Books and Documents > Medical Department of the U.S. Army in the World War, Volume III, Finance & Supply
SECTION X
MEDICAL SUPPLIES, AMERICAN EXPEDITIONARY FORCES
CHAPTER XLVI
ORGANIZATION AND ACTIVITIES OF THE SUPPLY DIVISION, CHIEF SURGEON`S OFFICE
On June 13, 1917, the office of the chief surgeon, A. E. F., was established in Paris, the location of General Pershing’s headquarters.1 On the staff of the chief surgeon was a medical officer who was detailed to supervise supply matters. At that time there were practically no American troops in France, and no supplies. The immediate concern of the chief surgeon, A. E. F., so far as supplies were concerned, was to determine the location of a suitable medical supply depot, to establish it, and to determine the possibilities of the European market.
On July 8, 1917, the first depot in France was established at Cosne, and operated under the direct supervision of the chief surgeon, A. E. F. 2 One of the other assistants of the chief surgeon was detailed to do the purchasing of medical supplies, in addition, however, to other duties.
On July 18, 1917, the office of the chief surgeon, base group and Line of Communications, was constituted.3 To this office certain of the supply functions of the Medical Department were assigned, including jurisdiction of the depot at Cosne.
At this time and until the removal of the chief surgeon, A. E. F., and his office to Chaumont, on September 1,4 the two offices were in the same building in Paris so that there was no distinct line of demarcation between them; the chief surgeon, Line of Communications, was, in effect, in addition to his other duties, the supply officer of the chief surgeon, A. E. F.
In August, 1917, the chief surgeon requested the assignment of the six regular medical officers who had been on duty as adjutants in the base hospitals, attached to the British Expeditionary Force. Two of these officers were assigned to the office of the chief surgeon, A. E. F., and four to the office of the chief surgeon, Line of Communications.5 Of these latter, one was detailed as supply officer, reporting August 22, 1917.
It will be remembered that at this time there was but one depot in France, that at Cosne, that the American forces were comparatively few in number but that the American activities were beginning to be widespread and that, therefore, many small organizations had to be supplied.
During this period, distribution of medical supplies to the forces was under tile immediate jurisdiction of the chief surgeon, Line of Communications. Procurement was under the chief surgeon, A. E. F. It was, however, the
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responsibility of the chief surgeon, Line of Communications, to determine and present his requirements to the chief surgeon, A. E. F. The initiation of these requests, he had delegated to the officer in charge of the medical supply depot at Cosne.
Purchases in France were being made by the purchasing officer, Medical Department, who was under the chief surgeon, A. E. F.
On September 1, 1917, the chief surgeon’s office, A. E. F., was transferred to Chaumont.4 This separation of the two offices prevented that personal conference that had theretofore existed and which had enabled the chief surgeon, Line of Communications, to act on all matters of supply in the Medical Department. The chief surgeon, Line of Communications, was not only separated from the chief surgeon, A. E. F., but also from general headquarters,
A.E.F.
Many duties pertaining to supply were retained at general headquarters,. A. E. F., under the provisions of General Orders, No. 43, H. A. E. F., 1917, and supervision thereover was assigned by General Orders, No. 8, H. A. E. F., to the members of. the general staff at those headquarters. These duties pertained particularly to tonnage, to procurement in France, and from the United States, and those connected with the supply of front line troops.
After the physical separation of the two offices, the delegation to the chief surgeon, Line of Communications, of the entire function of medical supply up to the combat troops, which had been planned in Field Service Regulations. and the Manual for the Medical Department, was not possible.
Almost necessarily, the chief surgeon, A. E. F., had to consider and dispose of in his own office, certain questions concerning medical supplies, questions over which the general staff at general headquarters, retained supervision, or questions which by general orders were devolved upon him.
The organization remained as before until shortly after November 8, 1917. On that date, an officer was ordered into the chief surgeon’s office at Chaumont, and upon his arrival a supply division was established in that office.6
Authority in the function of medical supply was thereafter divided between two offices, and it is apparent that difficulties were encountered. The exact demarcation between the functions assigned to the two offices was probably never clearly understood alike in the two offices. In the matter of distribution and in the matter of procurement from the United States, there was a lack of clear understanding as to the division of responsibility. For example, as regards distribution: Requisitions from units on the line of communications desiring medical supplies came to the chief surgeon, Line of Communications, were acted upon in his office, and sent to the medical supply depot at Cosne for issue.7 Requisitions for medical supplies from divisions presumably were to be sent to the respective division surgeon, acted upon by him and sent direct to the depot designated by the commanding general, Line of Communications.7 However, requisitions from divisions were sent, not perhaps by order, but possibly because of some indefiniteness in that order, and possibly by reason of the proximity of the divisions to the chief surgeon’s office at Chaumont, to that office and there were acted upon, being sent to the depots, or in some cases, to the American Red Cross. Direct correspondence between
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the depots and the supply division in the chief surgeons, office, A. E. F., resulted, not only in connection with these requisitions, but in connection with with the available stock and prospective needs. Shipping directions were given the depot direct.7
The chief surgeon, Line of Communications, being a staff officer of the commanding general, Line of Communications, derived his authority from that commander; however, General Orders, Nos. 8, 43, and 73, H. A. E. F., 1917, removed from the commanding general, Line of Communications, responsibility for the supervision and coordination of certain functions of supply arid placed it upon the general staff at general headquarters, A. E. F.a
In so far as procurement of medical supplies from the United States was concerned, requisitions either written or cabled, had to pass through general headquarters, A. E. F., and necessarily had to have the action of the chief surgeon, A. E. F. Many questions arising in the general staff at general headquarters, A. E. F., concerning Medical Department tonnage or equipment, were referred to the chief surgeon’s office and were definitely disposed of there.
On the other hand, notwithstanding the fact that the Medical Department purchasing officer, A. E. F., was under the chief surgeon, A. E. F., more and more that officer depended upon the chief surgeon, Line of Communications, for instructions and authority.8 This was occasioned by the removal of the chief surgeon, A. E. F., to Chaumont. Thus gradually, tacitly at first, the purchasing officer came under the jurisdiction of the chief surgeon, Line of Communications.
During this period, however, purchase orders, particularly of new types, developed in France, were placed by direct order of the chief surgeon, A. E. F. The Allies, and even the American Red Cross, which had had some years of experience in the type of warfare to be met, preferred to deal with the staff of the commander in chief, and their recommendations, therefore, were first known to the chief surgeon, A. E. F. There resulted, naturally, some duplication of effort and some confusion.
Apparently, in the chief surgeon’s office, A. E. F., Line of Communications, there was an intention and desire to charge the chief surgeon, Line of Communications, so far as possible, with distribution throughout the American Expeditionary Forces, and with procurement from the United States. The difficulties encountered resulted from the departure in practice from the intended precept, and, as has been shown, these practices were the natural result of the orders issued by higher authority.
In the chief surgeon’s office, Line of Communications, the understanding was that he was charged with the initiation of requests for medical supplies upon the United States; that procurement was to be handled by the chief surgeon, A. E. F.; that the chief surgeon, Line of Communications, was charged with distribution to Line of Communications units; that requisitions from the combat zone would be acted upon in the chief surgeon’s office, A. E. F.
In the matter of the medical supply of combat troops, in training areas near the front, or in line, it was ofttimes essential that action be taken in the
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aSee Appendix, for promulgations, General headquarters, A. E. F., concerning the procurement and distribution of supplies.
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chief surgeon’s office, A. E. F. It was there that the condition of supply in these units was known; it was there that early information as to prospective changes in equipment or prospective moves was obtainable; and it was there that the necessary authority to move the required supplies was obtainable.
This was of even greater importance in the later period of combat, and as will be seen below, remained an essential after the separation of the chief surgeon, A. E. F., from general headquarters.
On January 13, 1918, the office of the chief surgeon, Line of Communications, was moved from Paris to Tours,2 the ultimate location of the office of the chief surgeon, A.E.F.
On March 21, 1918, under the provisions of General Orders, No. 31, general headquarters A. E. F., February 16, 1918, the chief surgeon’s office, A. E. F., was moved from Chaumont to Tours, and placed under the jurisdiction of the commanding general, Services of Supply. The office of the chief surgeon, Line of Communications, was absorbed in the office of the chief surgeon, A. E. F. However, under the provisions of the same order, there was retained at general headquarters, A. E. F., supervision over certain matters of exceeding importance in the efficient functioning of the Medical Department supply service. These matters were control of the supply of the combat troops, and tonnage from the United States.
It was essential that the Medical Department should he in a position to make representation of its needs in direct conference and while the matter was still under discussion. Therefore, under the provisions of the order, the chief surgeon designated a deputy to represent him at general headquarters, A. E. F., and designated additional medical representatives on the general staff there. Thus, subsequently, although there was but one supply division in the Medical Department, A. E. F., and although as a result there was much improvement, there still remained an organization with which the supply division had no direct contact, but which supervised and controlled matters which gravely affected the supply division. This even after the establishment at headquarters, Services of Supply, of sections of the general staff to deal with these questions, sections with which the supply division did have direct contact. It was not until August 6, 1918, that the commanding general, Services of Supply, was authorized to deal directly with the United States on matters of supply, not involving policy.9
The medical representatives attached to the general staff, general headquarters, later became part of it. Orders prepared in the section to which they were assigned were issued from it by the assistant chief of staff and had the authority of the commander in chief.
These medical representatives on the general staff necessarily, because of the absence of the chief surgeon’s office from general headquarters, had two functions: One which related to matters properly classed as general staff work, and the other, the proper and adequate connecting up of the chief surgeon’s office with the combatant troops.10 It was only by virtue of the work of these representatives in connection with the second function that the Medical Department had any representation in matters of vital importance to its mission. Much of this work was in connection with the supply of the combat
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troops, and it was the only way in which the functions of the Medical Department could have been carried on. However, proper presentation of the chief surgeon’s views on many of the questions involved could be made only after detailed study and thorough knowledge and consideration of the entire supply problem and situation. Such study requires a very considerable personnel, and the undesirability of such a force at general headquarters, A. E. F., was one of the determining factors in the assignment of the chief surgeon to headquarters, Services of Supply. Nevertheless, detailed studies of the Medical Department supply situation continued to be made by the chief surgeon’s office, at Tours, sometimes differing therefrom to such an extent as to cause confusion.11
PERSONNEL
The personnel assigned to the supply division was always inadequate for the multiplicity of duties which confronted it. This was especially true as to officers, for few medical officers had had supply training. The situation with respect to enlisted men was different: Enlisted personnel was made available in sufficient number for the depots. Many of these men, after a period of duty at one of the established depots, were given commissioned rank and utilized in medical supply work.
The operating depots were made schools of instruction, and from them, as new depots were established, were detached the personnel required. Since the personnel available did not permit the assignment of permanent and temporary personnel, this meant that the detached personnel had to be taken from the active force of the depot which necessarily interfered with the normal working of the depot. This occurred repeatedly at the medical supply depot at Cosne, from which depot a large part of the personnel for Is-sur-Tille, Gievres, Bordeaux, St. Nazaire, and hospital centers and army parks was supplied. From Is-sur-Tille, also, a considerable number of men were sent to army parks and other depots.8
Certain units known as medical supply units, consisting of 3 officers and 45 enlisted men, were organized in the United States and sent to the American Expeditionary Forces. There was no time, however, at which that number of men could be spared for any particular depot; the available personnel had to be allotted to a number of depots.8 The situation in France, the method of administration, and distribution were different from that in the United States. These units, therefore, were sent to an active depot and there broken up.8
Especially in the office of the chief surgeon was the limited personnel for medical supply work evident. From August 22, 1917, to March 21, 1918, there was one Regular officer in the division; from March 21 to November, 1918, there were but two.
In the fall of 1918, steps were taken by the chief surgeon, A. E. F., to increase materially the number of personnel on this duty, in preparation for the problems which it was expected would confront the supply division in 1919.8 Experienced officers who had been on other supply duty, for which understudies had been available, were ordered to the chief surgeon’s office for administrative duty. Thus, the Medical Department purchasing officer, who
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had so covered the European market with orders for medical supplies as to obviate the necessity of placing additional orders for some time, was detailed to this duty, as was the officer in charge of the medical supply depot at Cosne. The division was well prepared at the time the armistice was signed for the work that had been in prospect.
During the entire period previous to this, however, the supply division was materially assisted by medical officers of the several professional specialties, not assigned to supply work.8 Following out the policy of decentralization, which will he referred to at length below, the chief surgeon called upon these officers, not only for estimates of future requirements, but in many cases for active efforts in connection with new development or purchase, and sometimes for distribution. That this reliance upon the specialists is the correct procedure, is believed to have been proven by the success of their efforts. The action taken was truly a functional delegation. The success of their professional work was dependent upon an adequate supply of their technical apparatus, and their interest in such supply was therefore intense.
PROCUREMENT
FROM THE UNITED STATES
As a result of its experiences in the Spanish-American War, the Medical Department had developed the practice of making initial shipments to newly established units without requisitions. These shipments were in the form of combat equipments, field hospitals, or base hospitals, and there were always available at the depots a number of these units packed and assembled available for immediate shipment. These units were not single items, but each comprised an assemblage of several hundred items in a proportion that had been determined upon by experience.
In anticipation of the departure, for France, of General Pershing and his staff, the Surgeon General, on May 17, 1917, had made arrangements for the shipment to France, to be used in the medical care of troops soon to follow General Pershing, 4 evacuation hospitals, 1 base hospital, 3 divisional medical reserve units, and the equipments of 3 division surgeon’s offices.12 At the same time the medical supply officer, New York, was directed to ship 60 ward units to complete the equipment.13
The Surgeon General’s plan was to send to France with each combat division the following medical units and supplies:14 4 base hospitals, with 40 extra ward units; 2 evacuation hospitals; 2 field hospitals and 2 ambulance companies extra; 1 division surgeon’s office; 1 divisional medical reserve unit; 50 ambulances; 1,000 litters extra; 6 months’ replenishment of field and post supplies for the division.
Thus, ample medical supplies and equipment were assured for the American Expeditionary Forces pending the establishment of the office of the chief surgeon, A.E.F.
On July 3, 1917, the chief surgeon, A. E. F., in a letter to the Surgeon General,15 requested that, as the command in the American Expeditionary Forces increased in size, ample medical supplies be sent from the United States
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without requisition. It seemed to the chief surgeon, at that time, that this arrangement would be necessary on account of the great delay in the transaction of business by mail.15 This request was but anticipating a system that was soon to be adopted at general headquarters A. E. F., for all the supply departments, A. E. F.
The following letter from the Surgeon General’s Office to the chief surgeon’s office, August 11, 1917, shows the situation of medical supplies at that time:14
Your letter of July 22 just received. I have also your letters of July 9 and 15 which were received together a short time ago.
Trying to answer you seriatim, all base hospitals being sent you are equipped with iron beds and mattresses. Instead of being for 500 beds merely, we have added 40 Wolfe ward units to each base hospital, so that there is equipment to accommodate 1,000 with each.
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Your depot surgeon has made requisition for six months’ supplies for 100,000 men, which will be filled as rapidly as possible. We will try to send you copies of everything affecting supplies, so that you will be better informed in the future. I can not give you at present the exact tonnage that will be required for the supply of 100,000 men for six months. Wolfe says he is working on it and will get it to you as soon as he can. He will also send you some data regarding the tonnage required for the medical supplies of a division.
I note what you say regarding the necessity for plenty of words in a cablegram and appreciate it. I did not send the cablegram asking what proportion of beds to strength you would need, but I would like to know what percentage of your total force should be provided with beds. The general says 25 percent. I understand the General Staff has authorized us to send beds to accommodate 20 per cent of the command that may be in France. Accordingly, we are sending four Red Cross base hospitals with the additional beds to accommodate 4,000 patients for each division, which will be smaller than our old division, and more nearly the size of the French. Then too, the regular evacuation hospitals come with each division. Wolfe answered the cablegram about iron beds for base hospitals and evacuation hospitals, and we thought we are sending so many base hospitals with increased accommodation that you would not need additional iron beds for the evacuation hospitals. I think you interpreted the cablegram correctly.
We want to give you everything you need, and if after the rather full explanation given above you find you need more than we are sending, let us know. We were sure you did not realize how many beds we had already ordered for you when we sent the cablegram suggesting that it was unnecessary to send additional iron bunks for evacuation hospitals. If you find you need more, do not hesitate to come back and say so.
Mount’s requisition included a considerable number of instrument cases, which were approved. It is to be understood of course, that besides the initial equipment that is sent with each division, the medical supply officer should make such requisitions as are necessary. We discussed this quite fully with Whitcomb when he was here, and came to a satisfactory understanding with him.
Meanwhile, two formal requisitions for medical supplies had been prepared by the officer in charge of the medical supply depot, A. E. F., approved and forwarded to the Surgeon General by the chief surgeon. A third was prepared and forwarded about the middle of August, 1917, calling for supplies for 100,000 men for six months. Such then was the situation: Certain supplies, both initial equipment and six months’ supply, were to be sent automatically with each expedition. Further replenishment supplies needed were to be asked for by requisition from the American Expeditionary Forces.
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AUTOMATIC SUPPLY
On August 20, 1917, General Pershing promulgated instructions concerning supply, which materially changed the manner of procuring medical supplies for the American Expeditionary Forces.16 Those instructions required that there would be established in France initial stocks for 300,000 men, for 90 days, and the stocks thereafter maintained without requisition. Supplies were to be divided into the following three classes: (1) Automatic supply for articles, whose consumption would be sufficiently regular to permit of automatic supply; (2) replenishment supply for articles of which specified stocks were to be maintained; (3) exceptional supply for articles of which no specified stocks were established.
The commanding general, Line of Communications, was to maintain 45 days’ supplies at base depots, 30 days’ at intermediate depots, and 15 days’ at advance depots, utilizing the same methods as those called from the United States, namely, automatic supply, replenishment supply, and exceptional supply.16
For shipments from the United States to France, lists were to be prepared in the American Expeditionary Forces of articles or classes of articles of which the consumption was sufficiently constant to warrant provision of an automatic supply. In preparing lists of material for automatic supply from the United States, great care was to be taken not to include articles obtainable in France or in England. Also careful check was to be kept on excesses and shortages so as to adjust the supply to the requirements with the minimum delays and thus economize on shipping.
General Pershing directed the chief surgeon, A. E. F., as well as the other chiefs of supply bureaus, A. E. F., to prepare an estimate, for cabling, under the foregoing system for: First, a list for four months’ supplies to accompany each movement of troops from the United States. This was to provide 90 days’ reserve and in addition one month’s automatic supply for consumption and emergency. Second, a list showing the amounts which had to be shipped for each 25,000 men of the American Expeditionary Forces.17 These last figures were to be used by the War Department as a basis for automatic shipment of supplies to France for the American Expeditionary Forces.
In compliance with the above-outlined instructions, the chief surgeon, A. E. F., initiated information to the Surgeon General, September 12, 1917, as follows: 18
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Paragraph 7. Automatic supply. For Surgeon General. Referring cablegram number 145, paragraph 5. Following is our requisition based on this cable. Supplies now on hand sufficient for initial reserve for troops here and now en route. Ship four months requisition in triplicate for all troops hereafter leaving the United States and thereafter ship automatically each month a month’s supply for all troops in France and en route. In making estimates for monthly automatic shipments and reserve, the usual supply of alcohol, ether, chloroform, rubber gloves, needles of all sizes, bandages, adhesive plasters and sutures of all sizes, and material should be multiplied 10 times, and the supply of gauze and all surgical dressings should be multiplied 25 times.
Subparagraph 1. Requisition already made, including the one for instruments dated August 27 and forwarded from here September 4, should be filled.
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Subparagraph 2. Investigation now in progress to ascertain supplies which can be purchased to advantage in France and England. Any modifications in automatic supply found advisable after this investigation will be promptly reported.
Subparagraph 3. All automatic and reserve supplies to be invoiced to supply officers.
Subparagraph 4. Automatic and reserve supplies to be considered over and above all supplies and equipment usually furnished organizations departing on foreign service.
