CHAPTER XIX
THE FINANCE AND SUPPLY DIVISION
MEDICAL SUPPLIES
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 AmericanExpeditionary Forces on July 18, 1917, the senior of these was madethe surgeon, line of communications;1 the other, the officerin charge of the medical supply depot which had been establishedat Cosne.2 The surgeon, line of communications, had broughtwith him from the United States a small but especially chosen detachmentof Medical Department enlisted men, a part of which he kept with him forhis own purposes, the remainder being assigned to the medical depot atCosne.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 officersof both the chief surgeon, A. E. F., and of the surgeon, line of communications, were not only in Paris but also they were inthe same building there; consequently, though they were separate, in effect the separation was to a lesser extent than onewould suppose. It was definitely understood, however, that the surgeon,line of communications, in his capacity as such, was directly responsiblefor all questions pertaining to supply, with the exception of purchasesabroad, which will be referred to below. This brought under his controlthe medical supply depots, and by this his responsibility was made to includedistribution as well as procurement.
Initially, the amounts and kinds of medical supplies were prescribedin certain tables which appeared in the Manual for the Medical Department. All
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Medical Department units of the American Expeditionary Forces were fieldunits, consequently, medical supplies were initially provided for them3and in theory were taken by them to France. In this connection, however,two factors influencing the medical supply question of the American ExpeditionaryForces must be taken into consideration. It was known from the first that,because of the wide separation of our field of operations from the UnitedStates, a more prolonged and a higher quality of hospital treatment ofour sick and wounded in France would be necessitated, thus creating thenecessity for more and a wider variety of medical supplies than had beencontemplated. Furthermore, in view of the fact that there was a shortagein shipping facilities, there was every necessity for obtaining abroadas many articles for our purposes as would, by so doing, obviate the necessityfor having them sent from the United States, thus releasing so much tonnagespace for other and more urgent purposes.4
The supply situation of course pertained to all supply branches of theAmerican Expeditionary Forces, and to obviate their entering the European markets as purchasers without regulation andcoordination, thereby being thrown into competition not only with themselves but with buyers from the Allied armies and thecivil population as well, General Pershing, in August, 1917, created ageneral purchasing board for the American Expeditionary Forces.4Since each supply department of the American Expeditionary Forces was tobe represented upon this board, the chief surgeon, A. E. F., appointeda medical officer, known as medical purchasing officer, to represent himon the general purchasing board.5 In view of the fact that thegeneral purchasing board functioned under general headquarters, A. E. F.,the medical purchasing officer consequently was answerable to the chiefsurgeon, A. E. F., in the performance of his duties, rather than to thesurgeon, line of communications, in whom, it may be recalled, was placedthe responsibility for procurement as well as the storage and distributionof medical supplies. As it eventuated, however, it was not unusual forthe medical purchasing officer to adopt the less time-consuming methodof having the surgeon, line of communications, approve his action in sofar as purchases were concerned.2 This practice, begun afterthe removal of the office of the chief surgeon, A. E. F., to Chaumont,and while the office of the surgeon, line of communications, was stillin Paris, continued thereafter without objections being made to it.
In November, 1917, the chief surgeon, A. E. F., established in his officeat Chaumont a division of supplies.6 It was not his purpose to duplicate the activities of the division of supplies inthe office of the surgeon, line of communications, and for that reason the office force of the division of supplies at Chaumont neverassumed similar proportions. However, since matters pertaining to medical supplies were constantly being presented to thechief surgeon, necessitating detailed study before being acted on, andother matters of equal importance were occupying the complete attentionof all the existing divisions of his office, the necessity for a supplyofficer could no longer be disregarded.
There was now, that is, about December 1, 1917, a supply division inthe chief surgeon's office, A. E. F., whose function was acting upon questionsof equipment, supply and transportation, and the division of supply inthe office of the surgeon, line of communications, whose function was similar,with the exception that it did not act upon matters of transportation.
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In the division of supplies, chief surgeon's office, A. E. F., routinematters, such as approval of the many requisitions for medical suppliesthat were received from tactical units in the advance section, were lookedafter. In addition, however, early efforts were made to establish a policyof supply. This necessitated a number of studies, chief among which werethose with reference to the general organization project and the priorityshipment 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:
HEADQUARTERS,LINE OF COMMUNICATIONS,
OFFICE OF THE CHIEFSURGEON,
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 transferredto you communications illustrating the difficulties and delays inherentin our present system of supply with more or less divided control. I feelit incumbent upon me now to make representation to you concerning the generalsituation, to submit my recommendations for your consideration, and torequest your decision. I do this because I am firmly convinced that theefficient and smooth working of the supply system demands unified controlof all issues, and will more and more require it as the demands increase.
2. While the individual instances are not important inthemselves, an accumulation of them works confusion in the minds of theofficers affected and thus lessens efficiency. A recent instance is this:I received and acted upon a request from the gas officer for purchase forhis laboratory. I am informed by Major Card that other copies of the identicalcommunication were referred to you and acted upon-your action differingslightly from mine.
Purchases.-I have upon a number of occasions madepurchases in France or England for stock, although this is, under the provisionof general orders, placed directly under you. This matter should certainlybe centralized, as I have previously written you, and I am convinced thatit should be placed in this office.
More and more the purchasing officer has referred directto this office questions of purchase, although he is immediately underyou. This has probably resulted from the proximity of the offices in Paris.But more and more, too, you have been sending communications to Major Cardthrough my office, not only for my information but for action. This I believeto be a tacit recognition of the advantage of the purchasing office beingpart of mine.
Red Cross.-The present situation is confusing Iam sure, not only for me but for the Red Cross as well. A typical instanceis the correspondence on mobile laundries referred to me under date ofFebruary the 13th.
I am informed that requisitions approved by division surgeonsare being sent directly to the Red Cross. Inasmuch as these divisions arealso making requisition upon the supply depots under my jurisdiction, thereis no way of preventing duplication. This duplication I have attemptedto prevent on the line of communications by directing all requisitionsto the Red Cross to be sent through my office. Upon receipt they are referredto the supply depot for issue if the stock is available. The Red Crossis not called upon unless our depots can not supply the material.
Divisions.-All requisitions for whatever materialshould, in my mind, be referred to the depot, and if the material can notbe supplied at that point should be referred to my office for suitableaction-purchase or reference to the Red Cross, as seems best.
3. While under these suggestions I seem to be taking overa good many of the functions heretofore exercised by you, it is only becauseI believe that I am thereby relieving you of the details.
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4. The needs of the Army as a whole or of any divisionthereof would be indicated to me, and it would become my duty to supplythose needs getting the material from whatever source was available.
F. A. WINTER,
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 willbe automatically settled when the supply division, C. S. O., S. O. R.,has been reorganized according to plans now contemplated and becomes operativethereunder.
By direction of the chief surgeon:
