Books and Documents > Medical Department of the U.S. Army in the World War, Volume III, Finance & Supply
CHAPTER IV
REQUIREMENTS
In the procurement of supplies, whether public or private, the first factor to be determined is the articles and quantities needed. The term requirements has, in recent years, come into use relative to this factor. It indicates the things to be purchased and the quantities required. The term estimates, on the other hand, relates to the funds required to pay for the things purchased or the services employed. The articles having been determined, the quantities to be ascertained then represent the needs for a definite period, in military affairs the quantities required depend further upon the number of troops to be supplied. The term requirements, then, covers three factors\u0014 articles, period of time, and number of troops. As a rule the articles to be purchased are those included in the standard supply table of the bureau using them or making the purchases. These form the bulk of the purchases. To them are added such new articles as the needs of the period indicate.
The paraphernalia required by the Medical Department for the successful performance of its mission necessarily covers a wide range of articles and involves many commodities and industries. Since the very beginning of the medical establishment of the Army these articles have been divided into two more or less definite and distinct groups. The first group represents the articles required on the field of battle and its immediate environs in rendering the primary or first-aid treatment of the wounded and in preparing them for evacuation to the rear. The second group includes the articles required in the more or less permanent and fixed hospitals of the rear and the home territory for the continuing or definitive treatment so long as that treatment is needed in times of a major emergency new needs always develop and articles not previously considered needful must he furnished. The question of the articles required is a comparatively simple one. The question of quantities is much more difficult of determination. For example, in the treatment of the wounded during and after a battle the articles required to dress the wounds, check hemorrhage, control shock, relieve pain, and immobilize fractures are well known. The quantities of these same articles are dependent upon several factors, none of which can be anticipated accurately. The number of persons wounded, the locality, character, and extent of the wound, the degree of shock, the probability of tetanus and gas gangrene, and the physical state of the individual at the time he was wounded, all affect the treatment and the quantity of supplies required. In camp or bivouac the presence or absence of epidemics and the kinds of disease present likewise are determing factors in the calculation of requirements. However, in this the observations and experience of years point the way. In times of warfare and assemblages of large bodies of troops into camps experience of peace time can be used as a guide but can not be observed as to quantities.
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Here the utmost liberality must be given to the quantities purchased. The morbidity rate from disease and injury other than battle casualties rises rapidly and tends to be more serious. The morbidity from battle casualties has a tendency to rise with each succeeding conflict due to the increase in destructiveness of enginery of war. Much, therefore, must be left to the judgment of the person preparing the estimates, both of the quantities likely to be required during the conflict or any given period of it and of the cost of the materials. While care should be taken to approximate the requirements to actual usage of the supplies, much less criticism will obtain from having a moderate excess than from an actual shortage however slight.
Supplies are divisible again into the expendable, or those which are consumed daily, and the nonexpendable, or those that may be used for long periods without wearing out. In the former class are medicines, surgical dressings, stationery, and many similar articles. In the latter class are furniture, surgical instruments, operating-room equipment, etc. Between these extremes is a great group of articles which neither are consumed daily nor last indefinitely but wear out after varying periods of service. This group may be illustrated by the ward linen, sheets, pillow cases, towels, operating gowns, etc. Every article provided has a definite period of usefulness, but this period is variable, depending upon the care taken in its use. It becomes necessary, therefore, in calculating the requirements of medical supplies, to determine the period of service which may be expected of any given article which is to be supplied. The rate of wastage must either be based upon observation and actual usage over a period of years or be estimated, due account being taken of the article, the purpose for which intended, and the manner of usage. Account must also be taken of the troops to be supplied, whether they be recruits or seasoned veterans. The observations of many years have shown that the morbidity rate from all causes is much higher among recruits than in older soldiers. It is higher also when troops are in camp than when they are in campaign.
Accurate records of the quantities used have been kept of the articles on its standard medical supply table by the Medical Department for the last hundred years. The Surgeon General in 1819, initiated the requiring, from all medical officers to whom supplies were issued, of definite returns at stated intervals of all medical property which came into their custody.1 The annual rate of consumption was more or less fixed. The allowances were based on average conditions and increases were granted to provide for such contingencies as epidemics. By consolidating the quantities reported on these returns as Expended with the sick, the total consumption of the expendable articles reported under that head was determined. By dividing this total by the number of troops in thousands, or hundreds, the requirements per thousand or per hundred for 12 months could be obtained. The quantities required for a longer or shorter period could be readily determined by multiplying by a factor representing the ratio of the period desired to the 12-month period.