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In explanation of this action of the chief surgeon, it should be said that the number of medical supply personnel in the American Expeditionary Forces at the time in question was too limited to permit of an immediate compilation of a list of all articles upon the supply table. Furthermore, medical supplies can not be computed upon a ration basis, and in respect of many articles there is not, and can not be, an “allowance” to be strictly adhered to. Rates of expenditure depend upon many factors, such as the number of troops and their distribution (concentration or dispersion), climate, condition of shelter, season, incidence of various diseases, character and severity of combat, number of wounds, type of wounds, length of stay of patient in hospital, the training of medical officers in care of supplies, facilities available for such care, and, to some extent, the personal equation as to remedies used. Rates of expenditure must be estimated after careful consideration of all those factors, and must be based upon experience tables for issue under similar conditions or, in the absence thereof, under peace time conditions.
The only experience tables, the only personnel having experience in such computation, were in the Surgeon General’s Office, and the desire of the chief surgeon was to utilize such personnel and such experience tables.
On August 20, 1917, the date when General Pershing promulgated his memorandum on automatic supplies,18 the Surgeon General informed the chief of embarkation service that the Medical Department had the following medical supplies for shipment to France, in addition to the supplies with troops, for the 26th Division: 2 field hospital equipments; 2 ambulance company equipments; 1 division surgeon’s office equipment; 26 motor ambulances, boxed for export; 10 motor cycles with side cars, boxed for export; 1 medical reserve unit, aggregating 90 tons and 12,926 cubic feet. There was a like quantity of equipment for the 42d Division. For the Line of Communications; 2 evacuation hospitals; 4 base hospitals, of 500 beds; and 40 ward units, aggregating 563 tons, 126,240 cubic feet. There was a six months’ replenishment of supplies for the zone of the army, field supplies, 161 tons, 18,200 cubic feet; and six months’ replenishment for the Line of Communications, hospital supplies and equipment, 280 tons, 40,667 cubic feet. Aggregating 1,185 tons, 198,000 cubic feet.
These supplies were sent as replacement for the beginning of automatic shipment of supplies to France. A list of supplies compiled for this purpose was largely used in the preparation of the actual monthly automatic replacement called for by the commanding general, A. E. F., in paragraph 2, cable 145, September 7, and paragraph 7, cable 155, September 11, 1917. A copy of this automatic replacement list for one month was forwarded to the chief surgeon, A. E. F., October 27, 1917, including post supplies, field supplies, dental supplies, veterinary supplies.19
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Thenceforward, the American Expeditionary Forces were supplied automatically both with initial medical equipment and with replenishment medical supplies. Additions to, subtractions from, or modifications in the list of articles desired by the chief surgeon, A. E. F., were to be made upon presentation of his wishes by cablegram or otherwise. The following extracts from cablegrams sent from general headquarters, A. E. F., to The Adjutant General, are examples of such action:
No. 175
SEPTEMBER 23, 1917.
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Paragraph 3. For the Surgeon General. Request that automatic supply be shipped as described in cable 145 and paragraph 7, 155. Storage facilities being enlarged. Twenty-five additional clerks trained in supply work will be needed before Christmas.
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No. 194
PERSHING.
OCTOBER 1, 1917.
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Subparagraph 2. Automatic supply. Veterinary instruments, medicines and dressings should be based on 0,600 animals for each division in France. This includes 10 per cent for replacements.
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No. 237.
PERSHING.
OCTOBER 21, 1917.
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Subparagraph A. Automatic supply. After studying, * * * decided that “Silvol” should be substituted protargol for all purposes. Request that 10,000 one-ounce bottles be shipped at once and that 2,000 bottles be added to the monthly automatic supply.
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No. 357.
PERSHING.
DECEMBER 9, 1917.
Paragraph 1. For Surgeon General. Order placed to-day in France for 50,000 bedside tables of improved pattern. Automatic supply of bedside tables should be reduced by this number.
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PERSHING.
On October 6, 1917, the Surgeon General furnished the medical supply officer, New York, with a list of supplies under the title “Automatic replenishment of medical supplies per month for a division of 26,000 men (expendable articles only).” For the month of October, he directed that three times the quantity of articles on the list be furnished the American Expeditionary Forces 20
On October 13, 1917, the list referred to above was modified by the Surgeon General, in so far as the post medical supplies were concerned,21 and on November 8, 1917, he directed the officer in charge of the New York medical supply depot to ship to the American Expeditionary Forces, for November, ten times the quantity on this list.22 In addition, on November 9, 1917, replenishments for the 26th and 42d Divisions were ordered shipped to the American Expeditionary Forces in twice the amount for the month of November.23
Up to and including the month of November, 1917, the automatic supply of the Medical Department, A. E. F., was in terms of 26,000 men, as indicated above. For December and subsequent months, however, the Surgeon General,
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instead of furnishing the New York medical supply officer with a numerator to compute the amounts of medical supplies to be shipped to the American Expeditionary Forces, computed each month the quantities to be shipped and transmitted the result to the medical supply depot for issue.
As to the individual amounts of articles to be furnished the American Expeditionary Forces, the matter was not entirely disposed of in France by the cabled request of September 12, quoted above. Study of the prospective needs in the way of medical supplies for the American Expeditionary Forces immediately was instituted in the office of the chief surgeon, Line of Communications. By September 18, in compliance with General Pershing’s instructions concerning automatic supply, previously referred to, the first list of medical and hospital supplies for automatic shipment from the United States, was submitted to general headquarters, A. E. F.8 But included on the medical supply table were some articles, which, though highly desirable in themselves, in view of the existing situation, could by reason of their bulk or weight, or by reason of their nonessentiality, be dispensed with. The importance of proper medical attention not only to the individuals concerned, but to the morale of the troops in the American Expeditionary Forces, and furthermore to the people at home, was such that the chief surgeon, Line of Communications felt confident that no request of his for supplies urgently needed could be disapproved. Being of this opinion, he had to assure himself that his requests did not include nonessentials. Acting upon his instructions, the existing supply was carefully scrutinized, and such articles were eliminated.
The following extracts from cablegrams from General Pershing to The Adjutant General, pertain to the elimination of certain articles from the medical supplies sent to the American Expeditionary Forces:
From Paris.
To The Adjutant General, Washington.
No. 232.
OCTOBER 20.
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Sub paragraph A. Reference paragraphs 7 my cable 215, following articles prescribed in Manual for Medical Department can be eliminated in present emergency: Paragraph 844; Basket., letters and waste paper, cups, sponge, envelopes and paper, official note; inkstands; steel erasers; desk pads and pen racks. Paragraph 845. Apparatus, electric; bags, obstetrical; basins,delft, for office; baskets, laundry; bed cradles; blowers for insect powder; book cases; boxes, fracture, folding; brushes, weighted for polishing floors; buckets, fiber; cabinets for dressings and instruments; cases, dental; cases, tooth-extracting; chairs; charts, anatomical; clocks; cuspidors; desks, office; fans, palm leaf; floor polish; floor wax; ice cream freezers; step ladders; lawn mowers;linoleum; mats, door, metal; pitchers, delft, for office; pots,water; refrigerators; iron safes; scales and weight platforms; setteesfor porch; tables, bedside; mouse and rat traps; garden trowels;portable bathtubs; foot tubs; water coolers; only 25 percent of hospital beds in France will need mosquito bars. It is urged thatthe committee on standardization to select the minimum number ofarticles essential to the Nation`s medical activities report on thestandard medicines to be required. It is believed that many of the medicines now mentioned in paragraph 843 can be eliminated duringthe time of war without detriment to the medical service.
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From HAEF.
To The Adjutant General, Washington.
No. 268.
November 3.
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Subparagraph A. * * *
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Following list of medicines, par. 843, can be omitted: Acetanilide; ascidium citricum; acidum oxalicum; acidum sulphuricurn aromaticum; adeps lanae hydrosus; aloe, powder; ammonii bromidum; amylis nitris; argenti nitras fusus; arseni trioxidum; asafoetida; bismuthi subgallas; calx chlorinata; capsicum, powder; cera flava; copaiba; creta preparata; eucalyptol; ferri et quininae citras solubilis; ferri sulphas exsiccatus; fluidextractum colchici seminis; fluid extractum ergotae; fluid extractum pruni virginianae; fluid extraetum zingiberis; heroini hydrochloridum; both sizes; lithii citras effervescens; magnesii carbonas, powder; oleum aurantii corticis; oleum morrhuae; oleum santali; oleum tiglii; pepsinum; pilocarpinae hydrochloridum; pilulae copaibas compositae; potassii bicarbonas; potassii bromidum; resina podophylli; rheum, powder; spiritus aetheris compositus; syrupus ferri iodidi; syrupus hypophosphitum compositus; syrupus scillae; thymolis iodidum (Aristol); tinctura aconiti; tinctura cantharidis; tinctura capsici; tinctura cinchonae; tinctura, gentianae composita; tinctura myrrhae.
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PERSHING
Copy for Surgeon General.
Before these cabled requests could be acted upon in the Office of the Surgeon General, an automatic supply list of articles for the Medical Department, A. E. F., was prepared in the supply division there, and, on October 27, 1917, sent to the chief surgeon, Line of Communications:24
1. A copy of “Automatic replacements for one division for one month” of (a) post supplies; (b) field supplies; (c) dental supplies; (d) veterinary supplies; is inclosed for your information and suggestion.
2. The officers in charge of the medical supply depots at New York, Washington, and St. Louis will be directed to ship each month as many times this replacement as there are tunes 25,000 troops in France. These instructions will be issued at the beginning of each month.
3. Furnish this office a copy of any modifications which you think should be made in this list. Any supplies deemed by you not necessary will be omitted. Any quantities which should be increased will be so increased.
4. Inform this office of the quantity of furniture deemed by you expedient to be issued with each base hospital equipment to be sent over. It is the understanding of this office that these hospitals are to serve as general hospitals and not in the strict sense of base hospitals as the term is used in the Manual for the Medical Department. For such hospitals it would appear that equipment more varied and more extensive than that for the ordinary base hospitals would be required.
The chief surgeon, A. E. F., was not in agreement with this arrangement in the Office of the Surgeon General, whereby automatic replacements were to be based on a division for one month; on the contrary, he was of the expressed opinion that medical replacements should be worked out on the basis of the total needs of 25,000 men for one month for all supplies, expendable and nonexpendable that were susceptible of automatic supply.25
Furthermore, he believed that the adopted system of supply necessitated the development, and use, of a rather large exceptional list, which was to include articles not susceptible of an automatic supply. Accordingly, on February 1, 1918, he directed the officer in charge of intermediate medical supply depot No. 3, A. E. F., Cosne, to express an opinion on the subject.25
Prior to the receipt of this letter, several conferences had been held between the chief of the supply division, chief surgeon’s office, Line of Communications, and the officer in charge of the medical supply depot at Cosne, and the latter was given the information contained in the letter of February 1, by
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telephone, and asked to furnish the comment desired by the chief surgeon. He had a copy of the automatic supply list, which had been sent to him direct by the Surgeon General.
After opportunity for studying the problem had been afforded the medical supply officer, the chief surgeon, Line of Communications, replied to the chief surgeon, A. E. F., on February 15, 1918, as follows: 26
1. I concur in the opinion expressed in your letter. I understand that portion of it recommending a unit of 25,000 men is now in effect. I am inclosing a letter from the officer in charge, intermediate medical supply depot No. 3 on this subject. His opinion seems to be the same.
2. I especially invite consideration of his recommendation of an elimination list. I am well aware of the personal idiosyncrasies with which this would interfere and of the probable protests that it would engender, but I believe that it is a matter of necessity and I am convinced that the cooperation of the medical officers could be obtained by a well-conducted campaign of education in which the necessity for economy of effort and tonnage were shown.
3. This elimination list is in my opinion all the more necessary by reason of the necessity of greatly increasing the allowance of certain drugs (as, for example, camphor and opium derivatives) and of the necessity for adding to the list many additional articles to meet new conditions (for example, sodium, camphor, soap, and oxygen in large quantities). I am submitting a supply table with the articles which you have already withdrawn erased in red ink, with articles proposed for elimination shown by an “X” in red ink, with articles the original packages of which are so small that shipments thereof could well be made automatically every three months indicated by a red “3,” with articles the supply of which would be controlled by requisitions indicated by the word “Req.”; shipment of all other articles to be made automatically in monthly shipments, and with self-explanatory remarks after certain other articles.
4. In addition to the elimination list, I propose that certain other articles be eliminated from the supply for other units than base hospitals. In fact I believe that mobilization tables similar to those in use in the British Army should he established and rather firmly adhered to. A statement of policy on such articles as desks and filing cabinets is highly desirable. I believe that tables, common, can profitably be substituted for desks. Apparently though the Surgeon General has a different conception, as stated in paragraph 4 of his letter. While highly desirable from the standpoint of a good looking hospital, in view of the tonnage situation I think they might well he dispensed with.
5. I especially invite your attention to the recommendation that all dishware should be enamel ware, cups to be without handles. Breakage of the porcelain has been great.
6. This elimination list was suggested in a recent conference with Major Mount, the officer in charge, intermediate medical supply depot No. 3, and it is recognized that it is tentative only. Medical officers must be taught that this is war, and that our hospitals can not be ideally equipped, and that in order to be assured of the essentials they must forego many desirable things. I believe that tonnage and packing costs could be saved by supplying the more commonly used medicines in two sizes, one for base hospitals, the other for smaller organizations.
7. The list of standard surgical instruments has not been considered because, so far, none of these instruments have been provided, and I am confident that we shall need all that it is possible to ship. Later when a stock has been accumulated the question of automatic supply or supply by requisition can be settled.
8. The veterinary supply I am unable to pass upon with any degree of assurance. I can say, however, that the demands heretofore made have seemed to total considerably larger than this present automatic supply
* * * * * * *
The report which the officer in charge of the medical supply depot at Cosne was directed to submit upon the same question is as follows: 27
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1.In compliance with long-distance telephone request from your office, I herewith transmit report on automatic supply recently furnished by the Surgeon General’s Office. It appears that the automatic supply as furnished covers expendable articles only, and applies to all medicines on the post supply table, including those that have already been placed on the elimination list.
It is not believed that the automatic supply should apply to all the articles needed in France; neither should it apply only to the expendable articles. It would seem the most rational procedure, first, to eliminate the articles that are not needed by the Medical Department in France; second, to make up an automatic from the revised list covering only the essential articles; third, to classify the remaining articles under the heading “Exceptional articles,” to be covered by timely requisition.
2. At present almost all the medicines on the field supply table that formerly came in tins are furnished in bottles, thus duplicating the post supplies except for the number of tablets in bottle. If this is to obtain during the war, it is believed that all medicines furnished in tablets on our post and field supply tables should come in a standard-size bottle with a specified number of tablets in each. Further, a great many supplies on the dental and veterinary supply tables are exactly the same as our regular post supply articles, the stationery on all four tables being almost exactly the same. If the method advocated of converting into one supply table be followed, the confusion of having automatic supply for stationery on four different tables and for medicines on three tables would be eliminated. The present lists as furnished show. automatic on stationery for post, field and dental combined, and a separate list for veterinary.
3. In general, anesthetics, ligatures, dressings, and essential drugs should be automatic; and, in addition, such articles as are used in large amounts could readily be included in the automatic arrangement. Nothing should interfere with the shipment of these automatic articles, and the full shipment should be made at one time, as otherwise a shortage will develop on the very class of articles that are absolutely essential Amounts should at first be, if anything, overestimated for the above reason.
4. The following increases in the automatic supply as shown on the list furnished by the Surgeon General’s Office are recommended:
[Increases in automatic supply]
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[Increases in automatic supply - continued]
5. This office does not feel competent to pass on automatic furnished for veterinary supplies; but from personal experience with a field hospital, and judging from amounts asked for by veterinarians now in France, the automatic seems greatly underestimated.
Animals seem to be scattered in many places, some detachments having only 40 horses on hand, and the smallest amount one is able to furnish such a detachment is one bottle or tin of a drug, or one tube of hypodermic medication. The veterinarians themselves seem uninformed, judging from their requisitions, as to whether or not to request on the field supply table or post supply table.
After analyzing the information thus made available to him the chief surgeon, A. E. F., on April 2, 1918, transmitted it to the Surgeon General in the following letter:28
1.The data inclosed with this communication b represent the desires of the Medical Department in France as regards the automatic supply, and in addition thereto there is indicated the equipment for a base hospital as desired for the American Expeditionary Forces, and all in answer to your letter, copy inclosed, of October 27, 1917.
2. New and unusual problems confront our supply division in France, and these questions must be met and solved. The departures from old and established customs that will be found recommended herein are explained by these radical changes in the environment of our forces here in France.
3. The general staff at general headquarters has directed that in the preparation of automatic supply lists all articles be placed thereon that are susceptible of such arrangement. It is the view of the supply division in this office that with few exceptions all articles expendable and nonexpendable should arrive in France automatically and in preparing this work this policy has been followed.
4.The item of first importance here is tonnage and all efforts are directed toward saving all possible ship space for the essentials. Radical elimination has therefore been found necessary and has been practiced. In a further effort to conserve this ship space it is urgently requested that unnecessary boxing material such as would ordinarily come with rubber goods, etc., be eliminated, and that all empty containers in so far as it is practicable be sent filled with such items as may be available for this purpose.
_______________
b The lists referred to have been omitted.
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5.The desirability of having a single list of articles used in common by the various divisions of the Medical Department has become more and more apparent, and this consolidated list has been produced. Furthermore, it is considered highly desirable to have medicines furnished in two standard-sized bottles, large for base hospitals and small for smaller organizations. This request, like others that appear above and below, must, of course, be coordinated with the problems of supply that confront your office, but it is hoped that these simplifications may become operative ultimately.
6. A separate list relative to the equipment of base hospitals and in answer to paragraph 4 of your letter quoted above is inclosed. This list is considered complete except for very special equipment and therefore gives you the ideas of those upon this side in relation to this question. Certain of the larger and heavier articles of furniture must, in the interests of economy of tonnage, be eliminated, and this elimination has here and elsewhere been indicated. Minor shortages, if such are found to exist, in such articles as instruments and the like may be supplemented from the depots in France.
7. The various lists have been arranged in accordance with the supply tables and where articles have been added they have been placed in the proper classification and with alphabetical arrangement. The legend used appears at the top of the sheets. The latest supply tables as indicated in changes, Manual for the Medical Department, for dental and veterinary items have been freely consulted, and the amounts and articles asked for are the result of mature consideration of all aspects of the present situation by officers best acquainted with the various special supply problems. The surgical instrument list was prepared from the Catalogue of Standard Surgical Instruments (revised to December, 1917) and the laboratory list follows the one outlined in a proposed change in the Manual for the Medical Department and recently furnished the laboratory division of this office by you.
8. It is contemplated that, from time to time, changes may be required in those tables. Upon the 10th of each month, therefore, a cable will be sent from this office indicating all items for elimination or addition and all amounts of various items where increases or reductions are needed to maintain the reserve in our depots at the proper level.
9. An additional copy of the “surgical dressings” sheet is inclosed, for your information, with this letter. The monthly requests shown upon this sheet represent a fairly large item of tonnage. It is the desire here, however, to have these quantities come so long as the tonnage is available, since at the present time practically no reserve of this class of finished dressings is in stock in France. Later, if necessary, this ship space may be released for other purposes and corresponding increases will be made in items needed to replace the Red Cross dressings here in France, such as gauze, cotton, etc.
10. The entire study as here presented meets with the approval of the general staff, and G-1 of general headquarters will issue each month an allotment of tonnage to the Medical Department, sufficiently ample, it is hoped, not only to provide for the monthly needs thereof but in amounts sufficiently liberal to provide for an increase in the reserve now in our depots.
11. A copy of this communication with all its inclosures complete will be mailed to you one week from this date in order to assure its reaching your office and copies of the entire study are on file in the administrative section, general staff, the intermediate medical supply depot No. 3, and this office. Changes requested from time to time that are accepted by your office will reach the United States a sufficient time prior to June 1 to permit of the scheme becoming operative that date. If feasible, an earlier date is desirable and it is requested that you cable this office to the effect that this communication has been received, is acceptable, and the date upon which it is to become operative.