A. P. CLARK, Major, MedicalCorps.
As is indicated in the indorsement to letter above quoted, at this timeplans 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 withthe office of the surgeon, line of communications. Subsequently to thiscombination, effected on March 21, 1918, there was but one division ofsupplies for the Medical Department;2 however, in view of theinterest of the Medical Department in getting its supplies shipped fromthe United States to France, the chief surgeon, A. E. F., upon the removalof his office to headquarters, Services of Supply, left a medical officerat Chaumont to represent him in the first section of the general staff,general headquarters, A. E. F., since all questions relating to ocean tonnagewere handled in that section.7
PURCHASES IN EUROPE
As previously stated, the policy of buying everything possible in Europethat would effect a saving in ocean tonnage was established early in the American Expeditionary Forces. But in so faras medical supplies were concerned it soon proved that European marketswere practically depleted and thus would be unreliable as a possible sourceof supply.8
Upon the organization of the general purchasing board, and the assignmentthereto of a medical purchasing officer, a copy of the Medical Department supply table, as it appeared in the Manual forthe Medical Department, was furnished the board, with the view of havingthe possible European sources of supply canvassed to secure whatever articleswere available.2 It soon proved that none of the desirable articlescould be obtained in this manner without a replacement of raw material;consequently, though arrangements were made later, through the generalpurchasing board, to procure such raw material, much of the work of themedical purchasing officer during the fall of 1917 was confined principallyto the making of small purchases in Paris to meet the pressing needs ofthe different professional services of the Medical Department, as wellas those of medical officers, and to the procurement of necessities, insmall amounts and from time to time, pending the arrival from the UnitedStates 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 Englandand in France.2
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In addition to purchases made by the medical purchasing officer, purchaseswere made locally by certain officers of the Medical Department, authority therefore being given from time to timeby the chief surgeon.2 Thus on December 15, 1917, the surgeon,line of communications, authorized commanding officers of base hospitalsto expend Medical Department funds for articles properly chargeable tothe funds appropriated to that department.2 Such expenditureswere not to exceed $100 per month. On January 28, 1918, division surgeonswere empowered by general headquarters, A. E. F., to authorize medicalofficers under them to make expenditures, chargeable to Medical Departmentfunds, in amounts not to exceed $100.2 On the 14th of the followingmonth, section surgeons were empowered to authorize medical officers intheir respective sections to expend not to exceed $250. As hospital centerswere established, each hospital center commander was given a like authority.2
This delegation of authority to expend funds was done with the viewof giving local Medical Department administrative officers more freedomthan had formerly obtained, in so far as the purchase of articles in smallamounts was concerned. Much inconvenience had obtained because of the uncertaintyof the mail service, requests for articles frequently being delayed longbeyond the arising of the urgent need for them, thus forcing the localcommander to make emergency purchases, which under Army Regulations necessitateda formal report in each instance.2 The delegated authority tomake local purchases, referred to above, obviated the necessity for suchformal reports.
In making foreign purchase of technical material for the Medical Department,A. E. F., it proved necessary to delegate much of this to representativesof the services concerned, such as X ray and laboratory.2
STORAGE SPACE
All departments were early called upon to make estimates of the storagespace that would be required for supplies needed for different numbersof men, and it is interesting to note the relation shown by these estimatesto the actual figures later established.
In September, 1917, the surgeon, line of communications, estimated thatfor 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 estimatedthat for 300,000 there would be required a total of 335,000 square feet.2Shortly afterwards the following estimates were submitted:2
| Square feet |
300,000 men, 30 days, at Gievres | 175,000 |
1,000,000 men, 30 days, at Gievres | 600,000 |
75,000 men, 15 days, at Is-sur-Tille | 20,000 |
| Additional (uncovered) | 5,000 |
1,000,000 men, 15 days, at Is-sur-Tille | 100,000 |
| Additional (uncovered) | 10,000 |
On November 17, 1917, a revised estimate was submitted in tables preparedby the chief engineer, line of communications, for 2,000,000 men in allFrance of a total of 2,880,000 square feet roofed, with an additional 220,000unroofed, 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.
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At the time of the signing of the armistice, with nearly 2,000,000 menin France, the Medical Department had the following
storage space allotted:2
Location | Designation | Date established | Maximum storage space |
Cosne-sur-Loire | Intermediate medical supply depot No. 3 | July 15, 1917 | 100,000 |
Gievres | Intermediate medical supply depot No. 2 | Oct. 10, 1917 | 391,436 |
Is-sur-Tille | Advance medical supply depot No. 1 | Nov. 18, 1917 | 95,862 |
Liverpool, England | Medical supply depot | Aug. 7, 1918 | 24,430 |
Cristo, Italy | .do. | July 29, 1918 | 2,700 |
Montierchaume | Field medical supply salvage depot | Dec. 13, 1918 | 162,500 |
Treves, Germany | Advance medical supply depot No. 2 | Dec. 27, 1918 | 100,000 |
Montoir | Base storage station | May 1, 1918 | 186,000 |
Nantes | .do. | Oct. 1, 1918 | 32,000 |
St. Nazaire | Medical supply depot | July 1, 1918 | 10,000 |
St. Sulpice | Base storage station | July 6, 1918 | 275,000 |
Bordeaux | Medical supply depot | May 6, 1918 | 25,000 |
Brest | .do. | Dec. 21, 1918 | 2,700 |
Marseille | Base storage station | July 8, 1918 | 76,000 |
Le Mans | Medical supply depot | July 20, 1918 | 10,000 |
WAREHOUSING
The fact that storage space was necessarily always assigned just aspressing need therefor arose prevented the warehousing of supplies in themanner best adapted to issues, and necessitated the constant shifting ofsupplies from warehouse to warehouse as supplies were received and spaceallotted.2
CENTRAL STORAGE FOR SORTING
As stated above, basic medical supplies were to accompany units goingoverseas. Such a shipment of supplies was sent at the time the earliestexpeditionary forces went to France.9 Anticipating the arrivalof these medical supplies in France and appreciating the necessity for securing in advance suitable storagespace for them, the chief surgeon laid his plans accordingly. Atthe time it was understood that, roughly, our lines of communications wouldextend from the west coast of France (Bordeaux-St. Nazaire-Brest) throughTours, Nevers, Dijon, and Neufchateau to the front.4 Using theselines 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,10Nevers was selected as a choice situation for the establishment of ourfirst medical supply depot. Assurances were given the Medical Departmentthat Nevers would be assigned to it; however, it proved later that Neverswas more suitable to other purposes than those of the Medical Department,in consequence of which another site for the interior location of a medicalsupply depot had to be selected. This secondarily selected site was Cosne,11and the recital of this in itself would have little if any present pertinencewere it not for the fact that, whereas Nevers was on the main line fromthe base ports to the front, Cosne was on a secondary railway, and about20 kilometers northwest of Nevers.
It is proper here to explain that the selection of a site for a medicalsupply depot so far inland as Cosne was based upon the fact that, becauseof the submarine warfare, it never could be foretold to which of the baseports convoys
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of supplies in bulk from the United States would come. With such suppliesas medical supplies, there are many items of which the amount used or thesupply on hand is so small that original packages must first be sent toa 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 theseveral base ports they were shipped in bulk to the medical supply depotwhere they were sorted, placed in stock, and accounted for. From here theycould be distributed as the occasions arose, and though some shipmentsnecessarily had to be made back over the lines toward the base ports forMedical Department activities, the seeming disadvantages of such a methodwere 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 consistedof an incomplete aerial bomb depot, being used at the time by the French.2The relatively few, floorless, and otherwise incomplete buildings availablecomprised about 50,000 square feet of floor space. Despite the absenceof unloading facilities, a lighting system and other requirements of anactivity of this size, this place was developed into our first fixed medicalsupply depot, a full-stock distribution point, and from this the entireMedical Department distribution system was largely elaborated. For a considerableperiod of time practically all medical supplies were concentrated at andlikewise 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 increasedshipments 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 medicalsupply depots, it is essential to state here upon what the supply systemof 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 variousservices, American Expeditionary Forces.13 In his memorandumof announcement, with its subsequent additions, there was outlined a definite method of supplyprocurement, both from the United States by shipment overseas and by purchase in foreign markets. In this it was furthermorespecifically set forth by what policy, under procurement, the incrementof reserve supplies was to be accumulated. The supplies were divided intothe following three classes: Automatic supply for articles regularly consumedso as to permit of an automatic supply; replenishment supply for articlesof which specified stocks had to be maintained; and exceptional supplyfor articles of which no specific stocks had to be established. Furthermore,on September 7, 1917, General Pershing, in a cablegram to The AdjutantGeneral, announced his decision to establish in France reserves of allclasses of supplies for 90 days.14 This reserve was based onauthorized issues, where such issues were regular, and on active periodicconsumption of other articles based on British and French experiences duringthe war. General Pershing directed the chiefs of the various services,A. E. F., to prepare estimates, for cabling, first, a list of
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four months' supplies to accompany each movement of troops from theUnited States. This provided not only a 90 days' reserve, but, in addition, one month's automatic supply for consumptionand emergency. Second, a list showing the amounts which would have to be shipped monthly for each 25,000 men of the AmericanExpeditionary Forces. In terms of days, the 90-day reserve plan provided for 15 days of the reserve to be in theadvance section, 30 days in the intermediate section, and 45 days in thebase ports.
