical andstrategic requirements. This greater flexibility was not achieved easily-thedegree of flexibility of a medical supply system is dependent in large measureon its administrative control, and such control shifted many times in the periodfrom 1959 to 1968. When in 1968 administrative responsibilities for medicalsupply activities were returned to the Army Medical Department, medical supportflexibility was enhanced.

In 1959, the Military Medical Supply Agency, a singlemanagership under the Secretary of the Navy, was assigned the responsibility forprocurement and distribution of standard items of medical materiel within theDepartment of Defense. This agency had been established to consolidate themilitary supply systems and to preclude duplication of functions, with asubsequent reduction in the expenditure of Government funds. The Surgeon Generalretained the responsibility for determining the items that he needed fortreatment and for prophylaxis requirements.

Under the Military Medical Supply Agency, the Army MedicalDepartment in 1959 was responsible for the

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operation of two of three major distribution points: theLouisville Medical Depot, Louisville, Ky., which serviced the central UnitedStates, and the Medical Supply Section, Sharpe General Depot, Lathrop, Calif.,which supplied the western area of the country. Additionally, in the northeast,the Medical Supply Section, Schenectady General Depot, Schenectady, N.Y.,provided a limited primary stock to that portion of the country, while in thesoutheast, the Medical Supply Section, Atlanta General Depot, Atlanta, Ga.,provided that same mission. Also included in the Army's medical depot systemwas the Memphis General Depot, Memphis, Tenn., which operated a carrying stockpoint for medical materiel. All five of these depots functioned as reserve stockpoints in the wholesale depot system.

As part of the Department of Defense programto consolidate materiel managerial efforts, these depots were transferred fromthe command jurisdiction of The Surgeon General to that of the Supply andMaintenance Command by 1 August 1962. The Supply and Maintenance Command wasestablished in the course of the reorganization of the Department of the Army in1962 to control supply functions within the Army.

Further indication of the effort of theDepartment of Defense to centralize the managerial control of supply procurementand distribution was the establishment in August 1961 of the Defense SupplyAgency-an agency accorded an authoritative position in the Department ofDefense organizational structure on the same level as the secretaries of thearmed services. The effect of this structural reorganization of the Departmentof Defense was a redesignation of the Military Medical Supply Agency as theDefense Medical Supply Center on 1 January 1962, and a shift of medical materielcontrol and management from the Department of the Navy to the Defense SupplyAgency.

In further consonance with the DefenseDepartment policy of centralizing managerial control and authority, the DefenseMedical Supply Center was "disestablished"

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in July 1965, and its function, together withother materiel and supply activities, for example, clothing, equipage, andsubsistence was transferred to the newly established Defense Personnel SupportCenter in Philadelphia, Pa. The Directorate of Medical Materiel within thestructure of the Defense Personnel Support Center, was the medical materielmanager responsible to the Defense Supply Agency for the operation of a NationalInventory Control Point in Philadelphia.

The consolidation of materiel and supplyeffort at the top of the Department of Defense organizational structure wasfollowed by a similar centralization of supply activities within the Armystructure. Although advantageous in many respects (namely, control,simplification, and funding), consolidation of materiel commodities precludedthe personalized attention and flexibility required in the handling of medicalitems. To this "lumping" of materiel, The Surgeon General and commandsurgeons throughout the Army objected strenuously.

The disadvantages in treating medical materielas just another category of supply items were not fully realized when medicalmateriel support in Europe declined precipitously. The situation became soserious that the Commander, U.S. Army, Europe, returned the control to medicalpersonnel for necessary remedial actions. A similar situation arose during theSoutheast Asia buildup in 1965. In November of that year, the Vice Chief ofStaff requested that The Surgeon General investigate and recommend appropriatemeasures to resolve the medical supply difficulties and shortages occurring inVietnam and other subordinate commands within the U.S. Army, Pacific. Arepresentative of The Surgeon General investigated the situation and discoveredthat the U.S. Army, Pacific, Inventory Control Point-which had theresponsibility for the control of all requisitioning of supplies within thetheater and for the centralized maintenance of records on the status of supplieswithin each of the subordinate commands-could not provide

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pertinent data regarding the medical supplysituation within U.S. Army, Pacific. Consequently, requisitioning objectiveswere being computed without the full knowledge of subordinate commandconditions, environment, or professional requirements. In fact, to ensureadequacy of objectives, subordinate commands were obliged to review theirrecords constantly and thus employ an undesirable duplication of effort. Theinvestigation revealed that the U.S. Army, Pacific, Inventory Control Point didnot contribute any assistance to the subordinate commands nor to the surgeonswho were responsible for the health of troops in those subordinate commands.