Thus three different automatic supply tables, Medical Department, A. E. F., came into existence: (1) The automatic shipment of initial unit equipment and initial supply, including medical reserve units. (2) The automatic shipment of initial unit equipment and initial supply, and of the replenishment supplies computed by the Surgeon General. (3) The automatic supply list forwarded April 2, 1918, by the chief surgeon, and its subsequent modifications.
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These tables differed in no respect in principle. The chief surgeon’s list rearranged the supply table, making a single list alphabetically arranged by the functions the supplies were designed to fill.
Automatic shipment of the supplies on the basis of the chief surgeon’s list began in June, 1918.8 Thereafter there were many changes made in the list by cable. After the armistice had been signed, discontinuance of the automatic shipments was requested, and dependence upon requisitions was had for the comparatively few supplies needed. It is obvious that with the experience which the American Expeditionary Forces had had at the time the tables were prepared the medical supply division in France was no better than, if as well prepared as, the supply division in the Surgeon General’s Office to indicate in detail item by item the probable rates of expenditure. However, it was prepared to indicate the number of units and the type desired, to indicate special and nonstandard equipment needed for conditions in the American Expeditionary Forces, and to indicate in a general way increases or decreases in standard items.
At the time the list was prepared (March,1918), reserve stocks of medical supplies in the American Expeditionary Forces were small.8 Rigid dependence upon the automatic was foreseen; therefore, one of the factors in the determination of the amounts considered as the supply of 25,000 men for one month was the necessity of increasing the amounts in reserve. No accurate information as to the amount of each article that would be used was available, so it was thought wise to be on the safe side. The amounts specified were excessive and were recognized as such.29
It was the purpose of the chief surgeon, A. E. F., to modify the automatic list from month to month, and, once adequate reserves were established, to keep pace with the demand. There was overlooked, however, the fact that this building up of the reserve medical supplies in the American Expeditionary Forces would not be as apparent to the Surgeon General as to the chief surgeon A. E. F., and that the imperfect liaison would make it difficult to apprise him of its existence. Also, there was failure of conception in the supply division of the chief surgeon’s office, A. E. F., as to the Surgeon General’s method of computing total requirements for procurement. It was assumed that American Expeditionary Forces’ requirements would come out of existing stocks in the United States, to be replaced by equal amounts procured, and that future curtailments of shipments to France could be compensated by absorption of the quantities in the needs of the troops in the United States.30
The Surgeon General, however, had placed orders for the requirements as he saw them. He considered the automatic list from the American Expeditionary Forces as a definite order to be filled, without change. To meet that requirement, production had to be ordered of the entire amount for a long period in advance. Once, therefore, the automatic list reached the Surgeon General, the momentum of the procurement machinery could not be stopped suddenly, and cancellation of, or reduction in, the quantities called for by the automatic list inevitably was followed by a surplus in the United States.
The situation in the United States with reference to rail and overseas transportation was such that supplies to be shipped in any particular month,
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had been ordered shipped and had been assembled sometime before shipment actually was made.
It is apparent that too prompt a reflection of the changes made in the automatic list was expected in the procurement, transportation, and loading of supplies. Cabled changes could not be made effective as promptly as expected.
Another factor of importance in connection with the inclusion in the automatic supply of a factor for reserve is that the rapidly expanded troop movement multiplied many times any error existing, and increased the absolute amount of surplus enormously. It is an axiom in supply that the reserve necessary does not increase in relative proportion to the troops served.
That the Surgeon General’s conception of the matter was that outlined above is amply demonstrated in a number of cables and letters. He proposed to fill the orders given, but in a number of instances, he called attention to the apparently excessive amounts, more particularly in connection with equipment rather than with supplies.
PROCUREMENT IN EUROPE
It was apparent very early, that procurement in Europe and particularly in France, would be desirable.31 Cost in money was a secondary consideration; time and tonnage were the important factors.
During the stay of General Pershing’s party in England, the chief surgeon, A. E. F., had had a study made of the British source of supply. One of the early assignments in the office of the chief surgeon at Paris was that of a purchasing officer. Under the provisions of the General Orders, No. 28, H. A. E. F., August 30, 1917, this officer was detailed for duty with the general purchasing board. The report which follows, gives in detail the activities of his office.
MEDICAL DEPARTMENT PURCHASING AND DISBURSING OFFICE, A. E. F.c
PURCHASING
The purchasing office, Medical Department, was established as a subdivision of the general purchasing board and commenced its activities about the 1st of September, 1917.
There were three distinct functions of this office, the first two of which were apparent at the beginning, and the third of which became obvious later when shipping difficulties arose.
The most evident need was to provide for emergency purchases--purchases of articles that were perishable, such as serums and vaccines; or they were exhausted at the depots or hospitals owing to unforeseen demands of the service, or to changes in methods.
The second need was to procure special equipment and materials not on the Medical Department supply table. This included such articles as special laboratory equipment and materials for use in the schools of the Medical Department of the American Expeditionary Forces.
______________________
c The following statements of fact are based on “History of Purchasing and Disbursing Office, Medical Department, A. E. F.,” by Col. D. C. Card, M. C. On file, Historical Division, S. G, O.
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And, finally, as the tonnage question became acute, it was necessary to purchase supplies of stock material available in France in order to reduce the tonnage from the United States. Purchases falling under the first two categories generally were made on requisitions, approved by the chief surgeon, A. E. F.; in the case of the third class, purchases usually were made in large quantities by direction of the chief surgeon, for the purpose of stocking the depots.
French Government purchases. - At first, purchase orders of a value not exceeding 1,000 francs could be placed in the French open market without authorization of the French Government; but from September, 1918, the limit was raised to 5,000 francs. Orders in excess of those amounts were made through the French or British Governments, passing by way of the office of the general purchasing agent, and also, in the case of the French Government, by way of the French mission. Where the French Government was unable to supply the material needed, the purchasing officer was authorized, subject to the approval of the general purchasing agent, to purchase in the open market.
The orders placed with the French Government were especially for material for stocking depots. The chief reasons for purchasing through the French were to avoid elevation of price by the bidding of one Government against another, and to secure raw material that was under governmental control.
Deliveries of material ordered from the French Service de Sante, were inspected by an officer from the purchasing office in the packing rooms of the Service de Santé. Count was made, and at times samples were taken for testing the quality of the material. This inspection before packing avoided much work and confusion.
Open-market purchases. - When an order was to be placed in the French open market, several firms were invited to submit estimates in writing and samples of the article in question. The invitation was extended personally by an officer of the purchasing office, who could by preliminary investigation judge whether or not the firm was in position to furnish the article desired. This procedure was deemed necessary as this office frequently was besieged by agents and middlemen who were willing to accept any kind of an order and make all kinds of promises as to delivery which they well knew they would be unable to fulfill.
In placing the order, the quality of the article, the time delivery could be made, and the price therefor had to be considered, the relative weight given these elements being governed by the needs of the service.
For some of the larger purchases, contracts were entered into; but, on account of the difficulties confronting the merchants, many were unwilling to sign formal contracts. All orders were placed in accordance either with A. R. 550-1, by contract, or with A. R. 550-3, as emergency purchases. In both eases, bids from several houses were sought, except for named articles of established valve which could only be secured from a particular house.
When articles were unobtainable through the French Government, or in the open market in France, recourse was had to the purchasing officer for Great Britain; but this procedure was avoided whenever possible on account of the difficulties of transportation and the element of time.
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Five, sometimes seven, copies were made of the order. These were distributed to various services for their information. The original went to the furnisher and one approved copy was retained in the files of this office. A third copy became part of the records of the office of the general purchasing agent. The fourth was delivered to the inspection and shipping section for their information and for the control of deliveries, inasmuch as dates, quantities, etc., of deliveries were given on the face of the order. The fifth was retained to be sent later to the disbursing section with the bill for vouchering and payment. On stock orders, additional copies were sent, one to the depot for which the material was ordered, and one to the chief surgeon A. E. F. for his information.
Many difficulties confronted the office in carrying out its functions. Demands were often urgent, and at times work proceeding in the normal course had to be dropped in the emergency. In France where stocks were depleted by three years of war, it was sometimes extremely difficult to find articles that had been plentiful in times of peace. This was especially true of small quantities of odd articles, for which prolonged search was sometimes necessary. It was seldom that the article on the medical supply table was to be had, and it was necessary in all such cases to select a satisfactory substitute from among articles that were available. Promises were made by the furnishers, ofttimes only to be broken. Many desired articles had as constituents raw material under Government control and it took time to arrange for the release of the raw material for use by the manufacturer. This last mentioned difficulty was one of the group that assailed the merchant and made him unwilling to sign a contract. Another difficulty was the matter of transportation--a problem that everyone in France was facing, but which was particularly difficult for the commercial house inasmuch as the railroads were under Government control. Even with “Certificates of classification of merchandise” it was sometimes impossible to make shipments. The market was unstable, prices were rising constantly, and the supply was uncertain. And perhaps most difficult of all was the question of personnel. The war demanded the able-bodied men, the skilled men, and left the shops and factories short handed.
For some time there was another element that added to the difficulty of purchase in the open market. This was a direct competition between different services of the Army, and also between the Army and the auxiliary organizations such as the American Red Cross and the Young Men’s Christian Association. At times the Red Cross and the Army would be searching the market for the same articles for the same place and use. As a result of this competition, the prices suddenly jumped upward. To put an end to this state of affairs, General Orders, No. 41, headquarters, Services of Supply, 1918, was issued, which placed articles in definite categories, and each purchasing office was assigned its categories. This order applied likewise to auxiliary organizations so that they were authorized to purchase in open market only such items as were unprocurable through the Army channels of supply, and after approval by the Army purchasing officers and the general purchasing agent.
Shipping. - By February 1. 1918, the purchases had increased considerably. The Quartermaster Department was crowded with shipping demands, and as a consequence there was a delay in the shipment of medical supplies urgently
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needed. To relieve the quartermaster of the burden of Medical Department shipping and at the same time to expedite the shipment of emergency supplies, a shipping department was started in connection with the purchasing office. A warehouse was opened at 15 Avenue Ledru-Rollin, and auto trucks were assigned to it. The warehouse was used for the reception and storage of incoming goods, for inspection, for checking and packing for shipment.
Shipments of small packages were made by registered mail, express, or courier, depending upon the urgency and the value of the shipment. Larger shipments to individual organizations were made by express in less than carload lots. Material in small quantities destined for the depots was held in the warehouse until a carload lot had accumulated, and then was shipped in a car convoyed to its destination. Large amounts of stock material were shipped in a similar fashion. This was not only the safest method of shipment but when, as in busy times, two or three carloads were shipped a week, it was the most rapid.
Results. - A few figures will serve as evidence of results accomplished by the medical purchasing office:
The estimated cubic tonnage represented by the Medical Department purchases is another index of the results accomplished by the purchasing office. The medical purchasing office was instrumental in the purchase of 19 hospital trains, of 16 cars each, in England, and 2 similar ones in France, and 14 mobile hospitals, each composed of 27 camions and complete hospital equipment, in addition to miscellaneous material.
Trains and hospitals....................................................cubic tons.............. 40,250
Other materials and supplies.........................................................do............231,805
Total.........................................................................do.....272,055
DISBURSING
With the commencement of Medical Department operations in France, the disbursing incident thereto was carried on at the base medical supply depot at Cosne. Soon, however, Paris was recognized as a logical location for a medical disbursing office.
The reasons for the selection of Paris might be summed up as follows:
(1) It was the place in which the greater proportion of the supplies were being purchased, and it therefore put the disbursing officer in close touch
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with the purchasing office and with the individuals from whom the materials were procured, thus avoiding the inconveniences and delays incident to mail communication. This enabled the disbursing officer to pay for material with the least possible delay after its delivery to the American Expeditionary Forces. (2) The French Government was furnishing large quantities of material to the American Expeditionary Forces, and it was necessary to be in close touch with the French Government officials in order to facilitate the work of reimbursement.
In a memorandum of September 22, 1917, from the chief surgeon, A. E. F., to the chief of staff, it was suggested that, in view of the trouble experienced and needless delays caused by the transmission of vouchers to and from Cosne, the Medical Department purchasing officer be made disbursing officer. This appointment was made, by cablegram, dated October 5, 1917; however, the office at Cosne continued for some time to do practically all the disbursing of the Medical Department, A. E. F., no disbursing personnel having been assigned to the Paris office. On April 6, 1918, Fes. 5,000,000 were transferred to the credit of the medical purchasing officer in Paris and, the necessary personnel having reported, work of paying the accumulation of French Government bills was begun.
The chief function of the disbursing office was paying for materials ordered from private individuals and firms by the purchasing office in Paris, and paying for materials obtained from the French Government, whether or not these materials were ordered here.
Payments to private individuals and firms. - Difficulties in paying for purchases from private individuals and firms were avoided by having the material inspected by and shipment made under the supervision of an officer from the purchasing office. It was therefore possible for the purchasing officer to approve bills and execute the second certificate on Form 330 without waiting for receipts from the consignees, thereby facilitating payment.
Payments to French Government - Purchases from the French Government may be divided as follows: (1) Purchases made by this office on written orders or contract. (2) Incidental purchases made by base surgeons, hospitals, and units in the field. (3) Hospital equipment taken over by American hospital organizations. This latter class comprised in many cases fully equipped base, camp, and field hospitals, and ambulances.
Bills were submitted in quadruplicate by the French Government to the liaison office. There they were numbered, the number being prefixed by a letter to indicate the French service furnishing the material, “S-” for “Service de Sante”, “A-” for Service d’Artillerie”, etc. They were then distributed by the American liaison officer to the American departments properly chargeable with payment.
At first, these bills were sent out to the organizations receipting for the material, for preparation of the necessary forms, and in order that the material might be taken up on the return of the accountable officer; this procedure was found to be impracticable due to the mixed and complicated character of the bills and also on account of the loss of bills and delay in the mail. Therefore vouchers covering these bills were prepared in this office and the second certifi-
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cate thereon executed by the purchasing officer, on the basis of the provisional receipt, after having changed this certificate to read: “Received by the A. E. F.” or “Received by the Medical Department,” instead of “Received by me.” The material was not taken up on the return of the purchasing officer; instead a copy of the Form 12 was sent as an invoice to the officer receipting for the material with the request that he take up the property on his return and send his voucher number to the chief surgeon, A. E. F.
Three main difficulties were encountered: (1) the bills were submitted in the French language and therefore required translation. (2) The supply tables of the different departments of the French Army did not agree in all cases with the supply tables of the respective departments of the American Army; therefore bills often were received covering materials to be paid for by two or more departments. For example a bill from the French Service de Sante, covering the taking over of a hospital, usually included some material to be paid for by the Medical Department and some by the Quartermaster Department, as well as items chargeable against the hospital fund of the new organization. (3) Materials ordered by the purchasing office frequently were furnished by French depots elsewhere than Paris and shipment made direct to American organizations, and this office often received no notification of shipment. In many of these cases, as well as in cases of materials turned over to units in the field on orders other than from this office, proper receipts were not obtained.
In the case of bills covering materials chargeable against hospital funds, checks were obtained from the proper organization in favor of the French Government for the amounts of such supplies. These checks were then submitted to the French Government, together with checks in payment of the medical portions of the bills. In the case of bills containing medical and quartermaster supplies, if the medical portion of the bill were larger, the bill was paid by this department and a bill submitted to the other department for reimbursement, in line with Army Regulations, 671.
In cases falling under the third category, efforts were made to secure proper receipts. If unsuccessful, the matter was submitted to the board of contracts and adjustments for authority to make payment.
Results. - The following table shows the number of vouchers and amount of funds disbursed for each month from December, 1917, to June, 1919:
770
STORAGE AND ISSUE DEPOTS
Reference was made above to the shipments, in June, 1917, of medical supplies from the United States, comprising divisional field units, base and evacuation hospital units, and medical reserve units, for the earliest combat divisions of the American Expeditionary Forces. About July 10, 1917, these supplies began to arrive in France, at the port of St. Nazaire.
At this time the extent to which America would contribute troops was probably not realized, and perhaps, also, the exact location of the operations to be performed.
Because the channel ports were overtaxed by the British requirements, the United States was practically limited to ports south of Cherbourg. Among these latter Brest was served by a long rail line, and the acute car shortage in France made service on this line difficult. St. Nazaire was the port chosen as the initial base, and it was, therefore, at St. Nazaire that the initial shipment arrived.32
There was immediate recognition in the Medical Department, A. E. F., that a depot not only nearer the front than St. Nazaire but also accessible to other ports to which shipments might arrive was required.33 Selection had been made of a most satisfactory building at Nevers, but just before the shipment of the supplies from St. Nazaire was effected word came that this building had been transferred to another service and that the Medical Department had been assigned space at Cosne. Shipment was made to that point, and upon July 8, 1917, the depot at Cosne was inaugurated.
The site of a medical supply depot was determined, first, by its facility to serve the troops, and, second, by accessibility thereto from the ports. With supplies in small quantities arriving at several ports, it was necessary to establish the first depot at a central point since the supplies received at any one port were not sufficient in quantity nor sufficiently balanced to stock a depot in each port.8 Later, another factor affected the matter--the necessity for clearing the ports.
It will be of material assistance if, in reading the history of this development, one will bear in mind the fact that while supplies in large quantities were received, for most of the period the demand was using up the supplies almost as fast as they arrived, and that while, later, certain supplies came in larger quantities than were immediately required, there was never a time during the period of active hostilities when there was such a surplus of all supplies as would enable the complete stocking of a second depot.
The Medical Department was meeting its needs from Cosne, and therefore Cosne had to be kept stocked. It could never divert shipments from Cosne in all articles for such a period as would enable it to transfer its activities to another depot.
General Orders, No. 20, H. A. E. F., August 13, 1917, prescribed the limits of the Line of Communications, A. E. F., and constituted base section No. 1, base section No. 2, and the intermediate section. General Orders, No. 66, H. A. E. F., November 27, 1917, constituted base section No. 4 on the channel ports and base section No. 3 in England, and constituted base section No. 5
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at Brest, which had theretofore been part of base section No. 1. General Orders, No. 75, H. A. E. F., December 14, 1917, prescribed the advance section, Line of Communications, and delimited the sections a little more definitely.
FIG. 43.- Intermediate Medical Supply Depot, No. 2, Gievres; entrance
As stated above, in General Pershing’s memorandum of August 20, 1917, concerning automatic supply, the following distribution of stock in France was prescribed: 45 days at base depots; 30 days at intermediate depots; 15 days at advance depots. So far as the Medical Department was concerned, no immediate change in its practice was required by this order. The problem was not to distribute 90 days’ supply in the proportion prescribed. There was not then, and there was not for months afterwards, anything approaching 90 days’ medical supplies. In many articles there was never at any time any such quantity, so that the supply division remained as before, faced with the problem of supplying the ever-increasing needs from an exceedingly small stock that increased little, if any, beyond the demand. However, in certain items the receipts became greater than the current issues and it was possible to begin the stocking of depots other than the one at Cosne.
Since there was practically no unused storage space in France, the American Expeditionary Forces very promptly developed plans for construction to meet its own needs.34 In each of the depots projected the Medical Department was to be assigned space, and the supply division, chief surgeon’s office, Line of Communications, was called upon to estimate the amount needed by
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the Medical Department and to determine the proportion in which such construction would be needed in the various sections of France.
Fig. 44. - Advance Medical Supply Depot, No. 1, Is-sur-Tille; general view
Aside from the medical supply depot at Cosne, which was not connected with any other depot activity, the first space assigned to the Medical Department under this arrangement was at Gievres, in the intermediate section, where intermediate depot No. 2 was established and where the Medical Department began its activities on October 10, 1917. 8 Shortly thereafter space was assigned to the Medical Department at Is-sur-Tille in the advance section, where advance depot No. 1 was established. Medical supply personnel arrived at Is-sur-Tille on November 18, 1917, although no supplies reached there, until a month later.2 Similar assignment of space was made later at St. Sulpice, in base section No. 2; at Montoir, in base section No. 1; at Marseille, in base section No. 6; and after the armistice had been signed, at Montierchaume (a duplicate of Gievres), in the intermediate section. A second duplicate was contemplated at Le Mans in the intermediate section.8
After the establishment of the depot at Is-sur-Tille, the immediate problem was to establish and maintain a stock at that point to supply adequately the troops in that area. It was not possible to stock every item for, as has been said, there was not sufficient stock in France to provide completely for two depots.