These property returns showed for the nonexpendable articles listed therein the quantities worn out or unfit for use. The aggregate of these articles reported from all stations over a definite term of years divided by the number of troops in thousands or hundreds, and that by the number of years, gave the
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wastage per thousand or per hundred per year. In addition to the articles expended with the sick and worn out by fair wear and tear, there was always a certain amount lost, stolen, or destroyed by unavoidable accident. The sum of the wastage of any article from all causes during any period represented ordinarily the quantities of that article to be purchased during the next ensuing like period. By this means the peace-time requirements for any article, period, or number of persons can be calculated.
It is true that in time of peace a percentage of the military force in service will be recruits. In a well organized and disciplined force this percentage will be small because the losses from failure to reenlist are comparatively small. In time of war practically all the force will, in the beginning, be without military training and a knowledge of the principles of self-preservation gained thereby. The requirements factor of such a force will he proportionately higher than that of the well-trained force in time of peace. Another element, and one of only a little less importance, is the inexperience and lack of knowledge of military sanitation and conservation of supplies on the part of the medical officers called from civil practice to look after the health of the untrained troops called to the colors. Greater waste of supplies will also occur under war conditions.
It must be evident, therefore, that calculation of the quantities of supplies needed by the medical service of an army in time of war is at best a complicated problem which can not be solved by any known mathematical or other rule. In the last analysis the solution must depend, to a large extent, upon the experience, judgment, and intelligence of those charged with the responsibility. The statistics of our own and foreign armies are valuable aids to the solution of the problem.
In addition to the wastage factor which calls for replacement and replenishment, there is to be considered the initial equipment. In time of war more and larger hospitals are required proportionately than in time of peace. Many of them are special hospitals devoted to a single class or type of disability, such as tuberculous, neuropsychiatric, maxillofacial, and fracture, for which special equipment is required. Tables of unit equipment must be developed to provide for all these types of hospitals as well as for general hospitals. The probable number of each type of institution must he determined. Once the tables of unit equipment have been developed and the number of each to be provided, the question of the quantities of the component articles, or the requirements for initial equipment is one easy of solution. Because of the difficulty of procuring the vast quantities of supplies needed for initial equipment and replenishment, the number of such units must be determined early. In calculating requirements for medical supplies, whether initial equipment or replenishment, it is well to remember that the unexpected always happens and that a little too much is just right.
For a number of years prior to the World War estimated requirements were used in preference to requisition requirements. By this method the supplies could be obtained before the need for them arose and requisitions from organizations could be filled promptly. The average quantities issued during a definite period formed the basis of the requirements for the ensuing
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period. Under this method the several supply depots were required to furnish the Surgeon General a statement of their probable needs for the next six months. The sum of these needs gave the quantities to be purchased. In arriving at their prospective needs the medical supply officers went carefully over their stock records, ascertained the quantity of each article issued during the preceding two years, divided it by 4, and compared the result with the stock of that article on hand. If the quantity in stock were equal to or greater than the average issues, none was requested. If the stock were less than the average issues, a quantity representing the difference would be requested. Because of the delay in securing the articles by purchase it became necessary to carry a greater stock. This involved but slight change in the method of determining the requirements. A six months` requirement was deducted from the stock on hand before a comparison was made between the average issues and the free balance. If the balance of the stock after deducting the six months` supply equaled or exceeded the six months` issues, none was requested; if less than the six months` issues, a sufficient quantity was requested to bring the stock up to a year` s supply.
The continuing study of actual issues resulted from time to time in modifications of allowances in the standard medical supply table and materially assisted in the revisions of that table as they became necessary. The quantities of some articles, which experience had shown to be little used, were reduced. Other articles were eliminated. The tendency, however, in a great majority of the articles was toward an increase in the quantities allowed. In the last revision of the supply table published in 1916 in the Manual for the Medical Department, the quantities of all articles appear to be quite liberal, at least for peace-time usage.