Now, in accordance with this plan to have 90 days' reserve medical suppliesin France, supply depots were established as follows: Base medical depots at each of the ports utilized by Americantroops; an intermediate depot at Cosne (intermediate medical supply depot No. 3, referred to above); an advance depot atIs-sur-Tille.12
To revert to the Cosne depot: The substitution depot, intermediate medicaldepot No. 2, was at Gievres, approximately midway between Tours and Nevers (the site originally selected for anintermediate depot) on the main line from the base port St. Nazaire toour front. This depot, established October 20, 1917, was to replace thedepot at Cosne as the main issuing depot, the Cosne depot being retained as an auxiliary.2As the situation developed the depot at Gievres was increased in capacity and utilized largely for shipments of carload lots.2
DISTRIBUTION DEPOTS
With the view of having a distributing depot in the advance sectionadvance medical supply depot No. 1 on November 18, 1917, was put into operation at Is-sur-Tille, a place subsequentlyused as our principal regulating station.15 This depot, an extremely important unit, largely took over the distribution of medicalsupplies to troops and units in the advance section. It was not, however,until considerably later that this depot was made a full stock unit. Priorto its being made a full stock depot, its activities were confined largelyto the supply of medical units on duty with combat organizations.
Lack of storage space throughout France added many difficulties to themedical supply question, but those difficulties were particularly increased by the lack of storage space at base ports andby the insufficient docking facilities at the ports assigned.2 Itwas appreciated early that a large amount of storage space would be requiredat base ports, and efforts were made to secure such space. No departmentcould meet this need, however, until construction by the American ExpeditionaryForces was accomplished, consequently it was many months before confusionat the docks was eliminated. During this period the Medical Department,as was the case with other departments, sent to the docks representativeswhose duty it was to search for and sort out the supplies, and to makeshipment of them to the proper depot in the interior.2 Evenlater when this work was taken over by the Army Transport Service the representativesreferred to remained at base ports to assist the Army Transport Service.2Shipments were received in every available port, many of which, for example,La Pallice, La Rochelle, Rochefort, Les Sable d'Olonne, had no storagespace, though usually some temporary shelter was provided. Representativesof the Medical Department supply
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division were assigned to duty in each of these ports.2 Supplieswere 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 establishedat Montoir.2 Close to Bordeaux, a depot at St. Sulpice was established.2A depot was established at Miramas, adjacent to Marseille.2In each of these depots, the Medical Department was allotted space.2No depot was established at Brest and later when the shipments throughthat port were considerable, this lack of local storage space necessitatedkeeping stores without protection against the elements until sufficientrailway cars could be provided.2 No depot was established atLe Havre, through which port many of the supplies purchased in Englandwere received.2
The car shortage in France was such that never was it possible to shippromptly 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 wasnot possible until after the establishment of the depots mentioned above.The following letter shows the situation in so far as it concerned theMedical Department:
HEADQUARTERS, LINEOF COMMUNICATIONS,
OFFICE OF THE CHIEFSURGEON,
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 seempertinent concerning medical supplies.
2. In my opinion the principle is good. Under presentconditions at the base, however, I can not see how any classification ofmedical supplies other than in one group as "medical supplies" can be made,owing to the multiplicity of articles upon the Medical Supply Table andto their varying importance-from articles of absolute necessity for thepreservation of life to articles that might be well dispensed with in timeof great pressure. This brings up the great importance of having at thebase a classification warehouse, referred to in my memorandum of January19.
3. Under present conditions, should our depots at thefront or in the intermediate section need articles of vital necessity,such as gauze, ether, morphine, request upon you for order of priorityfor such articles would involve an order of priority for all, of all medicalsupplies, many of which might not be needed, and the importance of manyof which would be less than articles supplied by other departments, thusworking a hardship upon those other departments.
F. A. WINTER,
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 MedicalDepartment requires storage space at base sections 1, 2, and 5, in orderthat some classification of medical supplies may be made in those areasprior to shipments to the intermediate and advance depots. It is also appropriatein 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 thatshipments of important medical supplies to fill existing emergencies wouldbe delayed, unless it were possible to make a separation of these suppliesfrom those of unimportant variety. I believe the matter of storage spacefor classification at these ports for the Medical Department is a veryimportant consideration.
F. J. KERNAN,
Major General, National Army.
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Because shipping medical supplies from France to England, for the useof our Medical Department units there, proved difficult, arrangements weremade to have such supplies shipped directly from the United States.2This necessitated the establishment in England of a medical supply depot,one being opened in Liverpool on August 7, 1918.2 It functionedunder the surgeon, base section No. 3, and was supplied in part throughpurchases made in Great Britain.2
"ARMY DUMPS" (MEDICAL)
The need was early felt for medical supply depots in advance of advancemedical supply depot No. 1, Is-sur-Tille; the lack of them was considerednot only uneconomical in the maintenance of supply but also a source ofreal danger to the supplies themselves.2 So long as our tactical divisions operatedindependently, during which time they were moved from sector to sector, relieving troops of another nation whose equipment differedmaterially from our own, it was necessary for each division to have availableat all times complete equipment, including many things not listed in thefield equipment.2 Division surgeons, in order to protect themselvesagainst possible emergencies, overstocked their divisions; when movementof divisions was ordered, they necessarily left behind a good deal of material.2
In an effort to overcome this situation the surgeon, line of communicationsmade the following proposal:
FEBRUARY11, 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 authorizedto provide itself with one or more small storage warehouses with capacityof approximately 5,000 square feet each so situated that they can be reachedby truck direct from the troops in the field. These storehouses are consideredessential 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 essentialarticles 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) Theproblems of the Medical Department differ considerably from the other staffdepartments in that shipments to any one organization are neither so largenor a matter of daily occurrence. (c) Another important reason isthe fire risk. Should the Is-sur-Tille depot be wiped out it would be mostadvantageous if there were small stocks in the front area sufficient tomaintain supplies until such time as shipments from Cosne or Gievres couldreach that area. (d) Economy: In my judgment if the troops in thefield have absolute assurance that supplies can be had promptly when neededthey will cut their requisitions to their immediate needs. They will thusnot encumber themselves with unnecessary impedimenta.
2. If this recommendation meets with your approval, Irequest 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, MedicalCorps.
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-
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ously in Paris a small medical receiving warehouse; and although thiswas utilized somewhat in the manner of an army dump, it was not essentiallythat type of depot. The first army dump established was at Lieusaint,16and this was organized and administrated for the purpose of supplying combat units in the Parisgroup and, later, the First Army.
The supply table authorized for an army dump, which in common parlancelater became known as the "Lieusaint list," grew out of the establishmentof 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 distributionpoint was authorized to maintain in storage as many times this amount asthere were combatant divisions in his area.16 This practicallyconstituted a stock maximum for his depot. Practically this same system,although with a modified list, was adopted for use in planning the distributionof medical supplies when the offensive operations, directed toward thereduction of the St. Mihiel salient, and later against the Meuse-Argonnearea, were in preparation. Gradually, however, a policy was developed ofestablishing army dumps for which there was authorized a definite fixedstock maximum without reference to the number of combat units to be supplied,but based more upon the number of such dumps established in relationshipto the known number of divisions to be employed in the operation. Suchdumps, for instance, were established at Toul, Souilly, Vaubecourt, Fleury,and Les Islettes, and in the order named.16
HOSPITAL CENTER DEPOTS
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 medicalsupply depot. The following letter on this subject was submitted to headquartersServices of Supply by the officer in charge of the supply division of thechief surgeon's office:
OFFICE OF THECHIEF SURGEON,
AMERICAN EXPEDITIONARYFORCES,
HEADQUARTERS, SERVICESOF SUPPLY,
France, April 23, 1918.
Memorandum for the General Staff:
1. I am informed that the present scheme of constructionfor hospitalization includes for storage space for medical supplies the following: For each base hospital of 1,000 beds, one20 by 160 foot building.
I understand that provision for a sorting warehouse forall 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 ofthe supply division have not been adequately provided for, and I request that the matter be given consideration, not alone fromthe standpoint of storage for a group of base hospitals, but as part and parcel of the entire scheme of storage and distributionof medical supplies in France.
The following data are pertinent: With a peace-time strengthof 100,000 men and with an average morbidity rate of approximately 3 per cent, there were in the United Statesthe 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 ofa hospital center of 10,000 or 5,000 beds would be sufficiently great towarrant the establishment of not only storage space but of an issuing depot.It has been found by experience that beyond a certain point the amountof work done in an issue room may not be expanded without loss of spaceand energy and that it is desirable when that point is reached that anotherissue room be established.