During the winter of 1917-18 many base hospitals either had been established or were being built in the neighborhood of Is-sur-Tille. The supply
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requirements of these units were large. Since the primary purpose of the advance depot at Is-sur-Tille was to supply the combat troops, instructions were issued that these permanent installations, except in emergencies, would obtain their supplies direct from the intermediate depot.35
It is obvious that this practice avoided double handling of the supplies and conserved transportation. Later when these base hospital units became enlarged and the available supplies became greater, the practice was to fill their requirements from the base ports, thus doing away with still another shipment and further conserving tonnage. (See “Controlled stores” and Hospital center depots.”)
Is-sur-Tille, therefore, was supplied initially from Cosne with large quantities of those items whose use by troops in the field was to be expected, and a 10-day automatic shipment from Cosne was instituted. This was supplemented, however, by special requisitions made by the officer in charge at Is-sur-Tille, and from time to time modifications in the “automatic” were asked for by him.
Since the supply division was working upon a small balance, the condition of the stock at this depot was always a matter of grave concern. A semimonthly stock report was required, one copy going to the officer in charge at the Cosne depot, another to the chief surgeon’s office. Always in both places the stock report was checked carefully, and shipments were made without requisitions, if the stock on hand appeared to be below the minimum.
For a long time, considerable difficulty was experienced in reconciling the requirements of the Is-sur-Tille depot with the available stock in France and the need for this material in the installations not supplied by Is-sur-Tille. It was, necessarily, a hand-to-mouth policy.36 Though Is-sur-Tille had its full share of supplies, even in the early days we had to rely upon small but frequent shipments. In field supplies it was given the major portion, and in such materials as prepared dressings, and splints which were obtained in a large measure from the American Red Cross, Is-sur-Tille was made the main depot. Also, in the later period, Is-sur-Tille was supplied directly from the base ports, the supplies arriving at Marseille being particularly applicable to this method of supplying this depot.
Is-sur-Tille, though a Services of Supply depot, was placed eventually under the jurisdiction of a representative of G-4, general headquarters, A. E. F., and issues therefrom to the troops were made under his direction.
With the establishment of intermediate depot No. 2 at Gievres, and the assignment of space therein to the Medical Department, it was possible for the Medical Department to contemplate the concentration in that depot, of all its supply activities in the intermediate section and the limitation of the activities of the medical depot at Cosne.8 The reason for this was: The two depots were in the same general area, were served by the same railroads, and could efficiently make issues only to the same forces. Since Gievres was to have better facilities than Cosne, and it was undesirable that two depots should serve identical forces, the initial assignment of personnel to Gievres was made with the thought that the entire personnel of the Cosne depot would soon follow and
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that the supplies would be diverted to Gievres when that depot was ready to function. Pending that time, Gievres was considered, so far as the issue of medical supplies was concerned, as a subsidiary of the depot at Cosne and issues were made only upon the order of the officer in charge of the Cosne depot, transmitted either as extracts of requisitions or by telephone. Shipment in carload lots from Gievres was the rule, issues in detail being made from Cosne.8 Requisitions continued to be sent to Cosne; however, the depot at Gievres, within this period, was prepared as an issue depot in order that in an emergency it might replace Cosne.
To summarize, then, early in 1918 there were three medical supply depots in Finance: Intermediate medical supply depot No.3, at Cosne, and intermediate medical supply depot No. 2 at Gievres, both in the intermediate section, and one, advance medical supply depot No.1, in the advance section at Is-surTille. Cosne was in active operation. Gievres was operating as a subsidiary of Cosne. Is-sur-Tille was completely stocked so far as field supplies were concerned, and was depended upon as the source of supply for the divisional troops. These troops were now in training areas in the advance section and were soon to be put into the line.
At this time the chief surgeon was concerned with two situations. One was the distance of Is-sur-Tille from the front line and from the troops it was to supply. It was admirably situated for the supply of items whose rate of usage was fairly constant and the need for which could therefore be anticipated. This was particularly so with supplies used in large quantities. Its location as the most advanced depot was not satisfactory from the standpoint of the supply of items used in small quantities and at an inconstant rate. Such a condition applied to many items of medical supply of great importance; the demand therefor could not be foreseen.
It is impracticable, or at least undesirable, to carry in the equipment of the combat troops even a small quantity of each of such items. The lack of such an item may be of vital importance to the individual needing it. It may even be of importance to the Army as a whole in that the early use of such an item may prevent the development of an epidemic. Repeated failure to furnish the supply might have its repercussion in the morale of the Army. These items can therefore only be supplied as emergency supplies. Adequate service involves proximity to the troops or available transportation for speedy delivery of emergency requirements.
Medical officers of combat troops should have the assurance that such speedy supply will be forthcoming. If they have not that assurance they will attempt to prevent disaster by having in their own possession supplies for all possible emergencies. This results in encumbering the troops. That is exactly what happened in the American Expeditionary Forces. Two divisions in line, early in 1918, were ordered to move; large quantities of medical supplies were necessarily left behind in the area turned over to an ally.8 No blame can be attached to this action for it was wise and far sighted, in view of the fact that methods of warfare were new and the equipment and remedial agents to be required uncertain.
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ADVANCE DEPOTS AND ARMY PARKS
To obviate the necessity for repeating such a disposal of medical supplies, the chief surgeon, Line of Communications, on February 11, 1918, recommended to the commanding general, Line of Communications, that the Medical Department be authorized to provide itself with one or more small storage warehouses, with a capacity of approximately 5,000 square feet of floor space each, so situated that they could be reached by motor truck from the troops in the field.38 No elaborate system of issue was contemplated; all that was desired was simply a “dump” where the essential articles, such as ether, gauze, dressings, morphine, first-aid packets, and standard Red Cross dressings could be stored and issued in emergencies. Since Is-sur-Tille was too far removed from the front line to be reached by motor truck with advantage and since rail transportation therefrom for less than carload lots was necessarily slow, it was considered as not being suitable for the most advanced medical depot.
As a result of this recommendation a building in Nancy was made available to the Medical Department for the purposes outlined, but before it could be occupied American troops had been moved to a section for whose supply Nancy was not suitable.
On April 12, 1918, this principle of maintaining a small amount of stores sufficiently close to the front-line troops so as to be quickly transportable there by motor truck, for emergency use, was applied by general headquarters, A. E. F., not only to the Medical Department, but to other supply departments as well.37 On that date, the regulating officer was directed to maintain a small supply of stores, at or near the railheads for emergency issue only. To carry out these instructions the assistant chief of staff, G-4, general headquarters, asked the chief surgeon to submit a list showing what Medical Department stores should be maintained by the local supply officer at the railhead.39
On April 25, 1918, the chief surgeon, A. E. F., submitted a list of supplies comprising twice the equipment of a field hospital, less stationery, and extra articles, such as anesthetics, first-aid packages, front-line parcels, splints and splint equipment, muslin bandages, and adhesive plaster.40 On May 24, this list was revised downward, both as to the number of articles and the amounts,41 at the instance of the assistant chief of staff, general headquarters, and again on June 1, 1918.42 The final revision comprised the following articles:42
Proposed list of reserve stock of medical supplies at railheads
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Proposed list of reserve stock of medical supplies at railheads - continued
On June 5, 1918, the medical representatives of the chief surgeon in the fourth section of the general staff, general headquarters, were given the problem of developing a list of replenishment medical supplies for an army park, to be located near Paris, as follows:
Memorandum for all divisions of G-4:
1. Colonel Moseley has gone to Paris to-day to select a site at which to locate an “army park” for the supply of the divisions served from the regulating stations at Nantes and Le Bourget. Effort will be made to secure this place in the vicinity of Melun.
2. The park will have for its personnel a commanding officer, representatives of each supply department, and necessary labor. Two or three truck companies will be attached for the purpose of forwarding supplies to the “issue points” of the divisions.
3. Automatic supplies and ammunition supplies for the divisions will be forwarded through the regulating stations by rail as at present. A reserve stock of these supplies will be maintained at the park, available to be forwarded by truck in case of emergency.
4. All class 2, 3, and 4 supplies, except ammunition, will be forwarded from the park.
5. The park will, in the absence of army headquarters, be under direct control of these headquarters through the regulating officer who is a member of G-4.
6. It is desired that each division of this section make a study of this matter and submit recommendations as to the quantity of stores which will be maintained by the departments which they represent.
GEO. VAN HORN MOSELEY,
Colonel, General Staff,
Assistant Chief of Staff, G-4.
Copy to Major Tuttle, medical supplies.
Action was taken thereon by the medical representatives and the following memoranda submitted:
GENERAL HEADQUARTERS,
AMERICAN EXPEDITIONARY FORCES,
G-1 GENERAL STAFF,
France, June 7, 1918.
Memorandum for assistant chief of staff, G-4:
Subject: Medical Department supplies proposed for army dump.
1. The following lists represent Medical Department supplies proposed for maintenance at an army dump. It is the understanding tnat these will be stored under canvas and that the personnel of a small supply unit will be in charge. The basis used has been one combat division for eight days, issues to be made from these stores direct to division by motor transportation. It has been assumed that all varieties of Medical Department supplies ordinarily required by combat troops for replacement only should be stocked at this depot. The initial equipment of units has, thelefore, not been considered.
A. P. CLARK,
Major, Medical Corps, United States Army.
GENERAL HEADQUARTERS,
AMERICAN EXPEDITIONARY FORCES,
G-1, GENERAL STAFF,
June 10, 1918.
Memorandum for Colonel Wadhams:
1. The study indicated in paragraph 6 of Colonel Moseley’s memorandum was turned over to me for completion.
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2. The lists were rapidly prepared after a careful interpretation of the memorandum had been received and after consultation with Colonel Stark, Colonel Siler, Major Tuttle, and Doctors Barr and Wagoner.
3. One copy complete is furnished you for your information and files.
A. P. CLARK,
Major, M. C., Med. Rep. with G-1.
____________
FOURTH SECTION, GENERAL STAFF,
June 9, 1918.
From: Commander in Chief.
To: Commanding General, Services of Supply (C. S.).
Subject: Proposed Medical Department supply table for an army park, on a divisional factor basis.
1. Inclosed herewith is a list of supplies to be maintained at army parks as the occasion requires. This list has been prepared at these headquarters but is subject to such modifications as the chief surgeon may see fit to make. Any changes made by him should be furnished these headquarters in order that the retained lists on file here may be corrected.
2. This list has been arranged upon a divisional basis and represents a supply for eight days. For each park established the supplies to be maintained therein can be readily determined by multiplying this unit by the number of divisions to be served.
3. As mentioned in letter to you from these headquarters dated June 7, 1918, an army park is now in process of establishment at Lieusaint, on the line between Paris and Melun. For the present this park will be called upon to supply the 1st, 2d, and 3d Divisions. Therefore, three times the quantities herein shown should be maintained at that depot. Steps have already been taken to have the chief surgeon recommend for assignment there one officer and such other personnel as may be needed to properly carry on this supply function.
4. Similar parks may be established from time to time. As a result of the experience to be gained in the operation of the park at Lieusaint it is expected that changes in the original list will become necessary. Every effort should he made to reduce it as soon as possible to a practical basis and then adopt a standard supply table which will be applicable in meeting these supply emergencies wherever they arise.
By order of the commander in chief.
GEO. VAN HORN MOSELEY
Colonel, General Staff,
Assistant Chief of Staff, G-4.
In the meantime, the need for the supplies had become acute. The chief surgeon, A. E. F., by telephone, directed the medical supply officer at Cosne to make an emergency shipment, using his own judgment as to the items and quantities to be shipped, and stating that the list would be furnished him later. The supplies, accompanied by a detachment, were sent forward by truck, and the first army medical park was established at Columniers where there was also an evacuation hospital. Later it was moved to Lieusaint, where an army park had been established.
To representatives of the chief surgeon, who visited the depot at Lieusaint, it became apparent that a complete stock could not have been supplied under the conditions set forth. Furthermore there were difficulties connected with replenishment. Requests therefor could not be sent direct to the intermediate depot by the medical supply officer, but had to go through G-4 and the regulating officer. There was an apparent shortage in the depot stock in certain essential items, such as ether, and blankets. Accordingly a conference with the assistant chief of staff, G-4, was asked for and obtained. The opinion
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was expressed by him that the supplies the army called for must be furnished, and that the Services of Supply must not be in a position to veto supplies asked for. The chief surgeon’s representatives pointed out that far from vetoing requisitions, the Medical Department was extremely desirous of getting supplies forward and keeping the stock adequate, that they were there for the furtherance of that purpose, but were stopped from sending supplies without authority of the army.
As a result of the conference, the representatives of the chief surgeon were authorized to use the chief of staff’s name on telegrams asking for immediate replenishment and were requested to prepare a list of the minimum stock to be carried at the depot and to stock the depot with the material so listed. The immediate needs were shipped and the list prepared.
For the operations of the Paris group, the depots at Cosne and Gievres functioned as advance depots.43 Frequently, shipments were made by truck train, notwithstanding the distance. Following the operations of June, and July, 1918, the progress of the First Army was so fast tha no further permanent establishments were made, the need being met by the establishment of army parks and dumps.
As stated above, the original basis for the stock to be carried in these dumps was the replacements necessary for one combat division for eight days, and the officer in charge was authorized to maintain in storage, as many times this amount as there were divisions in his sector. However, a policy was developed gradually of establishing corps or army dumps for which there was authorized a fixed stock maximum without reference to the number of combat units to be supplied, but based more upon the number of dumps established in relationship to the known number of divisions to be employed in the operation.29
The logical stock for army or corps dumps included only items of combat equipment and supplies and trench stores, and divisional units would naturally requisition such articles only, but in the early days of the development of the corps echelon, it was necessary for these dumps to carry limited replacements for such units as mobile and evacuation hospitals. This produced a useless dispersion of equipment difficult to obtain and quickly rendered immobile a unit which of necessity must remain mobile.
It became the policy to confine items on the fixed stock maximum of suchdumps to those of combat material and trench stores alone. This necessitated the establishment of a new echelon, inasmuch as large hospitals in the advance zone were requiredto replenish their stockfrom an advance supply unit.29
The establishment of fully stocked army advance medical supply depots, on the basis of one per army, was contemplated.29 So far as quantities were concerned, the depot was to be upon a very limited time basis. The functions of this larger army unit were to be, primarily, to fill the calls of the army or corps dumps, and, secondarily, to fill requisitions from medical units in the advance zone. So far as possible, it was to be relieved of the latter function by direct shipments to the unit from the Services of Supply. The limits of the fixed stock maximum for both of these units were to be fixed by the army G-4, upon the recommendation of the army chief surgeon, and were to be modified only by the same authority. The army advance medical supply
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depot was essentially an army unit and under the direct control of the army commander through his chief surgeon.
The method of requisitioning upon dumps was necessarily informal, by requests sent direct to the dumps. The method contemplated for replenishment of dumps from army advance depots was also an informal call, showing shortages in authorized stock.29
The contemplated procedure for replenishment of army advance depots was the automatic shipment of the differences between the stock maximum and the amounts shown on stock reports to be rendered periodically by the army advance depots direct to the forward Services of Supply unit.29
BASE STORAGE DEPOTS AND BASE SECTION DEPOTS
Conditions at the base ports were such as to make efficient handling and speedy dispatch of medical supplies difficult. This difficulty was common to all services, but in view of the lack of reserves of medical supplies in France, was a matter that gave much concern to the chief surgeon.
For a considerable length of time equipment at these ports was in adequate; dock capacity was inadequate; in some instances the depth of channel was insufficient for many of the ships used; personnel was limited; railroad equipment was scarce. But because of the lack, entire lack in some ports, of warehouse space, it was necessary to keep the ports clear, so ships were unloaded directly into freight cars. As stated above, representatives of the Medical Department were from the very first, assigned to the duty of sorting the cargo as it was unloaded, claiming Medical Department material, assembling it, and dispatching it to the intermediate depots. After the entire responsibility for this work was devolved upon the newly created transportation department, these representatives of the Medical Department remained as a necessary aid to that service in the identification and disposition of Medical Departmentmaterial.8
From the first, classification warehouses were a pressing need. In a memorandum to the commanding general, Line of Communications, on January 24, 1918, the chief surgeon, Line of Communications, stressed the importance of establishing at tile base ports classification warehouses for medical supplies so as to obviate the indiscriminate loading of such supplies into freight cars because of the non availability of warehouse space.44 General headquarters, A. E. F., on February 2, 1918, approved the recommendation, and left its adoption to the commanding general, Line of Communications.45 Accordingly, instructions were sent by the commanding general, Line of Communications, on February 6, 1918, to the base ports then being used, to provide such space if possible.46 Since all supply departments were making like insistent requests, however, no suitable warehouse space could be set aside for the exclusive use of the Medical Department, until after the construction of classification yards, then in progress, had been accomplished.47
In base section No.1, on April 23, 1918, 20,000 square feet were made available to the Medical Department in the base storage depot at Montoir, 3 miles from St. Nazaire. On May 1,1918, the medical depot at this point was established. Under date of May 27, 1918, 100,000square feet of the projected
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construction was allotted to the Medical Department. On October 1, 1918, space was secured in Nantes.
In base section No.2, on July 6, 1918, space was made available to the Medical Department at St. Sulpice, just outside Bordeaux.
MAP SHOWING LOCATION OF MEDICAL SUPPLY ESTABLISHMENTS A.E.F.
In base section No.6, on July 8, 1918, space was assigned in the warehouses taken over from the Allies, at Marseille.
In base section No.5, on December 21, 1918, a depot was established at Brest.
The development of these depots will be discussed in greater detail under “Controlled stores.”
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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 medical supply depot. The original plans called for storage space--one building 20 by 150 feet--for each componentbase hospital, and, in addition, there was to be a sorting warehouse 24 by 50 feet for all supplies for eachhospital.48 These facilities, the chief surgeon believed would not meet the supply needs of the Medical Department. Accordingly he recommended on April 23, 1918, that an issue depot be established at each hospital center, to replace the separate storage buildings mentioned above, thus affording opportunity for direct shipment thereto from the base ports of carload lots, economy of use, and elimination of the possibilities of an embargo in times of railroad stress.
The recommendation of the chief surgeon was approved forthwith by the commanding general, Services of Supply, action to be taken in individual cases as supply of labor and materials became available.49
CONTROLLED STORES
During the long period in which intermediate medical supply depot No.3 at Cosne, was the only completely stocked medical depot in France, and the only issue depot, American forces were being located in increasing numbers, at widely scattered point sand frequently in small detachments.
The chief surgeon attempted to effect the prompt supply of these troops and in the case of those located near the base ports, to avoid back shipments from Cosne by authorizing the larger medical units in the areas to carry a reserve beyond their own needs, and by directing them to supply the material needed by the smaller unit in an emergency. This was done in both the advance section 50 and the base ports.51
Continued efforts to speed up the establishment of medical supply depots in the advance section and at the base ports were made. However, these projects were but part of thec onstruction program of the American Expeditionary Forces, and but part of the construction for the Medical Department.. The departments having such construction in charge were confronted by an Herculean task and were working to maximum capacity.
It was particularly desirable to avoid, so far as possible, back shipments from Cosne of bulky articles such as beds and mattresses. It was not yet possible to avoid such back shipment of the smaller items, of which the full supply for France came in “packed boxes.”
The following correspondence shows what was done in base section No. 1. The action in this base section was followed by similar action for the others.
SERVICES OF SUPPLY,
OFFICE OF THE SURGEON, BASE SECTION No. 1,
France, March 26, 1918.
From: Surgeon.
To: Chief Surgeon, Services of Supply.
Subject: Medical supplies.
1. New camps are constantly being established in this base section on short notice, and it is necessary frequently to provide such camps with medical supplies for immediate use until they can be obtained from the depots on requisition.