When war was declared on April 6, 1917, the Surgeon General felt that there was no time in which to receive estimates from the several depots. Nor did the time permit, had the personnel been available, to compile the war requirements from either the property returns or from theoretical premises. The multitude of factors entering into the expenditure of medical supplies prevented the estimate from being made on an exact basis, as in the case of subsistence supplies where the quantities to be procured represented the number of troops multiplied by the number of days and that by the quantities of the several components of the ration. Some ready and fairly accurate method had to be found at once for calculating war requirements. A very simple expedient was adopted. The standard medical supply table prescribed the allowance as equipment and a year` s maintenance of the articles authorized for hospitals at military posts having an official population of 1,000.2
In translating this principle into actual requirements it was found by experience early in the World War that the quantities of many articles were inadequate, while a few were in excess. Some of the deficiencies were anticipated in the purchase, but others did not develop until later. On the whole, the requirements calculated by this method gave as satisfactory results, it is thought, as could have been obtained by a more detailed and complex method of computing them. Since they were based on peace-time experience it was necessary, of course, that they be corrected for war-time requirements
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when sufficient experience had been accumulated. They served as the basis for procurement of a majority of all articles supplied by the Medical Department until well along in 1918, when a new basis was introduced, that of the automatic supply table evolved by the chief surgeon, A. E. F.3
The procedure necessary to determine the quantities of field supplies and equipment which would he needed was not quite so simple. At no time since 1865 had any large bodies of troops of the United States forces served for a considerable length of time under actual field conditions. Consequently there were available no records of the quantities of supplies used under such conditions during any definite period. The types, too, of the equipment used under such conditions varied with the particular units of the Army which were mobilized. In developing the various units of medical equipment for field service much attention had been given to the period of time which the several components of the unit might he expected to last under normal service conditions. It was expected that replenishments could be effected within 10 days, or within 25 days at the longest. In determining the quantities of field supplies to be procured, the quantity of every article required for a division was first ascertained. This was accomplished by calculating the quantities required by each medical unit of the division as initial equipment and as maintenance for one year. The quantities of each article so obtained were consolidated and gave the total requirements for the division. The number of divisions being known, it remained only to multiply the quantity of each article required for a division by the number of divisions to be organized to ascertain the total requirements. Such a table of requirements for a division of Infantry as then authorized was prepared at the field medical supply depot early in 1917, and served as the basis for determining the quantities to he purchased for the first 1,000,000 men of the World War Army. After that the automatic supply table was largely used as a basis.
At the beginning of the World War the determination of the veterinary requirements, now a function of the Medical Department by reason of the national defense act of June 3, 1916, proved to be the most difficult. There was neither a standard veterinary supply table available, nor any definite record of supplies issued per thousand or smaller unit of animals for a year or other period. For many years, the providing of veterinary supplies had been a responsibility of the Quartermaster General` s Office, wherein the custom had obtained of allowing $1 per animal per year for veterinary supplies. Purchases had been made of such articles as the veterinary surgeons requested. Tentative supply tables were prepared and published as paragraphs 904, 966-997 of the Manual for the Medical Department, Changes No. 4, November 19, 1917. These tables soon proved inadequate, and, on the request of the Surgeon General, the British War Office lent a complete set of veterinary chests and wallets, which were used as models for those adopted for our service in the new supply tables compiled in the Surgeon General` s Office and approved by the Chief of Staff on January 22, 1918.4The total quantities to be procured were then calculated from these tables of allowances. These tables had hardly been put into circulation, however, before they gave place to a revision which added a few articles and deleted many. They were again modified some
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months later. Another difficulty experienced in determining the requirements of veterinary supplies was the uncertainty of the number of animals to be provided for. The extensive use of the motor truck and other motorized vehicles greatly reduced the number of animals required. After May, 1918, the requirements in veterinary supplies were calculated on the basis of the automatic supply table.
The requirements of medical and hospital supplies calculated from the supply table of annual allowances per thousand men were used as the basis of purchase during 1917, and especially in the earlier contracts. The first variant came during the latter part of May, 1917, when the Surgeon General decided that lying-down accommodations would be required for 25 per cent of the military forces sent overseas. This included all such accommodations from the field hospitals of the divisions at the front to the general hospitals in the rear. To meet these requirements it was deemed expedient to procure 3,000 ward units of 50 beds each in addition to the 85,000 beds already purchased under the supply table allowances.
The quantities specified in the original statement of requirements based on supply table allowances did not prove entirely satisfactory and were not fully in accord with the estimate of the situation as it presented itself to the officer in charge of the finance and supply division. In the latter part of December, 1917, and early part of January, 1918, the requirements were computed anew, item by item. The results of this computation were furnished the purchasing depots in January, 1918, as the new schedules of procurement. In some items the quantity was increased. A number of new articles, which had been added to the supply table subsequent to the declaration of war, were included in the requirements and the quantities specified. The quantities of all articles on the new schedule of procurement were still based on an army of a million men.
By the end of February, 1918, the military force in the service of the United States exceeded 1,500,000 men.5 In March, 1918, the military program contemplated that this force would be increased to 1,725,000 men by the end of June of that year.5 This number was increased in May, 1918, to 2,230,000 by June 30, 1918, 2,500,000 by December 31, 1918, 3,010,000 by June 30, 1919, and 3,560,000 by the end of 1919.6 Even the latter program was exceeded, for there were 2,500,000 men under arms on June 30, 1918.7 A new military program was promulgated in the latter part of July, 1918, which contemplated a force of 3,675,000 troops by the end of December, 1918, and 4,850,000 by the end of June, 1919.8 This program called for 2,350,000 troops in France by December 31, 1918, and 3,360,000 June 30, 1919. In September, 1918, the contemplated military program for the period July 1, 1919, to June 30, 1920, was promulgated to the supply bureaus.8 This program contemplated that the military force would reach 5,225,000 by December 31, 1919, and 5,550,000 by June 30, 1920. Of these forces it was intended that 4,260,000 would be maintained in the American Expeditionary Forces.