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When this becomes necessary no advantage is gained byestablishing 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 matterof an issue depot at the hospital centers are as follows: (1) Lessenedfire 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 bulkyarticles can be made from the ports, avoiding the difficulties and theuse of rolling stock incident to transshipment at the main depots. (3) Economy.A full knowledge on the part of the hospital commanders that their emergencyneeds could be promptly met will unquestionably lead to small requisitionsand particularly to an elimination of those articles infrequently used.(4) Embargo. With a depot in the immediate vicinity in times of railroadstress, shipments by the Medical Department can be entirely suspended sofar as these centers are concerned.
5. It is apparent that, aside from the additional issueroom, no greater amount of storage space is involved by these establishmentsthan would be required for storage at the larger depots. If it is thoughtthat this involves further construction and unnecessary storage space forthe Medical Department, I recommend that this storage space be providedin lieu of an equal amount of space at Gievres. This space could be laterprovided at Gievres if conditions warrant it. I am confident that the MedicalDepartment will require the space asked for.
6. I have estimated 10,000 square feet as the minimumthat will be necessary for this depot, and I am inclosing an exhibit whichis an approximate list of the supplies that will be carried in this depot,with their cubic feet contents. In addition to the actual space occupiedby the materials, there would be necessary approximately 2,000 or 2,500square feet as an issue room.
7. Of the 50-foot wide building, a 24-foot length of whichis already authorized for each 1,000 beds, I am informed that the quartermasterdesires 20 feet. This would leave for my purposes 200 square feet for each1,000 beds, a total of 2,000 square feet, which is not sufficient for theMedical Department.
8. I therefore request that this storage building nowauthorized be increased in size to take care of the needs herein specified.
By direction of the chief surgeon.
F. A. WINTER,
Colonel, Medical Corps, United States Army.
APRIL 29, 1918.
Memorandum for the chief of utilities:
1. Forwarded. Request from chief surgeon for the increasein storage area at base hospitals.
2. Approval in general principle granted. Action to betaken in individual cases as supply of labor and materials is available.
By order of the C. G.
J. N. PARSONS.
H. C. SMITHER,
Assistant Chief of Staff, G-4.
Hospital center medical supply depots were established, and shortlybefore the armistice were at the following principal hospital centers:17Allerey, Bazoilles, Beau Desert, Beaune, Clermont-Ferrand, Commercy, Kerhnon,Langres, Limoges, Mars-Sur-Allier, Mesves, Perigueux, Rimaucourt, Riviera,Savenay, Toul, Vichy, Vittel-Contrexeville.
MEDICAL SUPPLY PERSONNEL
More and more it became apparent that efficient service in the supplydivision of the chief surgeon's office was being hindered by the lack oftrained personnel and particularly by the lack of sufficient personnelof any kind.2 The
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needs of the supply service, though appreciated, could not be met bythe personnel division of the chief surgeon's office until such need became absolutely pressing.2 Plans were submittedby the officer in charge of the supply division, chief surgeon's office, calling for personnel in the main supply depots for trainingpurposes far in advance of the establishment of other depots, but theseplans, although carried into effect in part, were never put into full executionand the result was that the establishment of large depots necessitatedinterference with the normal working force of the main depot.2This 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.2From Is-sur-Tille also a considerable number of men were sent to army parksand 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 medicalsupply situation in France, and because the method of administration anddistribution was so entirely different from that which had been taughtthe members of the units in the United States, it was deemed inadvisableto send them out as units; furthermore, because the need was so pressingthat personnel as it became available had to be allotted to a number ofdepots, at no time could the number of men comprising one of these unitsbe spared for any one depot.2
MEDICAL SUPPLY INSPECTORS
It was planned also to have officers from the office of the chief surgeonact as medical supply inspectors. It was intended they should inquire intothe adequacy of supplies; to instruct in the method of requisitioning;to meet incoming organizations and to advise them of the location of medicalsupply depots and the methods followed in the American Expeditionary Forces,the local situation, etc., to acquaint new units with the shortage of suppliesand the necessity for economy; to supervise the establishment of storeroomsat camp hospitals, wherein supplies could adequately be cared for and conserved;to direct the return to the proper depot of excess supplies; to receivecriticisms; to make suggestions following investigations, as to the mannerin which distribution of supplies could be better accomplished.2Such personnel it was never possible to obtain.2 Officers ofthe Sanitary Corps, formerly noncommissioned officers, were thought tobe best prepared for this work, but their services were in demand for otherpurposes and it was difficult to secure them in sufficient numbers evenfor the purposes of medical supply depots.2
CIVILIAN EMPLOYEES
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 territorialsections in the American Expeditionary Forces this authority was delegated to section surgeons.2 Many of the early hospitalunits took over old buildings, oftentimes cut up into many small rooms and therefore unsuited for hospital purposes. The personnel assignedto the units
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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 witha 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 wereemployed in lieu of Medical Department personnel not then available.2The maximum number of civilians employed was 4,273.
SPECIAL UNITS
A number of small Medical Department units were sent to the AmericanExpeditionary Forces and there functioned partly under the control of the supply division of the chief surgeon's office.2Chief among them were the motor assembly units, instrument repair units, and optical units.
MOTOR ASSEMBLYPLANT
This plant consisted of a unit of officers and men for assembling and,later, repairing motor ambulances.2 The services of such skilledmen were so in demand that they were utilized at the base ports for assemblingall motor transportation, and later on were turned over to the Motor TransportCorps.2
INSTRUMENT REPAIRSHOP
An instrument and typewriter repair unit of officers and men was alsosent. Preparation for the reception of this unit had been made by the supply division of the chief surgeon's office and it wasinstalled in a building in Paris.2 Later, upon the publicationof General Orders, No. 10, G. H. Q., A. E. F., January 6, 1918, which providedfor the organization of the salvage service, the typewriter repair menwere asked for by the chief quartermaster, and this portion of the unitwas turned over to hisdepartment.2
OPTICAL SHOP
Personnel for eight branch shops were also sent to France completelyequipped.2 The main shop was established in Paris in connection with the instrument and repair shop; the eight brancheswere sent to various hospital centers.2 Later, others were established.
The demands on the instrument and optical shops were so great that theoriginal equipment and quarters proved inadequate. These were then moved to a larger building and an X-ray repair unitwas organized in the original quarters.2
As no specific provision had been made for the repair of electricalinstruments, 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, asit was found desirable to alter equipment to meet the needs of military service as well as to build much special apparatusurgently needed in hospital practice.2
During the entire period of their operation these shops were calledupon to work to their full capacity.2 They fully demonstratedthe wisdom of their selection and the necessity for such auxiliary unitsfor the successful operation of the functions of the medical service.