While the inadequacies and malfunctioning ofthe supply system were being investigated, a concept study advocating a bold,new approach to the problem of the administrative support of a theater Armyentitled "TASTA-70 (The Administrative Support-Theater Army 1965-70)"was under study in the Office of the Chief of Staff. Commenting on the study,The Surgeon General recommended that the Army Medical Department be givencontrol over medical depots and medical inventory control activities. Approvedby the Chief of Staff, The Surgeon General's recommendation was incorporatedin the TASTA-70 concept and provided the basis for the realinement of medicalsupply activities under the command surgeons in overseas commands which began inthe summer of 1966 and was completed on 1 October 1968.

Completion of the transfer marked the returnof managerial control over medical materiel to the Army Medical Department. Moreimportant, it marked the return of the flexibility necessary to satisfy directlythe medical needs of overseas commands.

REORGANIZATION WITHIN THE SURGEON
GENERAL'S JURISDICTION

When General Heaton became chief of the Army Medi-

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cal Department in June 1959, the supply anddistribution of medical materiel within the U.S. Army was managed by the ArmyMedical Supply Support Activity, a class II activity under The Surgeon General,which coordinated its efforts with the Defense Medical Supply Center. Bothactivities were located in Brooklyn, N.Y. In early March 1965 and in consonancewith the proposed movement of the Defense Department's medical materielfunction, the Army Medical Supply Support Activity moved to Phoenixville, Pa.,relatively near the National Inventory Control Point at Philadelphia, where itwas satellited on an existing medical facility, Valley Forge General Hospital.On 5 April 1965, the activity resumed operations and, shortly thereafter (15April 1965), was redesignated the U.S. Army Medical Materiel Agency. Agencyfunctions and responsibilities did not change with the redesignation butremained as follows: (1) The computation of the Army medical supplies andequipment quantitative gross requirements for peacetime (new items only), forgeneral mobilization, and for specific mobilization reserves; (2) theadministration of military and civilian foreign aid programs; (3) theredistribution of retail level excess medical supplies and equipment; (4) theoperation of a finance and accounting office; and (5) the performance of aliaison service in supply and stock control activities between The SurgeonGeneral and the Directorate of Medical Materiel, Defense Personnel SupportCenter.

During the summer of 1966, and as part of the four-phasetransition in managerial control of medical materiel, the medical supply systemsupporting military activities in Southeast Asia was realined by shifting theresponsibility for determining requisition objectives for stocked medical itemsand for ordering replenishment supplies from the Inventory Control Point, U.S.Army, Pacific, to the U.S. Army Medical Depot in the Ryukyu Islands. This depot,in turn, ordered replenishment supplies directly from the Defense PersonnelSupport Center through the U.S. Army Medical Materiel

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Agency. This same shift of medical materiel responsibilityand realinement followed for the remainder of Army medical units worldwide andwas completed before the end of calendar year 1968. The effect of thisrealinement was the routing of all requisitions for medical materiel fromsubordinate commands within the U.S. Army, Pacific, to the U.S. Army MedicalMateriel Agency where the order was recorded and reviewed before it wastransmitted to the Defense Personnel Support Center. Thus, the U.S. Army MedicalMateriel Agency was able to maintain control and "followup" on eachrequisition to ensure that the requesting agency was kept fully informedregarding the status of its order and, when necessary, to expedite the deliveryof urgently needed items.

Within the Office of The Surgeon General, the SupplyDivision, which provided staff assistance in medical materiel, was reorganizedseveral times to meet the changing requirements of the Department of Defensemedical materiel system. In fiscal year 1960, for example, the Supply Divisionwas reorganized by combining similar or related functions and by clarifying thevarious fields of responsibility in order to assure greater efficiency in supplyoperations under the single-manager system. Again, on 1 June 1962, to achievethese same objectives, the division was reorganized and reduced from anauthorized personnel strength of 77 (16 military and 61 civilian) to 63 (12military and 51 civilian). Since that time, and with the buildup of militaryforces in Southeast Asia, the authorized civilian strength has been increased to57, while the authorized military strength has not been altered.