These successive increases in the military program necessarily called for corresponding changes in the schedule of requirements and in the production program to meet them. The basis for calculating requirements remained essentially the standard supply table with such modifications as had been
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recommended by the chief surgeon, A. E. F., until the receipt in May, 1918, of an automatic supply schedule from headquarters, A. E. F.9 For overseas shipment many articles had been eliminated. In September, 1917, the supply of alcohol, ether, chloroform, rubber gloves, surgical needles, adhesive plasters, and all sutures were increased to ten times and gauze and surgical dressings to twenty-five times the allowances on the standard supply table.10The articles eliminated were principally heavy furniture and bulky articles not of great importance in the operation of hospitals.11
The basis of the automatic supply schedule was a unit of 25,000 men representing a mixed force of front and rear troops but without reference to an organized division.12 The period during which it was estimated that the quantities of each article on this schedule would last was one month. These quantities, for the greater part of the articles on the schedule, were materially greater than one-twelfth of the supply table allowances for that number of troops. A considerable increase in requirements and in the procurement schedule was made necessary by these increases. The quantities stated in this automatic schedule appeared unduly large, especially those of surgical instruments of all kinds. This led to an exchange of views between the Surgeon General` s Office and the chief surgeon, A. E. F.13 The conclusion was to let the quantities stand until a reserve had been accumulated in France, when the quantities would be revised. This revision was made August 20, 1918, and in it the quantities of surgical instruments were materially reduced.14 By that time large quantities of such instruments had been shipped to France, and the depot there was beginning to have enough. The quantities stated in the automatic schedule of supply were utilized during the remainder of the war as the basis for calculating requirements. The revision of the surgical instrument schedule was received September 28, 1918, too late to have any marked effect in the purchases made or in the quantities contracted for. By that time the bulk of the contracts had been placed and were allowed to stand.
REFERENCES
(1) Military Laws, Rules, and Regulations of the Army of the United States, January, 1820, 185.
(2) Manual for the Medical Department, 1916, pars. 842-848 ½.
(3) Report of the activities of the supply division, chief surgeon` s office, A. E. F., made to the chief surgeon, A. E. F., May, 1919, by Col. N. L. McDiarmid, M. C. On file, Historical Division, S. G. O.
(4) First Indorsement from The Adjutant General to the Surgeon General, January 22, 1918. On file, Finance and Supply Division, S. G. O., 742.
(5) Tentative strength table for requirements and supply estimates only, March 19, 1918. On file, Finance and Supply Division, S. G. O., 750-714 S.G./S-10.
(6) Memorandum for the Finance and Supply division, S. G. O., from the Purchase and Supply Division, General Staff, May 14, 1918. Subject: Revised Army program. On file, Finance and Supply Division, S. G. O., 750-714 S.G./S-10.
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(7) Memorandum for the Surgeon General from the Director of Operations, Office of Chief of Staff, July 25, 1918. Subject: Military programs for fiscal year 1918-1919. On file, Finance and Supply Division, S.G.O, 750-714 S.G./S-10.
(8) Letter from the Chief, Statistical Section, Administrative Branch, Office of the Chief of Staff, to the Surgeon General of the Army, September 11, 1918. Subject: Extension of military program. On file, Finance and Supply Division, S. G. O., 750-714 S.G./S-10.
(9) Letter from the Chief Surgeon, A. E. F., to the Surgeon General, U. S. Army, April 2, 1918, (received in S. G. O. May 10, 1918). Subject: Automatic supply. On file, Finance and Supply Division, S. G. O., 713-750/15.
(10) Cablegram No. 155, par. 7, from commander in chief, H. A. E. F., Chaumont, to The Adjutant General, relative to medical supplies.
(11) Cablegram No. 232, par. 2. A, from H. A. E. F., France, to The Adjutant General, Washington, October 20, 1917, relative to medical and hospital supplies.
(12) Cablegram No. 145, par. 5-2, H. A. E. F., France, to The Adjutant General, September 7, 1917, relative to automatic supply.
(13) Cablegram No. 1197, par. 7, H. A. E. F., France, to The Adjutant General, Washington, May 29, 1918, relative to surgical instruments, chests and cases.
(14) Letter from the Chief Surgeon, A. E. F, France, to The Surgeon General, U. S. Army, August 20, 1918. Subject: Revised list of surgical instruments. On file, Finance and Supply Division, S. G. O., 250 France/564.