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AUTOMATIC SUPPLY
On September 18, 1917, in compliance with General Pershing's instructionsconcerning automatic supply, previously referred to, the first list ofmedical and hospital supplies for automatic shipment from the United Stateswas submitted to general headquarters, A. E. F.2 It was appreciatedat the time that there were many inadequacies connected with this listthat would necessitate constant correction, for the requirements of theMedical Department, in so far as any one item was concerned, could notreadily be anticipated. Furthermore, the multiplicity of articles, togetherwith the varying needs for them, made it practically impossible to anticipateexact amounts required. At the time in question, no great amount of datawas available from allied sources; such data as were available had notbeen given much study.2
On February 1, 1918, the chief surgeon, A. E. F., caused to be revisedthe automatic supply list that had been prepared in September.2 This was in conformity with the Surgeon General'srequest. 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 overseasevery three months rather than monthly, and to determine what articlesshould be controlled by requisition. As a result, on April 2, 1918, thechief surgeon, A. E. F., submitted a table of articles, subsequently referredto as the automatic supply table.2
Though the principle of automatic supply never was questioned by theMedical Department, A. E. F., so far as the demands of that departmentwere concerned, the automatic supply was not reduced to a working basis,chiefly for the following reasons:2At the time the table wassubmitted the stock of medical supplies in the American Expeditionary Forceswas critically low. Not only was no information available as to the amountsof each article that would be used, but it was vitally essential that areserve in France be established; consequently, in many instances, amountsspecified in the revised automatic supply table were recognizedly excessive.It was not intended to perpetuate this; on the contrary, it was the intentionfrom the first, to modify the automatic supply list from month to month,once an adequate reserve had been established in France. That this wasdifficult of accomplishment may be shown by the fact that stores orderedfrom medical supply depots in the United States in one month in amountsbased upon strength figures for the American Expeditionary Forces for thatmonth, usually did not reach France for several months thereafter, andwere not available for issue for fully an additional month because of thenecessity for their shipment to an interior medical supply depot for sortingpreparatory to distribution.2 Furthermore, beginning with thespring of 1918, and by reason of military necessity, the troop movementto the American Expeditionary Forces was expanded in a totally unlookedfor manner, in consequence of which, when supplies ordered in January andbased on the size of the American Expeditionary Forces at that time, werereceived six months later, they were obviously entirely inadequate.2
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STATISTICAL STUDIES
Principally with the view of acquiring data that would permit of anintelligent revision of the automatic supply table, a statistical sectionof the supplies division, chief surgeon's office, was instituted in theearly summer of 1918.2
It was the function of this section to tabulate the amounts of suppliesreceived; amounts available at each medical supply depot; the daily movementsof railroad cars containing medical supplies; the movement of supplies(both by weight and bulk) into and throughout France; the rate of issueper unit of men under varying conditions.2 With such work itwas the intention to so gain a position as to insure estimating accuratelythe 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 therewere available neither figures on the amount of supplies required by eachunit of men for a given period, nor the relation of weight to bulk forthe medical supplies that would be required for the American ExpeditionaryForces.2 As a matter of fact, during the entire history of theMedical Department, A. E. F., initial supply formed a large part of therequirements, this in itself making the bulk of overseas shipments assumelarger proportions to the weight than would have been true later afterthe movement of troops stabilized. The disproportion of bulk to weightwas more marked as regards Medical Department supplies than was true ofother branches, a fact that required repeated explanations. What led tosuch queries was the situation with the British. Though efforts were madeto compare their Medical Department with ours, in so far as the relationshipof bulk and weight of supplies is concerned, this could not be done becauseour Medical Department was importing bulky, permanent equipment throughthe necessity of a prolonged hospitalization of our sick and injured inFrance.2 The British, on the other hand, elaborately equippedtheir hospitals only in Great Britain to which their sick and wounded couldbe 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 thebasis of the later estimates of Medical Department tonnage required.2Also, this section provided the data upon which subsequent revisions inthe automatic supply table were made, and upon which shipments of medicalsupplies from the United States were increased, decreased, or suspended.2
MEDICAL SUPPLY ECHELONS AND SYSTEMS OF REPLENISHMENT
Essentially this scheme of distribution involved the use of severalechelons. From front to rear they were as follows:16 Divisionalmedical supply unit; army park medical supply dump (for each corps); armymedical supply depots (for each army); Services of Supply depots (advanceand base).
Toward the end of hostilities the manner of distribution from the supplyechelons at the base to those in the most forward areas had been workedout with exceeding care. The plan of distribution, as evolved, was an elaborationof the policies under which the units previously had been functioning,but it
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was better balanced, and all echelons were much more clearly defined.This was also true as regards the important technique of filling the requestsfor supplies of forward units from the unit next in the rear.16
AT THE FRONT
The officer in charge of the divisional medical supply unit normallyindicated the need of all organizations in his particular division upon a consolidated requisition, which, after passing throughthe office of the division surgeon and that of G-1, was forwarded for filling to an army park.16 Often the divisionmedical supply officer was far removed from the division surgeon and thedivision staff generally, and as a result numerous requisitions had tobe sent to the nearest army park in a most informal manner and withoutany visa or approval. This was recognized as a necessity, and such contingencieswere provided for by authorizing the park personnel to honor such emergencycalls. It was found in practice that such authorizations increased theconfidence of those in the forward areas and that the end result was abetter and closer cooperation of all concerned.16
The logical medical stock for army parks included only articles of combatequipment and supplies and trench stores, and divisional units would naturally requisition only such articles, butin the early developmental days of the corps echelon it was found necessary to carry limited replacements at these parks, for suchunits as mobile and evacuation hospitals. It was very soon learned, however, that this produced a useless dispersion of equipmentwhich it was difficult to obtain, and quickly rendered immobile the army park medical supply dumps-units, which ofnecessity, must remain mobile. It therefore became the policy to confine articles on the fixed stock maximum ofsuch parks to those of combat material and trench stores. Just as soonas this decision was made it necessitated the establishment of a new echelon,inasmuch as large hospitals in the advance zone would now be required toreplenish their stock from a new advance supply unit.16
It was therefore contemplated immediately to establish (and sites wereactually selected) full-stock army advance medical supply depots on a basis of one per army.16 This unit, althoughcarrying 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 armyparks and secondarily to fill requisitions from medical units in the advancezone. The latter was obviated as far as possible by distribution from therear through "controlled stores" in other depots.16
SERVICES OF SUPPLY
CONTROLLED STORES
As medical supplies began to arrive in France in amounts larger thanthe immediate needs therefore, it became possible to begin the stockingof depots other than that maintained at Cosne.2
At first only articles of which there was a supply more than sufficientto meet the immediate needs were stocked in the base storage stations, all others being sent to the depots in the intermediatesection to maintain the stock there.2 Later as supplies began to come in larger amounts, more and more
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articles and larger and larger amounts were retained in the base storagestations.2 A typical instance is that of beds and bedding, infact of all initial equipment except the highly technical equipment thatneeded especially trained labor for its care and selection. It was impossibleto distribute such material if for no other reason than the lack of availabletechnical personnel to provide for its care in all the depots.
Because of the harbor facilities at Brest, shipment of supplies fromthe United States to France, assumed large proportions in so far as thatport was concerned, and, as previously mentioned, the fact that there wereno facilities for storage made it necessary to ship out as cars could beprovided. Practically all the supplies received at Brest had to be routedto Gievres which acted therefore as a reservoir for that port.2Is-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 quantityto warrant distribution.2 While the desirability of having completelystocked depots was appreciated, as matter of fact, it never became quitepossible to accomplish this.2 Though there was an abundanceof such material as gauze and bandages, never at any time was there a sufficientamount of surgical instruments to permit stocking more than a few depotswith them. It was felt that the depot should be stocked in the followingsequence: First, intermediate medical depot No. 3, Cosne, which was thenthe main distributing depot; advance medical depot No. 1, Is-sur-Tille,a distributing depot for the advance area; the supply depots in the varioussections; finally the hospital center depots. Necessity of the decentralizationof issues was early appreciated, but complete decentralization could neverbe effected because of the absence of sufficient stock of several importantitems, and it was not until shortly before the armistice began that themedical stock was sufficient to permit its distribution to these depots.2
At first it was the practice of local district surgeons to secure fromthe docks such articles as were needed in their areas, making report thereof to the surgeon, line of communications.2This practice was permitted in view of the shortages in medical suppliesat the ports and in view of the long delay in shipping to and from thedepots in the intermediate section; but in order that equal distributionmight be made, that accounting could be effected with the view of gainingknowledge of stocks available in France and, finally, that unnecessaryrail transportation might be prevented, on July 1, 1918, the policy of"controlled stores" was established.2 Thereafter, all suppliesentering a base port were immediately under control of the representativeof the supply division, chief surgeon's office, A. E. F., and were shippedin accordance with his instructions, or placed in storage subject onlyto the order of the chief surgeon, A. E. F.2 In each of thebase sections a local supply depot was established whence issues couldbe made upon the approval of the section surgeon, but issues from the controlledstores were not under his jurisdiction.2 Reports of all receiptsand issues from controlled stores were made to the office of the chiefsurgeon. Here they were tabulated daily, thus permitting the conditionof stock in France and in each depot to be known at all times.