MOBILIZATION RESERVE, PRESTOCKAGE, ANDMEDICAL ASSEMBLAGE AND REPLACEMENT PROGRAMS

The advent of centralized management of medicalmateriel failed to provide for any allocation of general

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mobilization reserve stocks held by thecontrolling agency. Under the single-manager system, from 1957 until 1 July1959, no provision had been made for the allocation of reserves on any specificbasis to the three medical services. The Surgeon General contended that such anallocation was necessary for the effective management of mobilization reservestocks. Following a detailed analysis of the policy in effect, stimulated inpart by The Surgeon General's position, the Department of Defense published adirective on 8 July 1959 which established a new policy for the management ofthese stocks. The directive stated that mobilization reserve stocks were to bedivided into two categories: Prepositioned War Reserve Stocks and GeneralMobilization Reserve Stocks. It provided that stocks previously identified forspecific reserve purposes were to be positioned, before hostilities, at or nearthe point of planned use or issue to the user, to ensure timely support of aspecific project or designated force during the initial phase of war. Noteworthyas reflecting the position which had been advocated by The Surgeon General wasthe fact that these stocks, to be designated Prepositioned War Reserve Stocks,were to be under the control of the respective services. In contrast, thedirective provided that gross mobilization requirements were to be allocatedadministratively to the military medical departments on the basis of prioritiesestablished by the Joint Chiefs of Staff. Although the policy that PrepositionedWar Reserve Stocks were to be under the control of the respective services wasadopted in July 1959, it was not implemented until November 1963. At that time,a Department of Defense directive was issued stating that reserve Defense SupplyAgency stocks which met the criteria for Prepositioned War Reserve Requirementswere to be transferred to the ownership of the military services. It was notuntil September 1966, however, that an agreement for the decapitalization andrecapitalization of Prepositioned War Reserve Stocks was negotiated

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between the Defense Supply Agency and themilitary services.

As a result of this recapitalization ofprepositioned war reserve medical stocks by The Surgeon General, medical stockswere returned to the ownership of the Army, and the maintenance of inventory andfinancial records became a responsibility of The Surgeon General. The custodyand accountability of the materiel, however, remained the responsibility of theDefense Supply Agency depot system. The management functions (that is, themaintenance of records, and so forth) were assigned to the U.S. Army MedicalMateriel Agency, and a subsequent increase in that agency's staff wasapproved.

In addition to reserve and prestockageprograms, two other programs were given special impetus during the past decade.The first of these was a program started during fiscal year 1958 and designed toreconstitute major medical assemblages. Its primary purpose was to reduce theweight and size of assemblages through the employment of the latest packagingconcepts and techniques and to replace wornout and obsolete equipment currentlypackaged. Although the program was fundamentally complete by the close of fiscalyear 1961, the same assemblage techniques were carried over into assemblyprograms which in fiscal year 1962 were necessary to meet the requirements ofactivated U.S. Army Reserve and National Guard units, and the requirements foroverseas commands and the Military Assistance Program.

The second program, which is discussed ingreater detail elsewhere, was the Hospital Equipment Program. This program,which was established by The Surgeon General in 1959 to assist commanders inacquiring modern equipment to keep pace with an expanding medical technology,had been enlarged over the years to encompass not just major capital equipment,as had been the early intent, but all medical equipment. Its objectives resultedin the Army Medical Department Equipment Replacement and Modernization Programand a Medical

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Equipment Programming and Reporting System. Itseffect has been far-reaching in the replacement and modernization of medicalequipment and the purchase of additional equipment throughout the U.S. Army.

In addition to the resumption of the controlof Army medical materiel, the supply and materiel function of the Army MedicalDepartment expanded greatly during this period. Owing to the many advances inthe military practice of medicine, many new items were type-classified asstandard for entry into the military medical supply system, while other items(not as great in number) were deleted from the system as outmoded, obsolete, ornonessential. Growth and advancement in the procurement and distribution ofmedical materiel was the theme of the 1959-69 period.

SPECTACLE FABRICATION

By 1959, Army optical laboratories located at theU.S. Army Medical Optical Maintenance Activity, St. Louis, Mo., and the MedicalSupply Section, Sharpe General Depot, had increased their workload of spectaclefabrication by furnishing spectacles for Navy personnel in the western UnitedStates, in addition to an already growing list of Army and Air Forcefabrications.