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2. In order to meet these emergencies, authority is requested to obtain and keep on hand at the medical property warehouse, at these headquarters, a moderate number of medical and surgical chests, M. and S. (supplementary),venereal prophylaxis units, the drugs needed to renew those in the chests, and blank forms, until such time as an issue depot may be established in or near the city where these headquarters are located.
CHAS. L. FOSTER,
Lieut. Colonel, Med. Corps, United States of America.
[First indorsement]
C. S. O., A. E. F., Hdqrs. S. O. S., March 29, 1918. To the surgeon, base section No. 1.
1. You are authorized to divert and keep on hand in the medical property storehouse a reasonable amount of medical supplies, the number to be determined by you, for distribution to the units coming into your section. The necessity for an issue depot at the base ports is realized by the chief surgeon. He has, however, learned from experience that difficulties arise with two depots furnishing supplies and he therefore desires that all units in your section receiving supplies from you in this manner forward their requisitions for others upplies made upon the intermediate medical supply depot through you, in order that you may exercise some control.
2. It is desired that in all cases where boxes are diverted, the number of the box, the shipping direction, and the contents thereof, be reported to the O. I. C.. intermediate medical supply depot No.3.
By direction of the Chief Surgeon:
N.L. MCDIARMID,
Major, Medical Corps, United States Army.
_____________
AMERICAN EXPEDITIONARY FORCES,
HEADQUARTERS SERVICES OF SUPPLY,
March 30, 1918.
Memorandum to the officer in command intermediate medical supply depot No. 3, A. E. F.
1. The surgeon, base section No. 1, has been authorized to divert to storehouse at that port a reasonable amount of medical supplies for distribution to troops in that vicinity and to incoming troops. He has been directed to furnish you with a complete list of markings on the boxes and their contents and has been instructed to have all requisitions from organizations who are supplied in this way come through his office.
By direction of the Chief Surgeon:
N. L. MCDIARMID,
Major, Medical Corps.
[First indorsement]
A.E. F., intermediate medical supply depot No. 3, France, April 6, 1918. To the chief surgeon, A. E. F.
1. Returned. Request that the surgeon, base section No. 1, transmit a copy of his bimonthly stock report to this office, and that he be directed to ship, upon telegraphic request from this depot, any stock needed in emergency.
2. Request to be informed if stock so diverted at the base will be invoiced to the surgeon, base section No. 1.
J.R. MOUNT,
Major, Medical Corps.
[Second Indorsement]
C S. O., A. E. F., Headquarters S. O.S., France, April 9, 1918. To the surgeon, base section No. 1, A. E. F.
1. It is believed that the bi-monthly stock report required by general headquarters of all supply depots should be made by the depot at your port. A copy is to be furnished this office and to the intermediate medical supply depot No. 3, and to the coordinating section of the general staff, general headquarters. It is assumed that shipments upon tele-
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graphic request from the officer in command, intermediate medical supply depot No. 3, will be made. Your recommendation concerning the second paragraph is requested.
By direction of the chief surgeon:
N. L. MCDIARMID,
Major, Medical Corps.
[Third Indorsement]
S. O. S., office of surgeon, base section No. 1, France, April 16, 1918. To the chief surgeon, A. E. F., S. O. S.
1. Returned. It is believed that for the present, while maintaining only a small emergency stock of supplies, that the stock diverted should be invoiced to the intermediate medical supply depot No. 3, as at present, and that depot kept informed of supplies diverted and issued on bi-monthly reports.
CHAS. L. FOSTER,
Lieutenant Colonel, Medical Corps, United States of America.
The plan of the chief surgeon for the distribution of supplies and the methods actually used in the period of development of the American Expeditionary Forces have been sufficiently outlined above so far as the organization on the Line of Communications was concerned. The plan was to decentralize, but the execution of this plan had been delayed because of two necessities: The shortage of stock in France; the absence of depots in the base sections, thus further necessitating awaiting construction before their establishment could be effected.
The status of early June is shown by the following letter sent in response to a memorandum of June 6, calling for the scheme or system of supply for units and stations in the intermediate and base sections.
OFFICE OF THE CHIEF SURGEON,
AMERICAN EXPEDITIONARY FORCES,
HEADQUARTERS SERVICES OF SUPPLY,
France, June 11, 1918.
From: The chief surgeon, A. E. F.
To: The assistant chief of staff, G-4, Services of Supply.
Subject: Your file No. 1499-G-4.
1. As inclosures hereto there are two copies of Circular No. 12, chiefsurgeon’s office, showing theprocedure now in force for the supply of troops in the intermediate and base sections.
2. Inaddition, base hospitals in the advance section have been directed toforward their requisitions to Cosne, inview of the fact that their requisitions are sufficiently large towarrant shipments in carload lots and are seldomemergency requisitions. The officer in charge of intermediate medicalsupply depot No. 3 has beers authorized tomodify requisitions to meet the needs of his stocks.
3. Heretofore only two depots have been issue depots--Is-sur-Tille and Cosrse. It is contemplated that in the near future depots will open at base sections No. 2 and No. 1, and at a number of the large hospital centers. This will necessitate a change in the plan, and the following program is proposed:
(a) Requisitions from organizations within a section to go to the chief surgeon of that section for his action; to be transmitted by him direct to the depot within the section for issue.
(b) Requisitions from depots to come to the chief surgeon’s office, A. E. F., for action; to be referred to whatever storage warehouse seems suitable. Storage warehouses containing “controlled stores” to be established at St. Sulpice, Montoir, and Gievres. “Controlled stores” to be subject only to the orders of the chief surgeon.
By direction of the chief surgeon:
N. L. MCDIARMID,
Major, Medical Corps, United States Army.
784
As indicated in the letter quoted, the situation was about to be materially changed. The hospital center depots whose establishment had been asked for in the letter of April 23, 1918,were about ready to function. The construction projects at the base ports were well under way and warehouses were available; finally, supplies were being received in such quantities as to warrant dispersion of stock in at least many items.
Advance depot No.1 and the two intermediate depots were fairly well stocked; at times, they were pressed for storage of material received. The chief surgeon, therefore, could carry out further his plan of “controlled stores.”
This subject is of such importance, and the benefit derived from the operation of the system in France was so great that quotations in extenso of the communications concerning it are made.
The policy of “controlled stores” was actually initiated, although not under that name, late in 1917 when directions were given to all base section surgeons to ship certain designated items to Gievres, all others going to Cosne. From time to time these were modified, additions to, or subtractions from, the list being made in accordance with the stock at Cosne upon the recommendation of the officer in charge of that depot.
It had been continued by the policy of holding the stock at Gievres subject to the orders of the intermediate depot at Cosne, making the latter the only issuing depot in the intermediate section.
In the summer of 1918, however, a more comprehensive system could be initiated, as follows:
OFFICE OF THE CHIEF SURGEON,
HEADQUARTERS SERVICES OF SUPPLY,
France, July 2, 1918.
From: The chief surgeon, A. E. F.
To: The surgeon, base section No. 2, A. P. O. No. 705.
Subject: Operation of base storage stations.
1Herewith are submitted two copies of instructions governing the operation of base storage stations, together with the list of the supply items to he carried in stock.
2.The storage station of base section No. 1 should proceed to establish these stock balances up to the maximum amounts indicated. When the maximum of these items has been reached at the base storage station the excess should automatically be forwarded to Gievres or Cosne under existing instructions or instructions to bes ubsequently issued by this office. Likewise, supplies not carried in base storage stations will in the first instance be routed to Cosne or Gievres under instructions of this office.
3. Issues of supplies from the base storage stations to advance medical supply depots or units other than the medical supply depots at Gievres and Cosne will be made only upon specific routing or issue instructions from this office as occasion arises. Specific instructions to ship specified quantities will take precedence over current shipments to Gievres or Cosne.
4.Until further notice all medicines (except those to be carried in base storage) in. mixed or original packages will be shipped direct to Gievres as promptly as possible.
5. The object sought in the establishment of base storage stations is to facilitate the shipment direct to advance points of supplies which singly or in combinations of two or three can be made up in carload lots. The maintenance of adequate stores in the intermediate section is of primary importance. The initial list has been selected with these considerations in mind. From time to time items will be added to or substracted from the list and the maximum amounts increased or decreased as the supply needs dictate.
By direction of the chief surgeon:
N.L. MCDIARMID,
Lieutenant Colonel, Medical Corps, National Army.
785
OFFICE OF THE CHIEF SURGEON,
HEADQUARTERS SERVICES OF SUPPLY,
France, July 3, 1918.
From: The Chief Surgeon, A. E. F.
To: The officer in charge, intermediate medical supply depot No. 3, A. P. O. No. 737.
Subject: Instructions governing the operation of base storage stations.
1.Attached hereto are two copies of general instructions governing the operation of base storage stations, together with the list of items to be stored in the base storage stations. You are requested to forward one copy to intermediate medical supply depot No. 2, with such instructions as you deem appropriate.
2. Pending the further development of the sorting work at the base, these items of supply not carried in base storage stations, and the excess over the maximum of items carried in base storage stations, will automatically be forwarded to Cosne or Gievres, under the instructions in effect at that time. In view of this fact, it is of primary importance that intermediate medical supply depots Nos. 2 and 3 show, on the warehouse receipt slips, whether the supplies were received direct from the docks, or were issued from controlled stores.
3. All issues of controlled stores from base storage stations will be recorded on warehouse issue slips, upon which will be indicated that fact. The warehouse issue slip will also show the car number or car numbers in which the shipments are made. The identification of the car thus furnished you, which will, presumably, reach you in advance of the car itself, will enable you to check out the contents of those cars. The copy of the warehouse issue slip furnished this office will be retained here in suspended file pending the forwarding of warehouse receipt slip furnished by the receiving depot.
4.It is recognized that the present list of supplies and the amounts there of are only tentative and that in all probability frequent changes therein will be required. You will he furnished with a copy of all changes made. As stated in paragraph 5 of the letter to the section surgeons, the needs of the depots in the intermediate section are of primary importance. This in view of the fact that for some time the supply of depots in the advance section will necessarily be from the intermediate depots.
5.Information concerning such needs can best be supplied by the officer in charge and it is desired that you make any recommendations concerning the present schedule or thef uture modifications thereof or concerning the needs of your depot as you deem pertinent.
By direction of the Chief Surgeon:
N. L. MCDIARMID,
Lieutenant Colonel, Medical Corps, National Army.
_______________
INSTRUCTIONS COVERING THE OPERATIONOF BASE STORAGE STATIONS OF “CONTROLLEDSTORES”
AMERICAN EXPEDITIONARY FORCES,
OFFICE OF THE CHIEF SURGEON,
July 3, 1918.
1.The warehouses for the storage of supplies at the several bases are to be operated independently of the issue medical supply depots of the bases. The former will be called base storage stations. Until other formal designation is given by the general staff, each base storage station will be referred to and indicated by the name of the place where located; for example, “Base storage station, Montoir.” This title should appear on all warehouse receipts and warehouse issue slips.
2.The issuing depots of the bases will be called base medical supply depots, the official designation ofe ach being as follows: “ Medical supply depot, base section
3.The receipt and issues of supplies by the base storage station will be controlled by the chief surgeon’s office, A. E. F. Instructions governing the receipt of stores in and the issue of stores from the base storage station will be transmitted direct from this office to
786
the officer in charge of the base storage station. The list of items to he received and stored in each base storage station and the maximum amount of each item to be carried in each station will be initially prescribed and revised from time to time by this office. Each official list will begiven a serial number.
4.Pending the development of adequately stocked base medical supply depots, the officer in charge of base storage station will be given blanket authority to issue to base medical supply depots designated items of supplies within the maximum limits prescribed by this office.
5.Requisitions upon base medical supply depots will be transmitted through the office of the base surgeon for modification and approval
6.All stores received into base storage stations will be taken up on warehouse receipt slips (medical supply depot Form No. 2). One copy of each receipt slip will be forwarded daily to the chief surgeon’s office (property division).
7.All stores issued from base storage stations will be recorded on warehouse issue slips(medical supply depot Form No. 4). These slips will be prepared intriplicate (printed pads will be furnished in triplicate; in the meantime a third copy should be improvised). One copy will be forwarded to the chief surgeon’s office (property division), a duplicate copy will be forwarded to the unit to which shipment is made; the triplicate should be retained.
8.The issue of controlled stores from base storage stations as explained in paragraph No. 7 will be indicated on the warehouse issue slip by marking or stamping (stamps will be provided for this purpose) “Issued from controlled stores.” The warehouse issue slip will also show the number or numbers of the car or cars in which the shipments have been made and the point of shipping destination if the latter differs from the place where the receiving unit is located.
9.The shipments of supplies direct from the docks to advance supply depots, or to units other than intermediate supply depots Nos. 2 and 3, must be handled as issue of supplies from controlled stores. Such shipments will generally be made from the storage stations, but these shipments, whether actually taken into the storage stations and there assorted and reloaded, or issued direct from the docks, must be taken up on warehouse receipt and issue slips. One copy of each warehouse receipt slip and one copy of each warehouse issue slip also mus tbe forwarded to the chief surgeon’s office as prescribed in paragraphs 6 and 7; also one copy of each warehouse issue slip must be forwarded to the unit to which shipment is made as prescribed in paragraph 7.
10.The slip pasted on each car of supplies issued from base storage station will contain the notation in bold type “Control stores.”
11. Car shortage at the base may occasionally require that supplies be temporarily taken into the base storage station that should be forwarded direct to intermediate supply depots. This may represent items of supplies not regularly carried in the base storage station or quantities, for items regularly there carried, in excess of the maximum amounts designated for such items. Such supplies will, when cars become available, be shipped without further instructions in appropriate amounts to the intermediate supply depots.
12.Until further notice, supplies which are loaded at the docks and shipped direct to intermediate supply depots Nos. 2 and 3 will not be taken up at the base on warehouse receipt and issue slips. Initial warehouse receipt slips (representing the receipt of these supplies direct from the United States) will be prepared at the particular depot where the supplies are received.
13.All supplies received at the docks will be considered as “controlled stores,” subject only to routing instructions published from time to time by this office. Any diversions of supplies, other than as mentioned in paragraph 9, will be made only upon specific authority from this office.
14.Beginning July 1, the chief surgeon’s office (property division) will maintain separate records of and account for the “controlled stores” of the base storage stations. These will be posted from the warehouse receipt and issue slips forwarded daily. Each storage station will, however, maintain such current stock records as are necessary for informational purposes. The use of medical supply depot Form No. 5(revised) is suggested. The storage
787
station, however, will not prepare or forward quarterly property returns; accountability in this sense reposes in the chief surgeons’ office. Returns of medical property received and issued by the base issue depot will be made by the officer in charge.
By direction of the Chief Surgeon:
N. L. MCDIARMID,
Lieutenant Colonel, Medical Corps, National Army.
Official list of items to be carried at base storage station
MEMORANDUM
OFFICE OF THE CHIEF SURGEON,
AMERICAN EXPEDITIONARY FORCES,
HEADQUARTERS SERVICE OF SUPPLY,
France, July 10, 1918.
To: The surgeon, base section No. 1, A.P.O. No. 701; the surgeon, base section No. 2,
A.P.O. No. 705.
1. In connection with recent correspondence on controlled stores” and issue depot at your port, it is desired that there be no uncertainty as to the chief surgeon’s desires that the section surgeons main stains supervision over the activities of the base storage stations.
788
2. The instructions stated that issues from the base storage stations would be only upon order, general or specific, of this office and that issues from the local issuing depots would be made only upon the authority of the section surgeons. The reasons for this central control of the storage stations are known to you and received your indorsement in a recent conference.
3.It is believed that your familiarity with and understanding of the reasons for the centralized control of issues from the base storage stations will make it highly desirable that, particularly during the formative period, you maintain close touch with the operation of the base storage station; and I request that you frequently make such recommendations concerning the effectiveness of the instructions issued and changes therein as you deem desirable. It is recognized that the successful operation of these base storage stations will depend largely upon the supervision exercised by you.
By direction of the chief surgeon:
N. L. MCDIARMID,
Lieutenant Colonel, Medical Corps, National Army
Third Indorsement]
OFFICE OF THE CHIEF SURGEON, A. E. F.,
August 10, 1918.
To the chief surgeon, base section No. 6.
1.It is desired that you take steps to establish a base storage station at an early date. For the present, it is not desired to use the storage spaces at Miramis for the purpose of storing a large reserve. It is the intention to have stored there such articles as are available for base storage (that is, such as are at present in France in sufficient amounts to more than meet the needs of the advance and intermediate sections) in such amounts as would be required for the depots on the main line north or in the vicinity thereof. This would include Is-sur-Tille, and the depots at the hospital centers of Beaune, Allerey, Bazoilles, and Rimaucourt. In addition thereto, such a depot would he the logical point from which the Americans troops in Italy would be supplied from the American Expeditionary Forces.
2. I am of the opinion that the importance of Marseille will increase materially, even though the Italians situation does not in itself demand such an increase; and I suggest that you ask for 30,000 square feet, with a prospective increase to 60,000. Additional copies of the letter of July11 on the base storage stations and of the authorized list of articles to he stored are inclosed.
3.When your report shows an accumulation approaching this amount, shipping directions will he given you from this office for a portions thereof; and as far as possible these articles will be sent to the depots mentioned above. Until further instructed, all other articles should be shipped as heretofore, to intermediate medical supply depot No.2. at Gievres, or medical supply depot No.3, at Cosne, according to general instructions, a copy of which has beets furnished you.
4. Special supplies, such as disinfectors, should be reported to this office. It has been found advisable to have the base storage and the distributions on the docks under the same control.
5.It is assumed that your present personnel is sufficient to take care of the stations. An effort will be made to provide additional personnel upon your request therefor. I request that you make such recommendations and suggestions from time to time as the local situation may render desirable.
By directions of the chief surgeons:
N. L. MCDIARMID,
Lieutenant Colonel, Medical Corps, National Army
Facsimiles of warehouse receipt slip and warehouse issue and transfer slip follow:
789
[Warehouse receipt and issue/transfer slips]
These were serially numbered so that missing numbers could be traced Based upon the copies furnished the chief surgeon’s office daily, there was established in that office a consolidated stock record. There was a card for every item on the supply table or existing in any depot. A sample follows:
790
In addition thereto, two stock cards were maintained for each item, showing a comparison of the expected receipts with the actual receipts. One was for purchases in Europe; the other was for receipts from the United States. Receipts expected in the latter case were based at first upon invoices received; later upon the automatic. A sample follows:
791
[Consolidated stock card]
It is to be noted that in connection with the establishment of base storage stations, there were also established medical supply depots for each of the base sections concerned. At some ports the two were in the same building; at others, they were widely separated.
There was, however, in all cases, a clear distinction between base storage stations and base section depots, even though they were operated by the same personnel.
All receipts at the port came immediately under the jurisdiction of the medical supply officer in charge of the base storage sections. The medical supply depot was authorized to stock in limited amounts certain designated items. These were transferred to the medical supply depot upon requisitions approved by the section surgeon and were designed to supply the troops in a given section. The limitations imposed upon the items listed and upon the quantities carried were made necessary by the limited amounts in France and the primary necessity of keeping the depots in the intermediate and advance sections supplied.
The number of items so stocked was gradually increased and in October, 1918, the condition was such as to warrant the following circular:
Circular No.52:
AMERICAN EXPEDITIONARY FORCES,
October 22, 1918.
* * * * * *
X. Requisitions for medical supplies: All organizations in base section No. 1, other than base hospitals and hospital center depots, will submit their requisitions for medical supplies to the surgeon, base section No. 1, A.P. 0. No. 701, and will hereafter submit none direct to intermediate medical supply depot No. .3, Cosne.
Upon approval of the sections surgeon, the requisitions will be sent to the medical supply depot, base section No. 1, for issue.
WALTER D. MCCAW
Colonel, Medical Corps, Chief Surgeon.
The number of items and the amounts of those items to be retained in base storage stations were increased gradually until practically the entire list, with the exception of “mixed boxes” and surgical instruments, was so retained.
In addition to the base storage stations, it was possible to begin the stocking of the hospital center depots. Necessarily here, too, there was a limitation on
792
the number of articles available for stock, but the shortage was in technical equipment rather than in expendable articles used in large quantities, so that much of the advantage anticipated from the operation of these depots was gained.