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REQUISITIONS
From organizations.-Requisitions were submitted to the chiefsurgeon, in one copy only;2 upon approval, they were forwarded to the proper depot. This method was established withthe view of eliminating so far as possible all paper work and of issuingso far as possible all supplies asked for.2 However, the factthat there was no duplicate requisition on file barred any possible checkingagainst previous requisitions from an organization; every requisition wastherefore acted on solely upon its face. Later, with the object in viewof further expediting action upon requisitions, these were ordered sentfrom organizations direct to the depot. The officer in charge of the depotwas designated assistant to the chief surgeon and was given authority tomodify requisitions, but instructed to make such modifications largelyupon the basis of the stock on hand.2 Though this delegatedauthority placed upon the officer in charge of the depot the burden ofresponsibility for modifying requisitions, not ordinarily his, it was necessaryin view of the many shortages in the stock in the early days.2
From supply depots and hospital center depots.-Requests fromhospital center depots and from supply depots were sent to the chief surgeon, A. E. F., in whose office extracts weremade according to the availability of stock and to the railroad situation;shipments were made from the most available point.2 This permittedshipments 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 andalso the saving of cars. Frequently shipments were made direct from thedocks.
PROPERTY ACCOUNTABILITY
In so far as accountability at the depots for goods received from theUnited States is concerned, it was early demonstrated that either accountabilitymust be abandoned or the needs of the American Expeditionary Forces mustbe neglected.2 Frequently invoices of medical supplies wouldbe received from each of the several depots in the United States, bearingthe same numbers. Since packages were numbered serially at each such depot,a shipment of supplies from the United States, when received at a depotin the American Expeditionary Forces, would contain not only not all ofthe supplies invoiced on one invoice, but several packages bearing thesame number, thus making it impossible to determine from which depot thesupplies were shipped and to which invoice they should be credited. Manysupplies were received in France marked for special units and no invoiceswere furnished. Frequently these found their way into the medical supplydepot and because the storage space was so inadequate there they were placedin stock and issued.2 Supplies marked "Replacement supplies-division"were received and likewise placed in stock. In a similar way supplies receivedfrom European sources arrived at the depots. Partial shipments were madeon purchase orders. It was therefore determined that accountability atthe 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 accountabilitythere.
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EXPENDITURES
The system of payment from medical and hospital funds by a central disbursingofficer upon an approved voucher proved to be full of difficulties.2Payment for laundry work done for moving organizations, payment for civilianemployees who demanded payment weekly, payment for purchases made in emergencyin small amounts, sometimes by a moving command, all theoretically hadto be vouchered on Form 330, M. D., approved, submitted to the disbursingofficer and paid by check. In order to obviate this difficulty the chiefsurgeon authorized the payment of such accounts in cash from hospital funds,making upon Form 330 a certificate to that effect, following which reimbursementwould be made.2 Such a system was required in the absence ofactual cash being made available to officers commanding Medical Departmentformations.
INFLUENCE OF TRANSPORTATION ON THE MEDICAL SUPPLY SITUATION
From the source of supply, whether this was in the United States orin Europe, to the ultimate consumer the distribution ofsupplies was influenced by the overburdened transportation system.2Necessarily, the railroads and the ports of embarkation in the United Stateswere congested; equally congested were the ports in France, several ofwhich 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 difficultiesthere. For a considerable part of the time lack of storage facilities at the base ports rendered impossible any satisfactory sortingof supplies, and lack of trained personnel to recognize the property of the various departments all combined to delay receiptof supplies at their proper depots.2 Every available means of transportation was used, and this resulted in the splittingof consignments.2 Frequently shipments were made by motor trucksand by canal barge from Havre and from inland points. The use of thesevarious means of transportation at first caused an uncertainty as to whetheror not delivery of the supplies would ever be made. With the growth ofthe American expeditionary Forces, however, a system of convoy was established wherebytrains or cars were accompanied by members of the American ExpeditionaryForces. This in a large measure corrected the fault.
The result of all the factors outlined above was that the availabilityfor issue of stocks received was much delayed, and that many supplies, even though known to be "somewhere in France," couldnot be considered as forming part of the reserve.2
MEDICAL SUPPLY LIAISON WITH THE UNITED STATES
It was early appreciated by the supply division of the chief surgeon'soffice that it lacked information concerning supplies for the AmericanExpeditionary Forces available to supply officers in the Surgeon General'sOffice.2 In other words, the supply division, chief surgeon's office was groping "in the dark" along certainlines. To remedy this, it was felt that conferees should be interchangedor that written reports should be submitted, but such a plan could notbe effective by reason of the lack of adequate personnel.2 On the other hand,
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in the light of after events, it is thoroughly appreciated that oneegregious error committed in the supply division of the chief surgeon's office was that, though it was known there that the automaticsupply table was excessive, this was not made known to the Surgeon General'sOffice, thus creating a confusion in an activity that should have workedsmoothly. Proper liaison would have obviated this.2
AMERICAN RED CROSS MEDICAL SUPPLIES
Regulations obtaining at the time we entered the World War requiredthat organized voluntary aid for our land forces would, through the American Red Cross, constitute a part of the Medical Department.18In the American Expeditionary Forces, in conformity with the regulations referred to, the American Red Crossmilitary hospitals which had been established became a part of the Medical Department. However, the American Red Cross wascharged 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 commanderin chief, A. E. F., independent of the Medical Department. In this independentwork, the Red Cross obviously required medical supplies, consequently largequantities were procured.
Since these supplies were freely made available to Medical Departmentunits, the result, so far as these supplies were concerned, was duplication not only of effort but of supplies as well.2Our Medical Department personnel, being for the most part new and untrainedin the methods of obtaining supplies, secured them from whatever sourcethey found most available, and frequently, having no realization of thedangers of shortage of supplies in the world markets duplicated their requisitionsand obtained supplies from both the American Red Cross and our medicalsupply department.2 As an example, there was always a shortageof sheets during the period of hospital expansion.2 The chiefsurgeon, A. E. F., established the policy of issuing six sheets per bed,and with this arrangement the Medical Department managed to keep just aheadof the demand.2 Meanwhile the American Red Cross in France alsohad sheets and was being called upon to issue to units other than thosefor whose supply they had accepted responsibility, including some who hadalready received their allotment of six.2 This duplication ofsupply resulted in a shortage in many of our hospitals at a time when thesearticles were needed. The result of this demand upon the American Red Crosswas a financial burden to that organization which it should not have beencalled upon to bear and which, in fact, its officials had no desire tobear.2
In extenuation, however, it should be stated that, if the personnelof the Medical Department was largely untrained, so, too, much of the Red Cross personnel was equally or more so. But being exceedinglydesirous of rendering service and frequently entirely unfamiliar with thenormal method of supply, the officials in immediate charge of issuing RedCross supplies felt that the burden of supplying hospitals was upon them.In some cases they were even unfamiliar with the existence of the MedicalDepartment supply service; as a result, they not only made issues whenevercalled upon regardless of the fact that the articles
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could have and should have been supplied from Army depots but they alsofailed to convey the information necessary to prevent a repetition of the demand upon them in the future.2In an effort to meet this situation, after consultation with the chiefof the American Red Cross in France, and in full agreement with him, orderswere issued by the chief surgeon, A. E. F., permitting issues from theRed 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 wasbelieved by the officer in charge of the supply division of the chief surgeon'soffice and by the American Red Cross officials in Paris that a furtherrestriction would have been better; however, with the extensive unfamiliaritywith our medical supply methods that obtained among requisitioning officers,it was felt unsafe to in any manner bar the way to the prompt securingof supplies.2
It is obvious that the purchase by the American Red Cross of articlesalso purchased by the Medical Department interfered to some extent withmarkets in Europe and in America. Articles that were available in the UnitedStates were shipped on both Medical Department tonnage and Red Cross tonnageand this duplication resulted in an overstocking of such articles in theAmerican Expeditionary Forces.2 This double procurement systemdid not in any way improve the situation in the American ExpeditionaryForces in so far as the articles of which there were still a shortage wereconcerned, since that shortage resulted largely from the depletion of themarkets at home and in Europe.2
Following conferences on the subject with the Red Cross officials, thechief surgeon, on February 11, 1918, initiated a cable to War Departmentasking that an agreement be reached in the United States with the AmericanRed Cross headquarters, and that the great amount of made-up garments preparedby the women of America be collected by the Red Cross and turned over tothe Army to meet their needs, thus permitting the demands upon the manufacturersto be reduced to a like extent.2
Red Cross contributions to the Army were considerable. Not only didthis society establish entire hospitals in emergency, but also at all timesits entire stock of supplies was made available to the Medical Department.2It supplied large quantities of front-line parcels made in France, which practically supplanted first-aidpackets, and turned over in bulk to our depots and to the hospitals bydirect shipment, in pursuance of a program given them by the chief surgeon,A. E. F., enormous quantities of made-up surgical dressings.2It undertook the production of standard splints and met the need thereofentirely until splints began to arrive from the United States.2 It undertook theproduction of nitrous oxide and oxygen for the American Expeditionary Forces and established a plant in Paris for that purpose.2In all of these activities it turned over in large part theproducts to the Medical Department by which distribution was made.