With the exception of a temporary"breather" in fiscal year 1963, attributable to a drop in strength ofthe Armed Forces and the release of National Guard and Reserve units from activeduty following the Berlin Crisis, this workload expansion in spectaclefabrication continued during General Heaton's entire tenure in office. Infiscal year 1960, the Optical Section, 32d Army Medical Depot, Brooke ArmyMedical Center, Fort Sam Houston, Tex., was given an optical training missionfor the fabrication of spectacles for two stations. By the summer of 1963,planning for the decentralization of optical fabrication activities(single-vision laboratories) had begun, and by December 1964, six laboratories(four of which were of the single-vision type) and two table

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of organization and equipment opticaldetachments were provided spectable fabrication services for Army and Air Forcestations throughout the continental United States.

During the period 1963-64, the base opticallaboratories at St. Louis, Mo., and Lathrop, Calif., underwent changes in theiroperations or location. The U.S. Army Medical Optical and Maintenance Activity,St. Louis, was moved in October 1963 to Fitzsimons General Hospital, Denver,Colo., and then deactivated; its optical laboratory functions were assumed bythe hospital. The control of the optical laboratory at Sharpe Army Depot,Lathrop, Calif., was transferred from the U.S. Army Supply and MaintenanceCommand and was activated, effective on 1 July 1964, as the U.S. Army OpticalActivity, Sharpe Army Depot, a class II activity under the jurisdiction of TheSurgeon General. (On 4 February 1969, the U.S. Army Optical Activity, SharpeArmy Depot, was redesignated the U.S. Army Medical Optical Laboratory and itsaddress changed to Tracy, California.)

By fiscal year 1965, spectacle fabrication wasbeing accomplished in overseas commands at five optical laboratories; the threein Alaska, Europe, and Korea were equipped and staffed to perform surfacingfunctions, while the laboratories in Hawaii and the Ryukyu Islands (Okinawa)fabricated single-vision spectacles only and forwarded multi-vision spectacleprescriptions to the continental United States for fabrication. The Europeanlaboratory had in fiscal year 1965 increased its fabrication workload bypreparing special-order spectacles for dependents of U.S. civilian and militarypersonnel on a reimbursement basis. The purpose of this provision was to reduceexpenditures on the local economy and thereby assist in alleviating the balanceof payments (gold flow) problem.

By the end of fiscal year 1966, two newoptical laboratories, one at the U.S. Army Medical Depot in Okinawa and one atthe 32d Medical Depot in South Vietnam

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(formerly at Fort Sam Houston, Tex.), hadbegun operation.

The fabrication of spectacles had so expandedthat, with the close of fiscal year 1968, a total of 1,596,638 pairs ofspectacles and other eyewear, an increase of almost 9 percent more than thefiscal year 1967 total, had been fabricated. What is startling, however, is theincrease in fabrications between fiscal year 1965, the last year before the Army'sVietnam buildup, and fiscal year 1968. During fiscal year 1965, 952,631 pairs ofspectacles were fabricated; this amount, when compared with the 1968 fiscal yeartotal, relates an expansion of more than 60 percent over a 3-year period.

NBC (NUCLEAR, BIOLOGICAL, CHEMICAL)
MEDICAL MATERIEL PROGRAMS

In 1959, the medical materiel program fornuclear casualties had finally progressed to the packaging and distribution tothe continental United States of emergency care, medical supply sets. By the endof fiscal year 1962, after funding had been made available, distribution wascompleted to all continental United States and overseas stations.

The medical materiel program, initiated in1956, provided two emergency Medical Treatment Units (phase I and phase II)which contained the medical supplies required to furnish emergency medical carefor nuclear casualties. The program had been initially devised to treatdependents in overseas commands as well as military casualties resulting from anuclear attack. The phase I sets were positioned with troops (one for each 100personnel) whereas the phase II sets were positioned with medical facilitieswith one set capable of providing supplies for 1,000 casualties.

In the summer of 1963, the Medical MaterielProgram for Defense Against Biological and Chemical Agents was established asanother preparedness measure against the threat of nuclear, biological, orchemical warfare.

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This program which prepositioned medicalsupplies in two phases was established to increase the capability of the ArmedForces to defend against chemical and biological agents. As monitor for theprogram within the Department of the Army, The Surgeon General took thenecessary action to assure that the required supplies were procured and shippedto complete prepositioning with individuals at treatment facilities and in depotreserves.