The following instructions from the chief surgeon’s office, A. E. F., to the commanding officer, hospital center at Mesves, explains not only the reasons for the establishment of medical supply depots at hospital centers but also the methods by which they could obtain articles on the controlled stores” list as well as articles not thereon:52
1. The underlying purposes in the establishment of supply depots at hospital centers were as follows:
(a)To have available in the center necessary supplies to meet the immediate requisitions of the individual hospitals.
(b)To enable shipments to be made direct from the ports in bulk of the larger and more extensively used articles, thus avoiding the useless transportation and handling.
(c)Lessened fire risk--in that distribution will be made in a number of depots
(d) To make unnecessary shipments to hospital centers during a period of activity at the front and consequent car shortage.
2. It is therefore contemplated that eventually a very considerable stock will be maintained at each hospital center. Lists are now being prepared at this office of the material to be carried. These lists necessarily will include in the beginning a comparatively small number of items because of the shortage of stock in France, but they will be increased from time to time as the stock increases. It is probable that there will be always many items, requisition for which will have to be made to the central supply depot. Until the full establishment of these depots it will be necessary for the individual hospitals to make direct requisition upon larger central supply depots such as Cosne.
3.You will be furnished with a list of what is known as “controlled stores “; that is, stock that is contained in the base storage stations. It is desired that your supply depot submit its requisitions to this office, making separate requisitions so far as possible for those items contained on the “controlled stores” list and those articles not there on its order that shipment may be ordered direct from the ports in the first case and from the intermediate medical supply depots in the second. With the hospitals fully stocked, each hospital having probably a two months’ supply, it is probable that the amount of property in the supply depot need not be very large, that the movement in and out will be sufficient to warrant shipment in carload lots only to that depot.
Obviously the car shortage in France was chronic; therefore, railroads were taxed to their capacity and beyond; embargoes were frequent. Obviously also it was desirable for the Medical Department., so far as possible, to avoid the shipment of its supplies during periods of stress. The establishment of hospital center depots and the establishment of several reservoirs at the base ports permitted this. Much of the benefit expected from their establishment was accomplished. In addition, there was given to the individual hospitals such a sense of security that overstocking was avoided, with a resultant conservation.
Requisitions from hospital centers and from depots came to the chief surgeon’s office, and orders were sent to one or more controlled stores stations to ship in carload lots. Consideration was given not only to accessibility and available stock, hut to the operating conditions of the railroads.
Distribution of initial equipment to incoming units on the lines of communications was made upon the recommendation of the hospitalization section, in advance, at such time as would result in its arrival at about the same time as the personnel. In theevent that the unit was to be assigned to a hospital center, or where other Medical Department units were stationed, the initial
793
equipment was sent well in advance in the care of the unit already established and made ready for immediate utilization by the new unit. This was particularly true during the period of rapid expansion in August, September, and October, 1918, when available hospital beds were just keeping ahead of the casualties and much needed medical personnel was beginning to arrive after a long suspension.1 Equipment tables for 1,000-bed, 500-bed, 300-bed, and 100-bed hospitals had been prepared and were available at all depots. Shipment of the assemblage was to be made upon telegraphic instructions. An example of such instructions follows:
AMERICAN EXPEDITIONARY FORCES,
HEADQUARTERS SERVICES OF SUPPLY,
March 8, 1918.
Memorandum to the officer in charge, intermediate medical supply depot No. 3.
1.Prepare for shipment and ship the equipment for a 300-bed camp hospital to Meucon, Department of Morbihan; to include approximately post allowance of expendable articles for one thousand men for one year.
By directions of the chief surgeons:
N. L. MCDIARMID,
Major, Medical Corps.
These equipments, while by no means complete, enabled the unit to function, particularly in respect of new units in hospital centers, which thus were provided beds and equipment for the nursing of the wounded for whom the strictly surgical procedures could be done at one of the well-established units.
The system of central accountability established under this policy remained in effect until January 1, 1919,when accountability was transferred to the officers in charge of each base storage station.53
On November 12, 1918,the chief surgeon, A. E. F., promulgated the following instructions, concerning the distribution of medical supplies in the American Expeditionary Forces. This circular is a compilation of the orders and practices of the Medical Department, A. E. F., up to that time, and represents the chief surgeon’s final plan, based upon the 17 months of experience in operating the medical supply system overseas, under the existing orders.
Circular No. 55:
DISTRIBUTION OF MEDICAL SUPPLIES IN THE AMERICAN EXPEDITIONARY FORCES, OUTLINING LINES OF SUPPLY AND DECENTRALIZATION OF BOTH REQUISITIONS AND SUPPLIES
AMERICAN EXPEDITIONARY FORCES,
November 12, 1918.
I. The following outline of medical supply department activities from front to rear will obtain in the future operations of this department.
(a) DIVISIONALMEDICAL SUPPLY DUMPS
On a basis of one to each division.
Activities - To supply divisional troops and to stock only such items as are needed by combat divisions. Items of stock carried to be identical in all divisional supply dumps, the amount of each item to be carried and controlled by a maximum stock list.
(b) ARMY PARK MEDICAL SUPPLY DUMPS
On a basis of one to each army Corps.
Activities. - To supply divisional medical supply dumps a nd its emergency to surrounding medical units. Stock items to be the same as those carried by divisional medical supply dumps. The amount of stock to be be carried on items to be based on the number of combat divisions concerned in the sector supplied.
794
(c) ARMY MEDICAL SUPPLY DEPOTS
On a basis of one to each army.
Activities. - To supply army park medical supply dumps, evacuation hospital, field hospitals, ambulance companies, mobile hospitals, mobile surgical units, veterinary field units, and such other units as specially designated. Stock items to be carried should meet all the requirements of the units concerned and should also be based on a maximum stock list.
(d) SERVICES OF SUPPLY MEDICAL SUPPLY DEPOTS
Number prescribed by the chief surgeon, A. E. F.
Activities. - To supply army medical supply depots and designated Services of Supply medical units. The stock in these Services of Supply depots in advance positions to fully cover all the items carried at army medical supply depots, as well as the surrounding Services of Supply medical units.
(e) CONTROLLED STORES
Includes all medical supplies in storage at base ports or other designated Services of Supply depots, the issues from which are under the direct control of the chief surgeon, A. E. F.
Activities. - To furnish supplies to the hospitals of the group concerned and to any other units specially designated by the chief surgeon, A. E. F. Hospital centers not having depots should consolidate requisitions and forward same direct to the chief surgeon A. E. F., A. P. O. 717.
DEPOT CONTROL
While the chief surgeon, A. E. F., controls all activities of the Medical Department, the immediate control of the army dumps and army medical supply depots is vested in the chief surgeon of the army concerned. The immediate control of all other medical supply depots being under the chief surgeon, A. E. F.
II. Decentralization of requisitions: Hereafter all requisitions, except those specially exempted below originating in the Services of Supply will be acted upon by the chief surgeons of the section concerned, who will modify the requisitions and forward same to designated depot for issue.
This modification will be final and any question thereto should be taken up by those depot concerned with the surgeon of the section approving these requisition.
Exceptions. - Requisitions from medical supply depots and medical supply depots at hospital centers and for initial equipment of medical units, will be sent direct to these office of the chief surgeon, A. E. F., A. P. O. 717, for his action.
Requisitions for laboratory supplies, except from medical supply depots, will be sent direct to the director, central laboratory, A. P. O. 721, Dijon, for his action, same will then be forwarded to the designated depot.
Requisitions for X-ray supplies covering initial equipment; i. e., base hospital X-ray outfits, portable X-ray outfits and bedside units, will be forwarded to technical consultant, Rõentgenology, A. P. O. 702.
Requisitions for veterinary supplies follow the course of medical requisitions except for initial equipment of units, which will be forwarded to the chief surgeon, A. E. F., direct.
Requisitions for dental supplies follow the course of medical requisitions except for initial equipment of base hospitals; i. e., base dental outfits, which will be sent direct to chief surgeon, A. E. F.
III. Pending the installations of additional depots, these following sections will be supplied by medical supply depots as follows:
Base sections 1, 4, 5, by base medical supply depot No. 1, St. Nazaire.
Base sections 2, 6, 7, by base medical supply depot No. 2, Bordeaux.
Intermediate section and Paris district by intermediate medical supply depot No. 3,Cosne.
Advance section, Services of Supply, by advance medical Supply depot No.1, Is-sur-Tille.
795
Surgeons of sections will take the necessary steps to notify the units now in their sections and new units arriving as to the proper channels for medical supply requisitions as above outline.
IV. This circular does not modify the method of handling requisitions in combat sectors.
WALTER D. McCAW
Colonel, Medical Corps, Chief Surgeon.
At the time of signing of the armistice, with nearly 2,000,000 men in French, the Medical Department had the following storage space allotted:
[Storage space allotted]
In addition, there was available and in use storage space of over 110,000 square feet at hospital center depots, in the following centers:
|
|
Maximum storage space (square feet) |
|
Allerey |
10,000 |
|
Bazoilles |
10,000 |
|
Beau Desert |
10,000 |
|
Beaune |
10,000 |
|
Clermont-Ferrand |
13,000 |
|
Mars |
10,000 |
|
Mesves |
10,000 |
|
Paris |
8,250 |
|
Rimacourt |
10,000 |
|
Savennay |
10,000 |
|
Toul |
10,000 |
FORECASTS
From time to time, the supply division of the chief surgeon’s office was called upon to furnish estimates of future requirements. These estimates involved the total amount of storage space, covered and uncovered, needed in France for varying numbers of men; the areas in which such space would be needed and of the proportion in each area. They involved the value, the weight, and the cubic contents of the supplies whose delivery from England, from France, from Spain, and from other European countries was expected. These were to be given, by months, for each country and were to be estimated through to six months in advance.54
Forecasts were asked for from all departments on forms or tables applicable to one department only. Usually the requirements and records of the Engineer Department were used as a basis for these demands and it was difficult, frequently impossible, to make a Medical Department report of any value correspond to the forms proposed. As a matter of fact, many of the early reports were so roughly estimated as to be without value, and this statement was frankly made at the time. The supply division of the chief
796
surveyor’s office made a sustained effort to furnish the data required, but it was not until the establishment of the statistical section, discussed in greater detail below, that the data furnished were satisfactory or of any value to the Medical Department itself, although the department had previously satisfied the demands made upon it.8
Accurate presentation of data of the nature called for presupposed the availability of the results of much prior detailed study. There were required not only accurate and complete mobilization and equipment tables, but also the weight and cubic contents of every item there on and of every item on the supply table, accurate expenditure tables, intimate knowledge of the European markets, and detailed computation of the raw material requirements. Much of this information was available in France.8
Gradually, these requests for forecasts were concentrated upon prospective orders from British and French sources, and upon the tonnage requirements, particularly for overseas shipment from the United States.
The American Expeditionary Forces requirements as to medical supplies had been presented for a considerable period as emergency requirements to meet a specific need. This was particularly true in respect of the French orders. In addition to the requests made upon the French by the Medical Department purchasing agent, many regional Service de Santé organizations were receiving requests from individual American Expeditionary Forces hospitals for emergency supplies. It was obvious that such piecemeal requisitioning disturbed the even tenor of their programs and interfered materially with their own production program. Under the general purchasing agent, A. E. F., efforts were made to improve this situation. (See “Purchases” above.)
On April 29, 1918, the chief surgeon received directions from the commanding general, Services of Supply, requiring a quarterly forecast in detail of the materials which might be obtainable in England, France, Spain, etc., and a separate forecast of the material that must be obtained in the United States with the tonnage required therefor.55 These were to be submitted through the general purchasing agent to the Allied Governments with a view to a determination by them of the material that might be supplied in France, with a consequent reduction of the tonnage required from the United States.
Prior to this time there had been some confusion in that these forecasts furnished to the Allies in connection with the search for information as to what could be furnished, had by them been considered emergency requests. At times, supplies had been furnished from their stock, the only source of which was in the United States. It was obvious that this was no saving in tonnage.
The forecasts required eventually were concentrated upon questions of tonnage, particularly in connection with overseas shipments from the United States. In connection therewith, the supply division was better prepared. Some experience in rate of usage had been obtained and a certain amount of statistical data developed and more had been received from the United States.
On April 6, 1918, the first call was made and the Medical Department given the following tentative allotment:56 Short tons, 7,500; ship tons, 32,000. The estimate was to be in the following form:
797
[Estimate form]
One of the great difficulties experienced by the Medical Department in connection with these allotments was due to the fact that its requirements in ship tons were greater in proportion to weight tons than those of any other service except the Air Service. This was due to the fact that a large proportion of the Medical Department shipments was taken up by initial equipment, much of it bulky, but yet essential. Attempts to secure this equipment in Europe had been made and had failed. Beds and mattresses are examples. Mattresses had a ratio of 1 to 12 in weight to space occupied. Certain technical apparatus, such as X ray, essential to modern treatment, bore a somewhat similar ratio. Other apparatus essential to definitive treatment were also bulky.
Because the proportions that existed in the Allies’ shipments of medical supplies had been determined as something less than 1 to 3, in attempting to secure adequate tonnage from headquarters, Services of Supply, it was necessary for the chief surgeon to point out that, whereas with the British most of the patients were promptly transported to England and that there was with them necessity for only a comparatively few completely equipped hospitals in France, there was for the American Expeditionary Forces no such possibility in prospect; therefore the supplies, including the highly technical apparatus needed for definitive treatment, had to be transported to France in large quantity.57
In connection with the semimonthly cables giving the supply prospects of the Medical Department, A. E. F., it would appear that they were of little value to the Surgeon General. In their preparation, the attempt to secure conformity with the form prescribed precluded the information that the supply division needed to send. Divisions of the medical supply table cannot be compared to “projects.” Sufficiency or inadequacy of the supply of any one item of a class is not a criterion by which the status of the stock of other items in the class may be judged. The Medical Department had attempted to solve this problem by its unit assemblages, and in the later cables, information concerning the status of such units was furnished. Either each item on the supply table, or specific information as to the items in which an increased stock is desired, must be given.
STATISTICAL SECTION
It became increasingly evident that the supply division of the chief surgeon’s office must develop an organization to compile the vast amount of statistical data from which deductions as to future needs could he drawn. It was evident that not only must a comparison of the actual rate of issue with the receipts on the automatic shipments be made, but those issues must be so correlated with the sick and wounded rates that deductions as to future issues under other morbidity rates could be drawn.
The automatic shipments then being made by the Surgeon General were based upon the best information at that time. They were the result of long experience. The rate of usage of many of the items would not be materially
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changed by conditions in France. The primary purpose of the statistical section was to determine what items would be demanded in greater or less amounts and to what extent, so that notification of the changes desired could be transmitted to the United States.
In May of 1918 an officer was assigned to this work and sent at first to the medical supply depot at Cosne to gather some data on tonnage. In June, 1918, he came to the chief surgeon’s office and thereafter the section grew rapidly. After the establishment of the section its work formed the basis for all estimates of tonnage required, of cars required, and provided the data upon which revisions of the automatic supply table were made, shipments suspended, decreased or increased.8
In this section were kept the consolidated stock records to which reference has been made under “Controlled stores,” and it maintained throughout the period of intense hospitalization expansion a record of all movements of initial equipment from depots to centers.
In connection with its primary function, records were established and maintained as shown below.
During the period shown on the first form, a few battle casualties were in hospital, and the sick rate was approximately 4 per cent, so that the influence of the increased hospitalization due to such cause is not reflected in the issues recorded.
Comparison of this record with later charts covering a period with battle casualties would, however, have reflected the increased issues due to such casualties.
AMERICAN EXPEDITIONARY FORCES,
CHIEF SURGEON’S OFFICE (SUPPLY DIVISION),
August 1, 1918.
Statistics of supplies consumed(issued from depots) in relation to automatic supply
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The following sheet converts the automatic supply list into terms of one day; supply for1,000,000 men gives the stock on hand, its weight, and the period in days for which it is sufficient on the basis of the automatic supply.
[One day supply list - July 1]
The next form gives a comparison of the available stock at succeeding periods; also a comparison of the period for which it is sufficient, based upon the automatic supply list and upon actual issue.
[Table]
800
The following estimate was prepared in connection with a forecast of tonnage requirements, and shows the detailed computation required.
Estimate of supply and tonnage requirements
The section had developed, at the time of the signing of the armistice, an active, well-organized force. Its work was of great value, and undoubtedly would have been of inestimable value had the war continued into 1919.8
I must be remembered in connection with the apparent delay in the organization of this section that prior to June, 1918, the American Expeditionary Forces had had no great experience in combat, that issues were largely of initial equipment, and, furthermore, that available personnel for the medical supply division was exceedingly scarce.
MEDICAL SUPPLY LIAISON WITH THE UNITED STATES
It was early appreciated by the personnel of the supply division of the chief surgeon’s office, A. E. F., that it lacked information, concerning supplies for the American Expeditionary Forces, that was available to supply officers in the Surgeon General’s Office.8 Contact through military channels was devious and inevitably associated with long delays; furthermore, because of the limitation in shipping facilities, there was the constant necessity for
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adherence to methods, of asking for supplies, which were not particularly applicable to the Medical Department. Correspondence by mail was limited, and had to be exceedingly guarded, by reason of the necessity for secrecy; correspondence by cable gram proved unsatisfactory because of the difficulties in making for clarity. Thus, the supply division, chief surgeon’s office, was following an unenlightened course along certain lines. To remedy this, an effort was made to exchange conferees; that is to say, to send medical supply officers from the American Expeditionary Forces to the United States, and vice versa. One such officer was sent to the United States in January, 1918.8 Although subsequent visits were discussed, never again was it possible to release from duty in France, even for a short period, any of the officers whose experiences in France would have made their services in this connection of any value. Undoubtedly it would have been of inestimable value to the American Expeditionary Forces and of great help to the medical supply service at home, had it been possible for an experienced officer to have visited France during the period when the demands of the American Expeditionary Forces were constantly becoming greater. However, not until after the armistice was this possible, due to the comparatively few officers who had had experience in supply work and to the few who were assigned to it during the World War. It was the conviction of the chief surgeon that for the efficient performance by the supply service of the Medical Department of the mission assigned it, it was essential that the service be operated throughout all echelons as a unit and that the most intimate, direct, and speedy contact be maintained throughout.
The method of automatic supply having been established by General Pershing’s memorandum of August 20, 1917, the submission of requisitions thereafter was discouraged. However, in view of the fact that there must necessarily be a period in which a satisfactory automatic could be developed, a period of transfer in methods, it was more or less essential that certain information be sent to the Surgeon General as to our needs. Therefore, the supply division, from time to time, had prepared, by the officer in charge of the medical supply depot, his estimates of future needs for the replenishment of the troops in France and sent them to the United States with the following indorsements:
[First indorsement]
A. E. F., Office of the Chief Surgeon, L. of C., France, January 11, 1918. To the chief surgeon, A.E. F.
1. Forwarded, recommending approval.
F.A. WINTER,
Colonel, Medical Corps, United States Army.
[Second indorsement]
H. A. E. F., C. S. O., January 14,1918. To the Surgeon General, United States Army, War Department, Washington, D. C.
1.This requisition is forwarded, not with the intention that it be filled but for the information of the Surgeon General.
2.Another copy of this document is being forwarded by mail one week from this date and will be labeled duplicate.
A.E. BRADLEY,
Brigadier General, National Army.