FINANCE AND ACCOUNTING
PURPOSE
An act of Congress, dated September 24, 1917, authorized the Comptrollerof the Treasury and the Auditor for the War Department to send to the American Expeditionary Forces portions oftheir organizations for performing there the functions of their offices.As a result of the establishment of the offices of
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the Assistant Comptroller of the Treasury and of the Assistant Auditorfor the War Department in France,19 and in accordance with therequest of General Pershing, the chiefs of the various War Department bureausorganized units to function in the American Expeditionary Forces in a mannersimilar to the finance and property divisions of the several departmentsin the United States. Thus the unit formed in the Medical Department eventuallybecame the finance and accounting division of the chief surgeon's office,A. E. F.20
PERSONNEL
In availing himself of the authorization referred to above, the SurgeonGeneral had an officer of the Medical Corps ordered to Washington for consultation,and upon arrival directed him to obtain and organize a force sufficientto care for the Medical Department accounts for an army of 2,000,000 men.9 Afterconsultation with the Assistant Auditor for the War Department and with various other departmental authorities this officer modeledhis organization on that of the corresponding division of the Surgeon General'sOffice.9 In order to get men qualified for this work all thelarge banks as far west as Chicago, and a large number of insurance companies,railroads, and department stores were requested to supply the names ofdrafted men qualified for service in this group.9 Prompt replieswere obtained but, meanwhile, almost all the men named had been assignedto such duties that their transfer was not feasible. Banks were then askedto supply lists of their employees who were about to be called to the colorsand from these by induction and enlistment the number desired was obtained.From time to time personnel to a total of 7 officers (including the chiefof the division) and 135 men pertaining to this group were sent to France.9It was purposed, in so far as the men were concerned, that many of themwould perform clerical service not only in the office of the chief surgeon,A. E. F., but also at medical supply depots, with division surgeons, andin similar assignments.9
Because of numerous transfers, the enlisted personnel of this unit wasfurther reduced to 37 men. One of the officers was sent to Paris for dutyin the bureau of accounts, A. E. F., and one was assigned to duty withthe general purchasing board, A. E. F.
On April 1, 1918, when the unit was attached to the office of the chiefsurgeon, it consisted of 6 officers and 47 men. Gradually other personnelwere added until in February, 1919, this division consisted of 10 officers,132 enlisted men, and 15 French civilians. This was its maximum strength.9
PREPARATORY WORK
In November, 1917, a temporary office was established at the New Yorkmedical supply depot where the plan of organization was developed, andrecruits were examined to determine their technical qualifications.9These men were then sent to Governors Island to be recruited and temporarilyquartered. While there they were given some drill and were instructed intheir prospective duties. Supplies also were collected at this place andplans made for the details of procedure and work of the detachment abroad.
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The first section of the detachment, consisting of 5 officers and 100men, left the United States on January 4, 1918, and arrived at St. Nazaireon January 17.9 From January 24 to February 13 the group wasstationed at Bois, where its organization was perfected.20 Plansof procedure were charted and suggestions worked out for the improvementof 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 originalunit now at Tours.9
On May 1, 1918, the finance and accounting division became a part ofthe division of supplies of the chief surgeon's office, A. E. F.9
SCOPE OF ORGANIZATION
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
DISBURSING
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.
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AUDITING MONEY VOUCHERS
In this section were audited all accounts which already had been paid(except those on civilian pay rolls) by disbursing officers of the MedicalDepartment, A. E. F.20 So far as possible any errors in theseaccounts were corrected before they were forwarded to the Treasury Departmentat Washington for final audit. Vouchers were examined to determine whetherthey were legal, were correct charges against Medical Department funds,conformed to authorization for disbursement, were arithmetically correct, and there was no duplication. The analysisalso 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 onlyan 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 Departmentdisbursing 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 MedicalDepartment. A cash refund of approximately $15,000 worth of overpaymentswas received, as a result of detection of overpayments and duplicationof vouchers. The value of carefully auditing money vouchers and recordingfinancial data was fully demonstrated when it was necessary finally tosubmit the accounts of medical disbursing officers to the Assistant Auditorfor the War Department. These accounts were in such condition that theycould be accepted without causing any difficulty to the disbursing officers.
ANALYSIS AND RECORD OF DISBURSEMENTS
This section made an index and abstracts of all vouchers before theypassed out of the possession of the Medical Department.20 These important abstracts included such dataas the name of the vendor, material, price paid, date paid, by whom paid. They were made with the view of facilitating future settlementof claims which previous wars showed would continue to be made for many years.20
ANALYSIS AND RECORD OF ACCOUNTS OF CIVILIAN PERSONNEL
This section audited and made abstracts from pay rolls of civilian personnelbefore the rolls were forwarded to the Treasury.20 The abstractsshowed names of civilian employees, authority for employment, when andwhere employed, when and by whom paid, etc. Prior to payment many erroneousitems were eliminated, some refunds were procured, and some payments weretransferred to other corps. Also in this section, efforts were made toprovide for prompt payments.
ANALYSIS AND RECORD OF HOSPITAL FUNDS
This section audited the individual hospital fund statements renderedby the mess officers of the various Medical Department units, maintained a file of custodians of hospital funds, and recordscovering the amounts due to various hospitals from individual officersfor subsistence while they were
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patients in hospital.20 At the peak of this work in March,1919, 691 organizations were rendering monthly statements and the transactionsrepresented by them amounted in one month to approximately 35,000,000 francs.20Not only were many underpayments and overpayments corrected, but efforts were made alsoto promote prompt payment of bills rendered by French civilians.12 Deficits were prevented by issuing warningsto those concerned; in some instances, when gross negligence was evident, liquidation was secured from the private funds of officerswho were responsible. Arrangements were made for the transfer of food stocksbetween organizations. The decision of the Comptroller of the Treasurygiving the Medical Department the right to retain proceeds from sales ofwaste, and the right to turn in to the Quartermaster Corps unused foodstocks led to relatively large savings; proceeds thus secured from thesale of garbage amounted to several hundred thousand francs.12One of the activities of this section pertained to the collection of fundsfrom officers for payment of their subsistence while in hospital at therate of $1 per day.12 Many officers inadvertently overlookedthis obligation, but thousands of dollars were saved by carefully followingthem up.12
TRAVELING AUDITORS OF HOSPITAL FUNDS
This section consisted of a small staff which checked up records whenthere appeared to be anything irregular, but whose chief duty was instructionin the field of mess officers and hospital fund custodians in technicalitiespertaining to these funds, the correction of errors, and the proper executionof disbursing and property papers.20 Constantly in the field,they gave instruction to Medical Department clerks in the preparation ofdisbursement vouchers, property vouchers and returns;20 also,they assisted very materially in closing money and property accounts ofunits returning to the United States.12 Always, there were morecalls for their services than could be met.20
CUSTODIANSHIP OF CENTRAL HOSPITAL FUND
The work which engaged this section was taken over about September 13,1918, when the hospital fund in the chief surgeon's office amounted to18,800 francs.12 Subsequently, this section controlled the centralhospital fund, the loan or donation of small amounts to new organizations,the transfer of hospital funds between organizations, the reception offunds from disbanding units, and the closure of balances.20The fund on May 1, 1919, was over one hundred fifty times what it had beenwhen taken over in the previous September, the item of interest alone amountingto 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 3,084,000francs.22
LIAISON WITH FINANCE DIVISIONS AND TREASURY OFFICIALS
By means of this section the finance and accounting division maintainedclose liaison with similar divisions in other departments, A. E.F., the finance officer, the finance requisition officer, and the officialsof the Treasury in the American Expeditionary Forces.20 Thiscontact proved to be of value in keeping abreast of the various developmentsin financial matters in the American Expeditionary Forces.