The phase I portion of the program, which includedbroad-spectrum antibiotics for the prophylaxis and treatment of infectiousdisease, naturally or artificially induced, and atropine Syrettes and automaticatropine injectors for treatment of casualties resulting from posure to nervegases, was completed by the close of fiscal year 1964, while phase II, whichconsisted of the preoverpositioning of pralidoxime chloride, an oxim to be usedas an adjunct to atropine in the treatment of nerve-gas poisoning, was completedbefore the end of fiscal year 1965.

PROCUREMENT ACTIVITIES

Although, as related earlier, the wholesalestocks of standard items of medical materiel in continental United States depotswere purchased by other Department of Defense agencies, there were certainpurchasing and contracting functions for which the Office of The Surgeon Generalwas responsible. Among these expenditures were those for research anddevelopment activities, the purchase of nonstandard items, and the procurementof supplies and services required by class II installations for hospital andother local mission operations. During General Heaton's tenure, thesepurchasing and contracting functions were performed with economy in mind and inkeeping with Department of Defense policy regarding small business contracts.(Department of Defense policy prescribed that a certain percentage of all

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Government contracts, at least 25 percent oftotal dollar amount, be granted to small business.)

FUNDING AND ACCOUNTING

Medical materiel inventories were an important part of themedical supply function. In 1959, the Medical-Dental Division, Army Stock Fund,managed the funding of bulk inventories of medical materiel at 22 class I andseven class II installations and activities in the continental United States andat six overseas commands. It performed this function with a home office managedby the Supply Division, Office of The Surgeon General, 22 branch offices in thecontinental United States (25 by fiscal year 1965), and an office in each of thesix overseas commands. The Army Medical Department procured the greater portionof its supplies and equipment from the wholesale medical supply stocks(capitalized under the Navy Stock Fund) of the Military Medical Supply Agency,the operating activity of the single manager for medical materiel (Navy).

On 1 July 1959, the six branch offices (nine by fiscal year1962) in the Third U.S. Army area were decapitalized and recapitalized in theZone of Interior Installations Division, Army Stock Fund, on a test basis toevaluate the concept of horizontal stock funding; that is, stock funding atcommand, rather than at technical service, levels.

While command-level stock funding was being tested, otherprojects and programs were either being expanded or added to the existing stockfunding system. Such an addition was the funding procedures for the MilitaryAssistance Program, which before 1961 had been designated the Army MutualSecurity Program. Effective during fiscal year 1962, the Military AssistanceProgram requisitions extracted by The Surgeon General from the Defense MedicalSupply Center were financed by the Medical-Dental Division, Army Stock Fund,with subsequent sales to, and reimbursement from, Military As-

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sistance Program funds, effected upon delivery in accordancewith new central reimbursement procedures. Previously, Military AssistanceProgram requisitions placed with the Defense Medical Supply Center were financedwith Military Assistance Program funds held by The Surgeon General. With thechange, Military Assistance Program funds became centrally controlled by theU.S. Army Military Assistance Program Logistics Agency. Therefore, to facilitatethe processing of requisitions and to expedite reimbursement to the DefenseMedical Supply Center, it became necessary to finance Military AssistanceProgram orders through the Army Stock Fund.

During the early period, 1960-62, funding requirements formobilization reserves continued to increase while the funding of operatingstocks achieved a leveling-off of expenditures.

In concurrence with the Department of Defense centralizationpolicy of materiel management, on 1 July 1964, the Medical-Dental Division, ArmyStock Fund, ceased operations as an active stock fund entity but continueddisbursement actions and reports until all outstanding obligations could beliquidated. The overseas commands, the U.S. Military Academy, West Point, N.Y.,and Aberdeen Proving Ground, Md., were decapitalized to their respective commandchannel stock funds, while the installations and activities under the commandjurisdiction of The Surgeon General (seven class II hospitals and medicalcenters and the Sharpe Optical Activity) were capitalized into The SurgeonGeneral's Subhome Office of the U.S. Army Materiel Command InstallationsDivision for peacetime operating and mobilization reserve requirements. Later,during that same fiscal year, the U.S. Army Medical Materiel Agency,Phoenixville, Pa., was also designated a branch office in the Office of TheSurgeon General for the purpose of centrally procuring Prepositioned War ReserveStocks-Medical Facilities materiel. Incidentally, this command channel stockfund was devised to manage nine other