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This was merely an attempt to give the Surgeon General advance information. On the other hand, the Surgeon General also tried to give the chief surgeon advance information, particularly as regards shipments to be expected in the American Expeditionary Forces. Copies of the orders for shipment from depots in the United States were sent to France and were of value. Copies of shipping tickets from depots came, but were of little value inasmuch as they frequently arrived after the shipment itself; furthermore, the supplies received could not be identified with any particular shipping ticket. All of these papers, taken together, were of value to the chief surgeon in that they gave him some conception of the status of the medical supply service at home--what articles it had, what it was prepared to ship, and had ordered shipped; however, what he wanted most was information as to what was floated. When this was made known to the Surgeon General early in 1918,58 he directed that lists of the supplies actually loaded on transports be prepared and sent to the chief surgeon. This was done.59
In June 17, 1918, the same procedure was made effective for all departments following receipt of cablegram from General Pershing.60
THE RELATION OF THE SUPPLY DIVISION TO THE RED CROSS
Prior to the World War the American Red Cross, so far as its military activities were concerned, was considered as the medium by which organized voluntary aid might be utilized to supplement the resources and assist the personnel of the Medical Department.61
In the American Expeditionary Forces, two factors very materially influenced the relations of the Red Cross to the Medical Department: (1) American Red Cross activities there were extended into many fields that were not primarily within the Medical Department sphere of action. Its welfare work, its gifts to troops, while of interest to the Medical Department, primarily concerned other branches of the Military Establishment. (2)The American Red Cross had for some months prior to the entrance of the United States into the World War been rendering assistance to the wounded on European soil. It had in France a strong organization. It was familiar with the sources of supply and with the methods best adapted to securing production. It had established under its own control certain centers of production for some of the material it was furnishing to the French troops. Notably this was the case with front-line parcels and splints.
The first factor named above resulted in the Red Cross occupying a position more or less independent of the Medical Department. The second had a very great effect upon the relations of the supply division of the chief surgeon’s office to the Red Cross and resulted in dependence upon it for the production in France of many items which under other conditions the Medical Department would have had produced under its own direction.
Production of the front-line parcels in great number was asked of the American Red Cross in France. That organization was producing them for the French and it was obviously better for the Medical Department to avail itself of the skill and going organization of the Red Cross than to start a new and perhaps competing organization. Large numbers of these front-line parcels
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and a very considerable number of made-up surgical dressings were delivered to the American Expeditionary Forces.62 It was known, however, that the ultimate requirements would be beyond the capacity of the American Red Cross organization in France and recourse was had to the United States. Specifications for these dressings were sent to the United States and production there reached high limits.
Briefly, the arrangement made in the United States between the Medical Department and the Red Cross for this production was that the Medical Department was to buy and turn over to the Red Cross the necessary materials;63 the Red Cross chapters were to prepare the dressings, which were to be packed and assembled and turned over to the Medical Department. Such of them as required sterilization were then to be sent to a contractor for that process and returned to the Medical Department. The Medical Department made shipment to France of such material. The Red Cross, however, continued to send to France on its own tonnage supplies needed for its own purposes.
At the request of the chief surgeon, A. E. F., the Red Cross undertook to so expand its facilities for the production of splints as to take care of the immediate needs of the American Expeditionary Forces.62 This work was done under the immediate supervision of a board of medical officers, A. E. F.64 These officers selected the types, determined the numbers wanted, supervised production, and inspected the deliveries. Certain new types were designed by them.65 The Red Cross managed the shops and secured the necessary personnel. The Red Cross also undertook the publication of the approved findings of the splint board, in the form of a manual.65 This manual was of very great help to the supply service.
By agreement with the chief surgeon, A. E. F., the Red Cross undertook the production of nitrous oxide for anesthesia and made arrangements to establish a plant for that purpose, machinery and trained personnel being obtained by them from the UnitedStates.62 Pending its establishment, they purchased the gas from a French firm. The Army provided the cylinders for this purpose, and made distribution of the filled tanks from its depots. Empty cylinders were sent to the Red Cross for refilling. The oxygen and tanks therefor were provided by the Army.
In all of these efforts they turned over the products to the Medical Department in large part and distribution was made from the Army medical supply depot.
It is obvious that the purchase by the Red Cross of articles also purchased by the Medical Department interfered with the market in Europe or the market inAmerica.2 In so far as purchases of medical supplies by the Red Cross in Europe is concerned, these were eventually coordinated with those of the Medical Department under the authority of the general purchasing agent, A. E. F. It was in procurement from the United States that duplication became most apparent and where there was the greatest possibility of injury to the interests of the American Expeditionary Forces because of the importance of tonnage. With the exception of the surgical dressings referred to above, articles
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that were available in the United States were shipped on both Medical Department tonnage and Red Cross tonnage and this duplication resulted in an overstocking for the needs of the American Expeditionary Forces. This double procurement system did not in any way improve the situation in the American Expeditionary Forces when it came to the articles of which there was still a shortage, since that shortage resulted largely from the depletion of the markets at home and inEurope.8
Following conferences with the Red Cross executives, representation of this condition was made in the following letter, which presents as well the solution believed to be the logical one.66
1. I am informed by the Red Cross that they are receiving from America in their chapter boxes large quantities of certain articles, many of which are on our supply table. It is my belief that an agreement must be reached between the Red Cross and the Medical Department as to the number of such articles needed, and as to the department to supply them, in order to avoid duplication and to conserve tonnage.
2. Doctor Burlingame, of the Red Cross, has suggested that if the production of surgical dressings by the chapters in America as heretofore made is considered excessive, the energies of the women of America might be diverted t othe production of these articles which they are now furnishing and the Medical Department purchasing. As he happily expresses it, “The women of America must do something.”
3.The articles to which reference is especially made are pajamas, operating gowns, bath robes, convalescent suits, bed shirts (summer and winter), ward slippers. These are articles that require a good deal of hand sewing, and, in my judgment, the labor of the women of America might well be employed in their production. The liaison between the Red Cross and the Medical Department, in my judgment, should exist inthe Surgeon General’s Office; for there it would obviate the necessity of purchases by the Medical Department and would prevent the duplication of these articles for overseas shipments.
4. The Red Cross is now shipping many other articles--items of Medical Department supply--in which hand labor is not so important a factor; such as sheets, bedspreads, bath, face, and dish towels, and pillow cases, and I believe an agreement as to the number and articles to be shipped should be reached; and in Washington a decision as to the department to supply them should be made.
5.This agreement would mean that the Red Cross would turn over in America these articles for the American Expeditionary Forces hospitals, that the Surgeon General would know that they had been shipped, and that shipment would be made direct to our depots in France, thus avoiding unnecessary delays and reshipments.
6.I am well aware of the necessity for certain publicity for the Red Cross in order to have maintained the support of the American people. I believe that this publicity could be obtained and our debt acknowledged by official announcement from the Surgeon General’s Office that the Red Cross had turned over certain amounts of stock.
7.If this meets with your approval, I request that this communication be referred to the Red Cross commissioner for France, for his consideration, and that it then be referred to the Surgeon General.
This letter and a subsequent one dated March 6, 1918, in which the matter was elaborated, resulted in the following letter from the Surgeon General to the director of military relief, American Red Cross, April 8, 1918:67
1. This office is in receipt of a letter from the officer of the Medical Corps in charge of supplies, Expeditionary Forces, France, in which lie refers to the present method of handling Red Cross supplies intended for American troops. He says that the receipt of such supplies--implies warehouse facilities at the ports. These facilities are extremely scarce. Further than this every time they receive a consignment of property for Red Cross activity, the property to be ultimately distributed to our forces independent of their enormous work with the
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French civil population, it must be sent from the base port to their warehouses in the interior and then transshipped to the points where it is to be used. You can readily see how this eats up transportation and warehousing facilities all along the line, and what I would like to do would be to effect an arrangement by which consignments of their property could be made to you in the United States, put in your depots, and sent over here consigned to our depot for issue. There would be an enormous saving of effort, and I think it is very well worth consideration.
2.For considerable time this manner of handling your supplies intended for United States forces has been under consideration by this office, and I would strongly urge that it be put into operation.
3.If you will invoice to the Medical Department the supplies which you desire to distribute to our expeditionary forces, I shall be glad to include them in our shipment, making all arrangements, for their transportation overseas, deliver them to our depot overseas and distributed therefrom, your organization being given credit for the articles so transferred and so issued.
I believe this would solve your transportations problem so far as our forces are concerned, and I am convinced that it would materially facilitate that smooth and equitable distribution of supplies so much to be desired and so difficult to obtain.
No change in methods of shipping Red Cross supplies resulted from this letter.
That there should be, as a result of the separation of the Red Cross from the Medical Department, some considerable duplication of effort and supplies was natural. The Medical Department personnel in organization, for the most part untrained in the methods of obtaining supplies, secured them from whatever source they found most available, and frequently, being without any realization of the dangers of shortage of supplies, duplicated their requisitions and obtained supplies from both the Red Cross and our supply department.8 As an example, there was temporarily a shortage of sheets during the period of hospital expansion. The policy was established of issuing six sheets per bed as initial equipment, further issues to be made when additional supplies were received. With this arrangement the Medical Department managed to keep just ahead of the demand. Meanwhile the Red Cross also had sheets and was being called upon to issue to units other than those for whose supply they had accepted responsibility, including some who had already received their allotment of six. This duplication of supply resulted in a shortage in hospitals at a time when these articles were needed. When attention was called to this condition the American Red Cross placed its entire available stock at the disposal of the chief surgeon and distribution was made in bulk to designated hospitals, which were then not supplied by the Army with the initial allowance of six. The result of these demands upon the Red Cross was a financial burden to that organization which they should not have been called upon to bear and which, in fact, the officials of the Red Cross had no desire to bear. If the personnel of the Medical Department was untrained, much of the Red Cross personnel was equally or more so. Being exceedingly desirous of rendering service and being entirely unfamiliar with the normal method of supply, they felt that the burden of supplying hospitals was upon them. In some cases they were even unfamiliar with the existence of the Medical Department supply service; as a result, they not only made issues whenever called upon, regardless of the fact that the articles could have and should have been supplied from Army depots, but they also failed to convey the information necessary to
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prevent a repetition of the demand upon them in the future. In an effort to meet this situation, after consultation with the Red Cross, and in full agreement with them, orders were issued permitting issues from the Red Cross only after approval by division, corps, section, or Army surgeon, or by the chief surgeon. As a matter of fact it was believed by the supply department and by the Red Cross officials in Paris that a further restriction would have been better. However, with the extensive unfamiliarity with Army methods and in view of the nonrecognition of the necessity for advance requisitions it was felt unsafe to bar in any manner the way to the prompt securing of supplies.8
In October, 1918, the national adviser on surgical dressings, American Red Cross, visited France and made a study of the status of surgical dressings in the American Expeditionary Forces. His report, except the exhibits referred to, follows: 68
1. The surgical dressings and raw material now available for the use of the American Expeditionary Forces in France are given in detail in the accompanying Schedule A, based on reports received from the Medical Department of the Army and the warehouse of the American Red Cross under the respective dates, Army, September 1, 1918; American Red Cross, September 20, 1918.
2. In addition to this, there is a considerable supply of surgical dressings in transport as shown ins Schedule B.
3. A further supply is available in the United States, the amount of which can be fairly computed from the figures given in Schedule C, which represents the number of dressings delivered by the American Red Cross in the United States to shipping points during the month of July. Similar amounts were delivered during August and September.
4. The stock of raw material and dressings included in sections 1, 2, and 3 represents the accumulated stores during the months of preparation since the entrance of the United States into the war, less the issues actually used by the Medical Corps of the American Expeditionary Forces during the same period.
Prior to the July offensive the number of wounded in the American Expeditionary Forces was almost negligible, and it is only during the last month that military operations of any magnitude have taken place. There are, therefore, available no actual data on which to base an accurate estimate of the number of dressings that may in the future be needed. A study, however, of the accompanying schedules demonstrates that no conceivable military operations can exhaust the available supplies for many months.
5. Up to the present time an inspection of hospitals from the advanced zone back to and including the bases shows that practically all surgical dressings are made up from raw material furnished by the Army Medical Department in the organization where they are used, and that only a very minor portion is obtained from the American Red Cross stores. This is true even in the field hospitals.
6. The front-line parcels are used to a certain extent by the regimental surgeons and occasionally in the field hospitals, but even these are overlooked by many of the surgeons, the wounds being covered with plain sterile gauze dressings. The number of these parcels shown in Schedule A, plus those already in the possession of the United States Army (see cable 9479-15772, dated September 30, 1918, Schedule A), will amply meet all requirements for many months.
7.Thedressings for “evacuation hospital use” made for the American Red Cross in the United States constitute an exception to all other types of dressings, as the production of these has been relatively small; and under certain conditions a large reserve of these should be held by each evacuation and field hospital.
8.Itis therefore recommended that the Army Medical Department in France be requested to hold all their surplus raw material for surgical dressings in reserve and requisition from the Americans Red Cross in France their made-up surgical dressings for issue to all hospitals.
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9. It is further recommended that all surgical dressings from the United States be shipped by the American Red Cross only under priority D, thus giving priority to other supplies, the stock of which in France is not in ample reserve. Exceptions should be made of surgical dressings for evacuation hospital use (see par. 7).
10. It is further recommended that the American Red Cross in the United States be instructed to discontinue making of all surgical dressings except the present monthly allotment of dressings for evacuation hospital use and such surgical dressings as may from time to time be specifically ordered by the French commission.
11.This program shall be continued, subject to monthly study, until such time as data can be obtained whereby a reserve of safety may be determined, and thereafter dressings from the United States shall be ordered and shipped only to an amount necessary to maintain this reserve.
As a result of this the chief surgeon, A. E. F., required that the Medical Department hold in reserve its supply of dressing material and use the made up dressings prepared by the Red Cross.69 Much of this material was in the medical supply depots.
RELATIONSHIPS WITH OTHER SERVICES OF THE MEDICAL DEPARTMENT
Expert assistance was rendered from time to time by the special services of the Medical Department, A. E. F., not only in the selection of new or proper articles of equipment, but also in the determination of adequacy and suitability of supplies in using organizations. A notable example in the selection of equipment was in the case of the laboratory service. An officer from this service was ordered in March, 1918, to London for the purpose of procuring in the British market certain laboratory supplies in a series of transportable laboratory units which he had designed in France. The success which attended this effort and the good results obtained from these transportable units are due to this delegation of authority.
The laboratory service also aided materially in the distribution of special supplies for laboratories and in the distribution of sera and vaccines. Not only did it do the distributing, but it also worked up the plan therefor. Similar assistance was given by the other special services--the X-ray, the surgical, etc.
That there was a certain element of danger in this policy is evident. There was a tendency to depart from the general scheme of supply and to attempt to establish for each service a special method. That such departure would have corrected the difficulties existing in the special service, which it was intended to correct, is problematical. That it would have caused greater difficulties in the supply of other materials is certain.
Much of the information needed by the supply division concerning the adequacy of supplies in the using organization, which information the supply division itself was unable to gather, by reason of lack of personnel, was obtained by professional consultants and transmitted to the supply division. On the other hand, the chief surgeon encouraged these consultants to visit the medical supply depots, acquaint themselves with the stock there, and transmit this information to the man doing professional work. This was particularly applicable because of the unfamiliarity of many of the reserve officers with the supply table and its nomenclature. Desiring equipment for a certain purpose, they would ask for the equipment with which they were familiar. In the
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absence of such equipment, their needs were not met. Knowledge of the existence at the depots of certain other equipment designed or usable for the same purpose, was not available to them. It was this knowledge that the consultant could and did convey.
That this was properly a function of the supply service was recognized, and it was planned to have medical supply personnel traveling out from the office of the chief surgeon.8 It was intended they should inquire into the adequacy of supplies, to instruct in the method of requisitioning, to meet incoming organizations and to advise them of the location of depots and the methods followed in the American Expeditionary Forces, the local situation, etc.; to acquaint them with the shortage of supplies and the necessity for economy; to assist in the establishment of storeroom hospitals wherein supplies could be adequately cared for and conserved; to arrange for the return to the proper depot of excess supplies; to receive criticisms, and to make suggestions following their investigations, as to the manner in which distribution of supplies could be better accomplished. Such personnel it was never possible to obtain. Officers of the Sanitary Corps, formerly noncommissioned officers, were thought to be best prepared for this work, but their services were in demand elsewhere and it was difficult to secure them insufficient numbers even for the purposes of medical supply depots. It is believed that in this respect the Red Cross had the advantage of the Medical Department. They had men attached to each base hospital, to each division, and to each territorial section, working directly under the American Red Cross central office in Paris, privileged to travel to and fro, having available transportation never allotted the medical supply service of the Army, and it is probable that many supplies were asked for of the Red Cross because those officers would obtain them even at great expense of time and money without trouble to the medical officer making the requisition 8
MISCELLANEOUS ACTIVITIES
In addition to the matters which have been discussed, many of comparatively minor or of temporary character were handled in the supply division of the chief surgeon’s office.
AUTHORIZATION FOR EMPLOYING CIVILIANS
Until the arrival of the finance and accounting unit in February, 1918, the activities of which are described in the following chapter, the authorization of civilian employees by the Medical Department was handled in the supply division.8 Usually blanket authority to employ not to exceed a certain number at the prevailing French rates was the method pursued. Many of the early hospitals took over old buildings, ofttimes cut up into man small rooms and therefore not particularly satisfactory for hospital purposes. The number of personnel assigned to the units was insufficient, and due to the critical shortage of enlisted personnel, Medical Department, it was impossible to supply reinforcements. Camp hospitals were established in large numbers with a skeletonized force from casuals, since these organizations were not provided for in War Department Tables of Organization. Therefore, a liberal policy was established in the employment of civilians, and realization of this assistance to
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the Medical Department was made to the fullest extent possible at each location. The maximum of such civilians under employment at any one time was 4,273. With the establishment of territorial sections this function was delegated to section surgeons.8
UNIT EQUIPMENT PURCHASED FROMPRIVATEFUNDS
Elsewhere,a reference has been made to the purchase of base hospital equipment from private funds and by the American Red Cross.
Though the attempt was made by the Medical Department to send these units to France as complete assemblages, the difficulties of such overseas transportation made this impossible. The property arrived, split among several convoys and at different ports. Meanwhile, the personnel usually had arrived and been supplied with equipment from the depots in France. It was obviously unnecessary to ship much of the equipment belonging to the unit. Such things as beds and bedding were placed in the general stock. However, in view of the personal interests which these units had in the equipment selected by them, the chief surgeon did attempt to send to them the additional special and technical equipment which they had included. In some cases, numbers of the unit were sent to the base depots to pick out what they wanted.2 However, the efforts of the chief surgeon along these lines were not productive of the desired results as was natural under the conditions existing. The matter is worthy of mention because the failure to get the equipment which they had so carefully selected and so patriotically stored for many months was undoubtedly a disappointment to these men and difficult for them to understand. They had to be reconciled by the fact that undoubtedly it was of service somewhere in France even though they were not privileged to use it.
HOSPITAL FUND
Hospital fund statements were credited in the supply division and the central hospital fund administered until September 13, 1918, when these duties were turned over to the finance and accounting unit.8
VOUCHERS
Vouchers were approved until this, too, was taken over by the finance and accounting unit.8 Some difficulty was encountered in the early period with laundry vouchers, and those for civilian employees. The units needing the services of civilians had no Government funds with which to employ them. Nor was any disbursing officer of the Medical Department immediately available. Vouchers were prepared and sent to the disbursing officer. Mail service was slow and unreliable. Those rendering service desired prompt payment. In the case of civilian employees, payment weekly was desired. Sometimes the unit changed station before the check was returned and there was still further delay and a misunderstanding upon the part of those to whom the debt was owed.
______________________
a See pp. 94-96, Vol. I, of this history.
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The chief surgeon authorized the use of the hospital fund for the payment of these vouchers, or, in the absence of a hospital fund, the payment from private funds, reimbursement in either case to be made upon presentation of the voucher with proper notations.8
In March, 1918, the chief quartermaster, A. E. F., upon the request of the chief surgeon, authorized quartermasters to liquidate these accounts from funds in their possession, reimbursement to be made by the Medical Department. This measure was of material assistance since quartermaster disbursing officers were at most stations.70
ACCOUNTABILITY
It was impossible to maintain accountability for medical supplies as between the United States and the American Expeditionary Forces. It is true that invoices were received, but usually not until long after the supplies had been received and frequently after their issue. Invoices were received from each of the several depots in the United States. Each depot numbered its invoices serially, and the packages from each depot were also numbered serially. A single shipment of supplies received at a depot in France would not include all of the supplies listed on one invoice, but, on the other hand, would contain several packages having the same number. Markings on the boxes were indefinite, and it was impossible to determine from which depot they had been shipped and to which invoice they should becredited.8 Many supplies were received in France marked for special units and no invoices were furnished. Frequently these supplies found their way into the supply depot, where, because the necessity for supplies was so great and the storage space so inadequate, they were placed in stock and issued.8 The supplies shipped as “replenishment supplies, -- Division,” caused some difficulty in this connection at first, as it was not understood in France that by such marking only could shipments from the United States be effected. The supplies so received were obviously not intended to be carried in the division train and it was impracticable, even had it been desirable, to segregate these supplies as a reserve for the particular division. They were placed in stock. Supplies received from European sources arrived at the depots in partial shipments.8
It was early apparent that entire accountability must be abandoned or the needs of the American Expeditionary Forces be neglected.8 At the medical supply depots in the American Expeditionary Forces, accountability remained for the property received, and there was accountability in fixed units. At the front it was impossible to maintain any system of accountability and General Orders, No. 74, general headquarters, A. E.F., December 13, 1917, provided for the cessation of all accountability there.