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ISSUE OF CLEARANCE CERTIFICATES
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.
BILLING ALLIES FOR HOSPITAL CHARGES
One section of the finance and accounting division was engaged in compilingdata, from all available sources, relative to the hospitalization of allied troups in American hospitals, in convertingthese data into proper bills, and in submitting them to the governments concerned.20 During the period that this workwas being conducted by this section, these bills amounted to $194,084.32. In April, 1919, this work was turned over to the MedicalDepartment representative at Paris in compliance with orders that thatofficer be charged with the conduct of all financial transactions withforeign governments. Also, this section formulated some of the bills againstother departments of the American Expeditionary Forces but this work alsowas turned over eventually to the Medical Department representative inParis.
COMPILATION OF STATISTICAL DATA AND FINANCIAL REPORTS
This section compiled monthly, semiannual, and annual financial reportsof various kinds, and also certain special reports which were of peculiarvalue at different times.20 These financial reports, which wererendered to the offices concerned, covered almost every phase of the financialoperations of the Medical Department. From statistical data which thisdivision maintained it was possible to trace completely all Medical Departmentfunds from the time they left the United States Treasury until they wereexpended for material and labor. These records covered the financial transactionsof the Medical Department from the inception of the American ExpeditionaryForces until April 30, 1919.
EXAMINATION AND FILING OF PROPERTY VOUCHERS
This section maintained from 7,500 to 10,000 individual files each ofwhich concerned an accountable or responsible officer.20 Duringits most strenuous period approximately 3,500 vouchers per week were handled.Invoices,
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receipts, and returns were compared; discrepancies noted; certificateswere audited, recorded, and filed; a card index for all officers responsible for medical supplies was maintained. The determinationof property responsibility was the source of much trouble throughout theentire period of activity of the finance and accounting division, for itwas seriously handicapped by the uncertain states of property accountabilityin that jurisdiction. This was occasioned by confusing orders capable ofvarious interpretations. Before the armistice was signed accountabilitywas 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, statementsof differences were drafted and the balance of the returns filed in sucha way as to be accessible and to show the final disposition of the caseand the authority for this action.
EXAMINATION OF PROPERTY RETURNS
More than 1,000 returns were received and audited by the section engagedin this duty.20 It would have been completely overwhelmed had not Circular No. 68, chief surgeon's office, February8, 1919, been issued, conformably to existing orders. This circularlimited the officers responsible for Medical Department property to thoseat base hospitals, supply depots and schools and thus eliminated from suchaccountability thousands of other officers who would have been requiredto render returns.
LEGAL REFERENCE LIBRARY
The section in charge of the legal reference library maintained completefiles 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 theComptroller of the Treasury, the Auditor for the War Department, the Judge Advocate General, etc.20 This sectionhad been organized merely for the use of the finance and accounting division, chief surgeon's office, in settling questionsof 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 generalstaff, financial bureaus of other departments of the Army, and by variousofficers of the Medical Department either in the office of the chief surgeonor elsewhere.9This section was also called upon to draw upcontracts.12 Questions were referred to it much as opinionswere asked of attorneys in civil life, for the personnel of this sectionwere lawyers in civil life.
LIAISON WITH BUREAU OF ACCOUNTS AND FINANCE BUREAU
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 memberof the finance and accounting division, chief surgeon's office, was in liaison with each of them and was permittedto pass upon many contemplated plans which affected financial operations in which the Medical Department was concerned.20The cash expenditures
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of that department until April 30, 1919, amounted to $15,000,000. ByMay 8, 1919, the Medical Department had purchased in Europe medical andhospital supplies to a value of $21,084,943.14, exclusive of the cost of19 hospital trains (approximately $5,166,666.67).20
CENTRAL HOSPITAL FUND, THIRD ARMY
By March 21, 1919, instructions had been given for the establishmentof a central hospital fund in the office of the surgeon, Third Army, and authority had been given that office to give or takefrom hospital funds of units in the Third Army such sums as might seemproper, to retain in the central fund such portions of hospital funds,of departing units as might seem desirable, to audit hospital fund statementsof units in the Third Army and to retain audited statements, to arrangefor payment of civilian personnel out of the hospital funds, Third Army,and to audit civilian pay rolls.23
ARRANGEMENTS FOR RETURNING IMPORTANT FINANCIAL AND PROPERTY PAPERS TOUNITED STATES
Early in April, 1919, arrangements were made to send important financialand property papers to the United States by regular courier service,and at the same time a commissioned officer from the finance and accountingdivision, who was thoroughly acquainted with these various documents andcould explain them to the interested departments in the United States.24A section was established in this division to collect all these MedicalDepartment finance and property papers to be sent back to the United Statesand to compile a complete index of all communications and other paperswhich previously had been sent there.
DISCONTINUANCE OF FINANCE AND ACCOUNTING DIVISION
By May 14, 1919, the chief surgeon, A. E. F., approved the discontinuanceof the finance division as of June 15 following.20Small detachments of the office force were to remain in service atTours, Coblenz, Antwerp, and Washington, while othermembers of it were to be discharged. The entire division was then preparingcopies of all records that might be needed after the originals had beenreturned to the United States. These copies were to be retained in thechief surgeon's office, A. E. F.20
A small part of the finance and accounting division continued in thechief surgeon's office, to make such disbursements as were necessary andto maintain liaison with fiscal offices in the United States.20This service continued after the American Expeditionary Forces was succeeded by the American Forces in Franceand the American Forces in Germany.25
During the period August to November, 1919, the closing months of ouractivities in France, claims for services rendered or supplies delivered to various hospitals and units throughout Francewere investigated and vouchers prepared and paid.25 Many ofthe accounts so paid were of long standing, the original bills apparentlyhaving been lost.25 Investigations of these charges were difficult,not only on account of insufficient receipts but also because officerswho gave the orders, received the supplies, or engaged the services hadreturned to the United States.
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After November 15, 1919, no further payments were made by the MedicalDepartment, but all vouchers were prepared and submitted to the quartermasterdisbursing officer for payment.25 Since the medical disbursingofficer ceased to function, a total number of 70 claims for services renderedor supplies delivered (many of these being final settlements covering aseries of transactions with the various persons or companies and requiringa complete check of all bills rendered and paid in order to avoid duplication)were investigated and vouchers prepared for submission to the quartermasterfor payment.
PERSONNEL
(July 28, 1917, to July 15, 1919)
SUPPLIES
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.
FINANCE AND ACCOUNTING
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.
REFERENCES
(1) Memorandum for the chief of staff, H. A. E. F., fromthe chief surgeon, A. E. F., July 21, 1917. Subject: War diary. Copy onfile, Historical Division, S. G. O.
(2) Report on the activities of the supply division, chiefsurgeon'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.
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(3) First indorsement, War Department, Surgeon General'sOffice, July 25, 1917, to the chief surgeon, A. E. F. Subject: Forwardingmedical 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., fromthe chief surgeon, A. E. F., September 2, 1917. Subject: War diary. Copyon file, Historical Division, S. G. O.
(6) Memorandum for the chief of staff, H. A. E. F., fromthe chief surgeon, A. E. F., November 25, 1917. Subject: War diary. Copyon 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 beginningand end of American participation in hostilities, December 31, 1918, byCol. S. H. Wadhams, M. C. Copy on file, Historical Division, S. G. O.
(8) Memorandum for the chief of staff, H. A. E. F., fromthe chief surgeon, A. E. F., October 7, 1917. Subject: War diary. Copyon 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, HistoricalSection, 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 Europeto 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, HistoricalDivision, 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 AdjutantGeneral, 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, fourthsection, 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 inthe office of the chief surgeon, A. E. F., as of October 17, 1918. Copyon 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 accountingdivision, 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. Onfile, Historical Division, S. G. O.
(22) Letter from the chief surgeon, A. E. F., to the chiefof staff, A. E. F., May 28, 1919. Subject: War diary for week ending May24, 1919. Copy on file, Historical Division, S. G. O.
(23) Letter from the officer in charge, finance and accountingdivision, 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 accountingdivision, 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 inFrance, 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.