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materiel categories in addition tomedical-dental. The Military Assistance Program was capitalized into the U.S.Army Materiel Command Division of the Army Stock Fund, with the Army MedicalSupply Support Activity as a branch office; during fiscal year 1966, thisdivision was assigned the additional responsibility for procurement and directshipment of high priority medical items required in Southeast Asia.Consequently, what occurred in the Office of The Surgeon General during fiscalyear 1965 was a "phaseout" of the Medical-Dental Division, whichcontinued to exist until the close of fiscal year 1968, and the addition of twonew command channel segments of the Army Stock Fund, the U.S. Army MaterielCommand Installations Division and the U.S. Army Materiel Command Division.

The management of these new Army Stock Fund segments entailedprogramming, budgeting, accounting, reporting, and supply management, and was theentire responsibility of The Surgeon General. An interesting aspect of these twofund entities was a decrease in the sales and obligations of the U.S. ArmyMateriel Command Division, Army Stock Fund, and an increase in those same areasin the U.S. Army Materiel Command Installations Division, Army Stock Fund. Thereason for the former was a shift in certain funding obligations (namely,Southeast Asia requisitions for Vietnamese forces and some U.S. Armyrequirements) from this stock fund to a U.S. Army, Pacific, stock fund. Thereason for the latter-the increase in U.S. Army Materiel Command InstallationsDivision, Army Stock Fund requirements-can be attributed to the necessity forsupporting units for deployment to Southeast Asia and for the expansion ofpatient load in Army Medical Department class II facilities.

When discussing stock funding and stock funding procedures,particularly as they pertain to bulk inventories, the subject of stockaccounting quickly comes to mind. Again, in consonance with a consolidation andeconomy of managerial effort, an economic inventory procedure

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system was implemented by The Surgeon General at all ArmyMedical Department class II installations and activities during the last quarterof fiscal year 1962. Also, before Army-wide implementation of the MilitaryStandard Requisitioning and Issue Procedure system on 1 July 1962, arepresentative from the Supply Division of the Office of The Surgeon Generalassisted class II installations and activities in training supply personnel inthe procedures. The Surgeon General, in concurrence with Army and Department ofDefense policy, emphasized a continuing program of improvements in stockaccounting and inventory procedures.

THE MILITARY ASSISTANCE PROGRAM

The Military Assistance Program was of specialinterest to The Surgeon General in that he had staff responsibility fortechnical evaluation, coordination, and direction of medical materiel programsrelated to it. The program consisted of two main elements: Grant aid, whichprovided direct assistance financed by U.S. funds; and military assistancesales, which provided U.S. defense materiel to friendly nations on a direct-salebasis, financed through the recipient nation's treasury. The Surgeon General'sMilitary Assistance Program activities were quite extensive; they includedplanning and forecasting requirements and deliveries, assistance to MilitaryAssistance Advisory Groups and customer nations in the development ofspecification and technical descriptive materiel, and computation ofquantitative requirements for such items as repair parts. The medical materielsupplied through grant aid and sales included all items in the Defense MedicalSupply Catalogs, and also nonstandard materiel.

MEDICAL SUPPLY SUPPORT OF EMERGENCY
OPERATIONS

During the 10 years of General Heaton's serviceas

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The Surgeon General, the Army Medical Department respondedquickly and skillfully to the medical materiel requirements of the U.S. Army.The Berlin, Cuban, and Dominican Republic Crises of 1961, 1962, and 1965,respectively, were ably supported with necessary medical materiel. In the BerlinCrisis, provisions were made to prepare medical assemblages for newly activatedReserve and National Guard units. In all three crises, plans were formulated anddistribution points alerted for the automatic resupply of units designated toprovide medical support. Also, in addition to the medical resupply of militaryforces, provisions were made for the medical materiel support of civil affairsoperations in the areas of operation.

During the initial stages of the Dominican Republic Crisis,April 1965, requirements for automatic supply and resupply for troop support andcivil affairs were processed through the Office of The Surgeon General.Effective on 4 June 1965, however, normal requisitioning was established forsupport of U.S. Army troops in the Dominican Republic, and only nonstandardmedical materiel requirements continued to be processed through the Office ofThe Surgeon General.