DECENTRALIZATION
Very early in the history of the American Expeditionary Forces the necessity for decentralization was recognized. It was forseen that the judgment of the man on the spot would be required, therefore the authority to act should be delegated to him. Consistently the chief surgeon attempted to follow this policy in matters of supply.
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At first requisitions for medical supplies from units on the lines of communication were made in quadruplicate, one copy being retained by each requisitioning officer. Three copies were sent to the chief surgeon, Line of Communications, and after action by him, were sent to the medical depot for issue.8
On August 13, 1917, Circular No. 1 was published, of which the following is an extract:
Circular No. 1.
HEADQUARTERS LINE OFCOMMUNICATIONS,
AMERICAN EXPEDITIONARY FORCES,
OFFICE OF THE CHIEF SURGEON.
"Requisitions for medical supplies” will be sent to the surgeon, B. G. and L. O. C., at his office, which for the present time is in Paris. Two copies of the requisition should be made, one to be forwarded and one retained by the officer making the requisition.
A. WINTER,
Colonel, Medical Corps, Surgeon, B. G. and L. O. C.
Approved:
By order of Brigadier General Blatchford:
J.P. MC ADAMS,
Captain,11thInfantry, Acting Chief of Staff.
This was an early effort to relieve the using units of any burden connected with supply. It was contemplated that supplies asked for were to he issued to the greatest possible extent, since there would be under this procedure no retained copy of requisitions in the office of the chief surgeon and, therefore, no way of checking requests against previous requisitions.
In Circular No. 6, issued by the chief surgeon, Line of Communications, on September 28, 1917,attention was called to the need for one copy only.
On the theory that the only legitimate reason for withholding supplies asked for was the necessity for protecting the interests of other, later, requisitioners by maintaining in the depots sufficient stock to meet their requirements, on December 4, 1917, the policy of sending requisitions direct to the depot was was instituted and the depot officer was given the authority to modify the requisitions in the name of the chief surgeon, Line of Communications, if such modifications were necessary to the maintenance of at least a small reserve of essential items.71 Such practice did not, in any way, deprive units of needed supplies. It gave them less reserve in their own possession, and necessitated other requisitions at shortintervals.8
This policy was applicable also to vouchers; 71 but, in so far as vouchers were concerned, it was modified on June 12, 1918, when upon the establishment of the finance and accounting unit, chief surgeon’s office, these vouchers were again sent to the chiefsurgeon.72
On December 15, 1917, the commanding officers of base hospitals were authorized to meet emergency needs by local purchases.73 The purpose of this authorization was perhaps not clearly understood by all of those to whom it was given. It was, of course, never thought by the chief surgeon that $100 a month would meet the entire supply needs of a base hospital. The purpose was to relieve the commanding officer of the necessity for making requests for authority to purchase in each case, or to make a written explanation of the
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circumstances requiring an emergency purchase without authority. It was. intended to enable the commanding officer to have made minor repairs to Medical Department equipment.
Circular No. 19, published by the chief surgeon, Line of Communications, February 14, 1918, indicated further his desire to decentralize the operation of the Medical Department:
1. Report of expenditures. - Expenditures made from Medical Department funds under-the provisions of paragraph 4, Circular 15, this office, will be reported monthly to the section surgeons, showing amount of each expenditure and the purpose for which expended.
Section surgeons are empowered to authorize expenditures and to approve vouchers therefor from Medical Department funds for purposes properly chargeable under regulations against such funds, of amounts not to exceed$250.
Section surgeons will furnish monthly to the chief surgeon, general headquarters, A. E. F., through this office, a list of vouchers approved by them during the month, giving the amount, from whom purchased, the organization making the purchase, with the name of the officer signing the voucher, and the general class of article purchased.
* * * * * *
3. Statement of hospital funds - These statements will hereafter be sent to the section surgeons, who will act upon them, forwarding them, when approved, direct to the chief surgeon, general headquarters, A. E. F.
Subsequently, the following circulars, which are self-explanatory, were promulgated:
Circular No. 26.
AMERICAN EXPEDITIONARY FORCES,
OFFICE OF THE CHIEF SURGEON,
France, May 4, 1918.
* * * * * *
5. Forwarding of purchase vouchers. - All vouchers covering purchases made under the provisions of paragraph 4, Circular No.15, Chief Surgeon’s Office, Line of Communications, and all vouchers for purchase made under the provisions of paragraph 1, Circular No.19, chief surgeon’s office, Line of Communications, will be sent through the section surgeon to this office, for payment by the disbursing officer attached hereto.
6. Requisitions upon the Red Cross. -Hereafter requisitions upon the Red Cross will be honored at the Red Cross depots after approval by the following officers:
For all troops within a division, by the division surgeon.
For all hospitals and troops in the Services of Supply, by the section surgeons.
Attention is again invited to the fact that the Red Cross should not be asked for articles on the supply table or properly chargeable against Medical Department funds, except in emergencies, and to the undesirability of submitting to the Red Cross requisitions for articles erased from the medical supply tables by reason of their unimportance.
* * * * * *
8. Purchase of technical apparatus locally. - It is believed that many small purchases, particularly of surgical instruments and minor technical apparatus, are being made in the local markets. This is no doubt due to the fact that there was great difficulty in securing these articles from the supply department in the early days. A well-balanced and well-maintained shipment of such equipment is now being received from the United States and it is desired that all requests for this material should pass first through the medical supply depot; the officer in charge of which will, if necessary, make request upon the purchasing officer.
M.W. IRELAND,
Brigadier General, National Army, Chief Surgeon.
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Circular No. 43.
AMERICAN EXPEDITIONARY FORCES.
OFFICE OF THE CHIEF SURGEON,
August 1,1918.
* * * * * *
9.Authority to authorize expenditures and approve vouchers on Medical Department funds. - Authority to authorize expenditures and to approve vouchers for purchases properly chargeable against Medical Department funds, in sums not to exceed $250, is granted to the commanding officers of all hospital centers and to the chief surgeons of armies.
The authority to authorize expenditures and to approve vouchers for purchases properly chargeable against Medical Department funds, in sums not to exceed $100, is hereby granted to chief surgeons of army corps.
M.W. IRELAND,
Brigadier General, Medical Corps, National Army, Chief Surgeon.
Circular No.45.
AMERICAN EXPEDITIONARY FORCES,
OFFICE OF THE CHIEF SURGEON,
France, August13, 1918.
* * * * * *
III. Civilian employees for hospital centers. - Authority is hereby granted to commanding officers of hospital centers to authorize the employment of such civilian employees as may be necessary for the administration of the base hospitals under their command. The employment of these civilians must be in accordance with existing regulations; and attention is invited to Bulletin No. 14, headquarters, Line of Communications, February 13,1918, and Circular Order No. 7, headquarters, Services of Supply, March 11, 1918.
M.W. IRELAND,
Brigadier General, Chief Surgeon.
Following the shifting of the duty of acting upon requisitions to the officer in charge of the supply depots, the supply division of the chief surgeon’s office was concerned with matters connected with storage space for future needs; with estimates of supplies needed for succeeding months; with estimates of tonnage requirements, and with their defense; with purchases for American Expeditionary Forces units; and wit-h occasional purchases for stock; with the authorization of civilian employees; and with Red Cross aid to American Expeditionary Forces units; with priorities for Medical Department supply units and personnel therefor.
REFERENCES
(1) Report of the chief surgeon, A. E. F., to the commanding general, S. O. S., March 20, 1919,concerning the activities of the chief surgeon’s office. On file, Historical Division, S. G. O. Also: Final Report General John J. Pershing.
(2) Historical Report of Medical Activities, Line of Communications, American Expeditionary Forces, during the War Period, umidated, by Brig. Gen. F. A. Winter, M. C. On file, Historical Division, S. G. O.
(3) Weekly War Diaries, chief surgeon, A. E. F. (Memoranda for the chief of staff, A. E. F.) July 21, 1917. On file, Historical Division, S. G. O.
(4) Ibid., September 2, 1917.
(5) Wadhams, Sanford H., Col., M. C., and Tuttle, Arnold D., Col., M. C.: Some of the Early Problems of the Medical Department, A. E. F. The Military Surgeon, Washington, D. C., 1919, XLV, No. 6, 636.
(6) Weekly War Diaries, chief surgeon, A. E. F., November 25, 1917.
(7)Letter from the chief surgeon, L. O. C., to the chief Surgeon, A. E.F., February 14, 1918. Subject: Centralization of supply control. Copy on file, Historical Division, S.G. O.
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(8)Report of the activities of the supply division, chief surgeon’s office, A. E. F., May, 1919, by Col. N. L. McDiarmid, M. C. On file, Historical Division, S. G. O.
(9) G. O., No. 130, G. H.Q., A. E. F., August 6, 1918.
(10) Memorandum from the medical representative of the chief surgeon on the General Staff to the chief surgeon, A. E. F., April 28, 1918. On file, Historical Division, S. G. O.
(11) Letter from the chief surgeon, L. O. C., to the chief surgeon, A. E. F., January 17, 1918.Subject: Therapeutic sera. Copy on file, Historical Division, S. G. O.
(12) Telegram from the Surgeon General to the officer in charge, medical supply depot, El Paso, Tex.,May 19,1917. Copy on file, Finance and Supply Division, S. G. O., 14778-C.
(13) Telegram from the Surgeon General to the officer in charge, medical supply depot, New York City, May 19,1917. Copy on file, Historical Division, S. G. O.
(14) Letter from Lieut. Col. H.C. Fisher, M. C., to Col. M. W. Ireland, M. C., August 11, 1917,relative to medical supplies for the American Expeditionary Forces. Copy on file, Historical Division, S. G. O.
(15) Letter from the chief surgeon, A. E. F., to the Surgeon General, July 3, 1917. Subject: Forwarding medical supplies without requisition. Copy on file, Historical Division , S. G. O.
(16) Memorandum, Headquarters, A. E. F., August 20, 1917. Subject: Automatic supply. Copy on file, Historical Division, S. G. O.
(17) Cablegram No. 145-S. From General Pershing to The Adjutant General, September 7, 1917.
(18) Cablegram No. 155-S. From General Pershing to The Adjutant General. Paragraph 7, for the Surgeon General.
(19) Letter from the Surgeon General to the chief Surgeon, A. E. F., October 27, 1917, relative to automatic supply. On file, Finance and Supply Division, S. G. O., 713-250/15.
(20) Letter from the Surgeon General to the officer in charge, medical supply depot, New York, October 6, 1917.Subject: Automatic replenishment of medical supplies per month. Copy on file, Historical Division, S. G. O.
(21) Letter from the Surgeon General to the officer in charge, medical supply depot, New York, October 13,1917.Subject: Automatic replenishments. Copy on file, Historical Division, S. G. O.
(22) Letter from the Surgeon General to the officer in charge, medical supply depot, New York, November 8,1917.Subject: Automatic replacement of post supplies. Copy on file, Historical Division, S. G. O.
(23) Letter from the Surgeon General to the officer in charge, medical supply depot, New York, November 9, 1917. Subject: Replenishments for the 26th and 42d Divisions. Copy on file, Historical Division, S. G. O.
(24) Letter from the Surgeon General to the surgeon, medical base group, A.E. F., October 27,1917. Subject: Automatic replenishment of supplies. Copy on file, Historical Division, S. G. O.
(25) Letter from the chief surgeon, A. E. F., to the officer in charge, Intermediate Medical Supply Depot No. 3, February 1, 1918. Subject: Automatic supply. Copy on file, Historical Division, S.G. O.
(26) First indorsement, office of the chief surgeon, L. O. C., to the chief surgeon, A. E. F. February 15, 1918. Copy On file, Historical Division, S. G. O.
(27) Letter from the officer in charge, Intermediate Medical Supply Depot No. 3, to the chief surgeon, L. O. C., February 4, 1918. Subject: Automatic supply. On file A. G. O., World War Division, Chief Surgeon’s File, 401.
(28)Letter from the chief surgeon, A. E. F., to the Surgeon General, April2, 1918. Subject: Automatic supply. Copy on file, Historical Division, S. G. O.
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(29) Report of chief of medical group to assistant chief of staff, 4th section of general staff, December 31, 1918.Subject: Activities of medical group, 4th section, general staff, General Headquarters, A. E. F. Copy on file, Historical Division, S. G. O.
(30) Memorandum from Col. S. H. Wadhams, General Staff, G. H. Q., to the chief surgeon, A. E. F., May28,1918. On file, A. G. O., World War Division Chief Surgeon’s File, 319.2.
(31) Final Report of Gen. John J. Pershing.
(32) Organization of the Armies of Supply, A. E. F., Monograph No. 7. Prepared in the Historical Branich, War Plans Division, General Staff, June, 1921, Washington, Government Printing Office, 1921,10, 11.
(33) Letter from the adjutant general, A. E. F., to the acting commander, L. O. C., July 19, 1917. On file, A. G. O., World War Division, Chief Surgeon’s File, 370.41.
(34) Organization of the Services of Supply, 123.
(35) Supply Circular No. 19,office of the chief surgeon, L. O. C., February 14, 1918.
(36) Third indorsement, from the chief surgeon, L. O. C., to the officer in charge, advance medical supply depot No. 1, Is-sur-Tille, August 21, 1918. On file, A. G. O., World War Division, Chief Surgeon’s File, 400.01.
(37) G. O., No. 55, G.H.Q., A.E. F., April 12, 1918.
(38) Letter from the chief surgeon, L. O. C., to the commanding general, L. O. C., February 11,1918. Subject: Storage for Medical Department. Copy on file, Historical Division, S.G. O.
(39) Memorandum for the Medical Department from the assistant chief of staff, G-4, G. H. Q., A. E. F., April 19,1918. Copy on file, Historical Division, S. G. O.
(40) Memorandum for the assistant chief of staff, G-4, G. H. Q., from the chief surgeon, A. E.F., April 25, 1918.Copy on file, Historical Division, S. G. O.
(41) Letter from the chief surgeon, A. E. F., to the fourths section, general staff, G. H. Q., A.E. F., May 24, 1918.Subject: Reserve stock at railhead--G. O., No. 55. Copy on file, Historical Division, S. G. O.
(42)Second indorsement, chief surgeon’s office, A. E. F., June 1, 1918, to the assistant chief of staff, G-4,general staff, G. H. Q., A. E. F. Copy on file, Historical Division, S.G. O.
(43) Telegram from the assistant chief of staff, G-4, G. H. Q., A. E. F., June 12, 1918, to the officer in charge, Intermediate Medical Supply Depot No. 3, Cosne. On file, A. G. O., World War Division, Chief Surgeon’s File,322.33.
(44) Memorandum for the commanding general, L. O. C., from the chief surgeon, L. O. C., January24, 1918.Subject: Priority of shipments from base ports. Copy on file, Historical Division, S. G. O.
(45) Third indorsement, G. H.Q., A. E. F., chief surgeon, general staff, February 2, 1918, to commanding general, L. O. C. Copy on file, Historical Division, S. G. O.
(46) Fourth indorsement, office of the commanding general, L. O. C., February 6, 1918, to the commanding officers, Base Sections Nos. 1, 2, and 5. Copy on file, Historical Division, S. G. O.
(47) Based on correspondence between the commanding general, L. O. C., and the commanding generals, base sections, A. E. F. On file, A. G. O., World War Division, Chief Surgeon’s File, 400.24.
(48) Memorandum for the general staff, from the chief surgeon, A. E. F., April 23, 1918, concerning supply depots for hospital centers. Copy on file, Historical Division, S. G. O.
(49) Memorandum for the chief of utilities, A. E. F., from the assistant chief of staff, G-4, Hq., S.O. S., April 29,1918. Copy on file, Historical Division, S. G. O.
(50) Letter from the chief surgeon, L. O. C., to the commanding officer, B. H. No. 18, A. E. F., October 19, 1917.Subject: Issue of medical supplies to divisional troops in your area. Copy on file, Historical Division, S. G. O.
(51) Report of the Medical Department activities of Base Section No. 1, undated, by Col. Charles L. Foster, M. C.On file, Historical Division, S. G. O.
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(52)Second indorsement from the chief surgeon’s office, A. E.F., July 27, 1918, to the commanding officer, hospital center at Mesves, concerning hospital center medical supply depots. Copy on file, Historical Division, S. G. O.
(53) Letter from the chief surgeon, A. E. F., to surgeons of base sections, January 1, 1919.Subject: Accountability. On file, A. G. O., World War Division, Chief Surgeon’s File, 143.
(54) Correspondence pertaining to tonnage forecasts. On file, A. G. O., World War Division, Chief Surgeon’s File,400.314.
(55) Memorandum from the adjutant general, S. O. S., to the chief surgeon, A. E. F. April 29, 1918. Subject: Quarterly forecast. On file, A. G. O., World War Division, Chief Surgeon’s File, 400.314.
(56) Memorandum from Hq. S. O.S., to the chief surgeon, A. E. F., April 6, 1918. Subject: Tonnage priority lists. On file, A.G. O., World War Division, Chief Surgeon’s File, 440.1.
(57) Letter from the chief surgeon, A. E. F., to the assistant chief of staff, G-1, Hq., S. O. S., July 16,1918. Subject: Report of tonnage estimates. Copy on file, Historical Division, S. G. O.
(58) First indorsement from the chief surgeon, A. E. F., to the Surgeon General, January 11, 1918,relative to overseas shipments. Copy on file, Historical Division, S. G.O.
(59) Lists of overseas shipments from all ports for the month of July, 1918.
(60) Letter from the Chief of Embarkation Service to the Surgeon General, June 17, 1918. Subject: Overseas shipments. On file, Record Room S. G.O., 400.16.
(61) Manual for the Medical Department, U. S. Army, 1916, par. 536.
(62) Military History of the American Red Cross in France, by Lieut. Col. C. C. Burlingame, M. C. Copy on file, Historical Division, S. G. O.
(63) Letter from the Surgeons General to Mr. Henry D. Gibson, general manager, American Red Cross, March 8,1918. Subject: Order for surgical dressings. On file, Finance and Supply Division, S. G.O., 602/78.
(64) S. O., No. 73, H. A. E.F., August 20, 1917.
(65) Manual of Splints and Appliances, for the use of the Medical Department of the United States Army, 1918.
(66) Letter from the chief surgeon, L. 0. C., to the chief surgeon, A. E. F., February 11, 1918.Subject: Red Cross production. Copy on file, Historical Division, S. G. O.
(67) Letter from the Surgeon General to the director of military relief, American Red Cross, Washington, April 8,1918. Subject: Method of handling Red Cross supplies. On file, Finance and Supply Division, S.G.O., 250 Fr./302.
(68) Letter from Maj. J. A. Hartwell, to Lieut. Col. Fred T. Murphy, October 15, 1918. Subject: Report on surgical dressings. Copy on file, Historical Division, S. G. O.
(69) Circular No. 56,office of the chief surgeon, A. E. F., November 19,1918.
(70) Circular No. 16,office of the chief surgeon, A. E. F., March 28, 1918.
(71) Circular No. 14,office of the chief surgeon, L. O. C., December 4,1917.
(72) Circular No. 33,office of the chief surgeon, A. E. F., June 12, 1918.
(73) Circular No. 15,office of the chief surgeon, L. O. C., December 15,1917.