Early in fiscal year 1966, Army medical materiel supportunits were faced with another expanded support mission-the buildup of U.S.Army troops in Vietnam. One of the most significant supply problems at the onsetof the buildup was a lack of adequate medical supply personnel in the theater.The 8th Field Hospital at Nha Trang was assigned the responsibility for medicalsupply distribution to the medical units in South Vietnam. This unit wasaugmented by a small staff which was not adequate to provide the necessarycontrol over the tremendous requirements being generated practically overnight.This situation was compounded by the protracted delay in deployment of the 32d(Field Army) Medical Depot which, although "ready" in July of 1965,was not deployed until late October. One supply detachment had been deployed inJuly and another

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shortly thereafter, but thesedetachments did not have a sufficient depth to manage supply activities in atheater of operations the size of Vietnam. With the escalation of United Statesefforts in Vietnam, greater dependence was placed upon the Ryukyu Islands as theoffshore base to support units in Vietnam. A supply detachment was deployed toOkinawa in August, and in November 1965, the 70th Medical Depot was deployed toaugment and expand the operation of the medical depot in Okinawa.

The Surgeon General, handicapped by an insufficiency instrength and capability of medical supply and other types of supplyorganizations, coordinated with the Commander in Chief, U.S. Army, Pacific, toestablish a system of automatic shipments of medical materiel for the support ofU.S. Army troops in Vietnam. These shipments, initiated in July 1965, were basedupon schedules developed to support forces which were deployed from thecontinental United States to Southeast Asia. The materiel shipped consistedprimarily of medical resupply sets and later, after their development, includedoptical resupply sets. The automatic supply support system continued for aperiod of approximately 10 months, with peakloads of resupply occurring duringNovember 1965 through January 1966. This system, although only a temporarymeasure, did not meet with the success that was anticipated. Delays in shipmentfrom continental United States ports and in off-loading procedures at SouthVietnam facilities and the splitting of the medical resupply sets into variousshipments on board vessels were the major problems experienced.

The lack of qualified medical logistics personnel in SouthVietnam, the shortcomings of the medical resupply system related above, and theinability of a centralized supply management activity in Hawaii to meet themedical materiel demands occasioned the request by the Vice Chief of Staff foran investigation and subsequent recommendations for a resolution of the medicalmateriel problems. The ultimate result was The Surgeon

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General's plan for the realinement of the managerialcontrol of medical materiel under the Army Medical Department.

The Surgeon General's plan, as it pertained to SoutheastAsia, was to assign the management of medical materiel to the U.S. Army MedicalDepot in Okinawa; this assignment, which was put into effect on 1 July 1966,included the computation of replenishment needs and the requisitioning of suchmateriel needs directly from the Defense Personnel Support Center through theU.S. Army Medical Materiel Agency.

The result of this assignment of medical materiel managementto the Okinawa depot was the expansion of that depot in size andresponsibilities. These responsibilities increased to such a degree that thedepot ultimately supported U.S. Army units in South Vietnam and Thailand; theArmed Forces of South Vietnam, Thailand, and Laos; and activities of the Agencyfor International Development in Southeast Asia, while also supplying militarycustomers on the Ryukyu Islands. The amount of depot sales to customers duringfiscal year 1968 ($64 million) more than doubled the sales figure for fiscalyear 1967 ($28.5 million).

In South Vietnam, the 32d Medical Depot, which had beendeployed in October 1965 and which received its medical materiel support fromthe Okinawa depot, provided medical materiel for units of the United States Armyand the Armed Forces of Korea, the Philippines, Australia, and New Zealand,operating in South Vietnam. Its functions included the fabrication ofsingle-vision spectacles and the maintenance and repair of medical equipment ofsupported units throughout South Vietnam. The depot operated through fivelocations (four advance depots and a base depot at Cam Rahn Bay). Two of theseadvance depots and the base depot utilized a National Cash Register Company 500computer system for stock control and inventory management. During fiscal year1968, the 32d Medical Depot issued about $30 million of medical materiel inSouth Vietnam.

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During the past decade, the medical supply system was markedby extensive change and improvement. These changes ranged from the revision ofsupply catalogs, bulletins, and regulations to the development and issue of newresupply sets, from the modernization of storage techniques to the automation ofthe supply system, and from the establishment of effective equipment maintenanceto the renovation of the ambulance fleet. By these and other means, GeneralHeaton's objective of flexibility and responsiveness in the supply system wasachieved.