Books and Documents > Medical Department of the U.S. Army in the World War, Volume III, Finance & Supply
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INTRODUCTION
EVOLUTION OF THE MEDICAL DEPARTMENT SUPPLY SYSTEM
REVOLUTIONARY PERIOD
The procurement of medical and hospital supplies during the Revolution divides into three quite definite, but somewhat overlapping, periods. The first began with the raising of troops by the individual colonies in 1774, and not only continued until those troops were demobilized in December, 1775, but obtained to a greater or less extent until near the close of the war. The second covers the period from the appointment of Dr. John Morgan,1 director general of the hospital, October 15, 1775, to July 15, 1781. The third period began in July, 1781, with the transfer, by resolve of Congress,2 of the procurement of all supplies for the Army to the superintendent of finance, and continued until the close of the war.
During the first period each colony, as it passed resolves for the raising and equipping of its troops, directed that the necessary medicine chests and surgical instruments be purchased and issued to the several regimental surgeons.3 These resolves frequently did not specify the agency to arrange for their procurement. In some instances the committee of safety was directed to arrange for them by importation or otherwise;4 in others, individuals were designated to procure or supply them.5 Hospitals were authorized, buildings, were selected and altered for the purpose, equipment was collected, surgeons were designated to have charge of them, and persons were selected to provide provisions, refreshments, and necessaries for the sick.6
A medical commissary was appointed for the troops assembled at Cambridge whose duty it was to receive, store, and issue, upon proper orders, such medicines, instruments, and hospital stores, supplies, and equipment as might be obtained for the colonial forces. He was authorized by the Provincial Congress, Massachusetts Bay, to purchase medicines and hospital stores as needed, and was empowered to impress beds, bedding, and other necessaries for the sick. For such articles as were taken in this manner a receipt was given the owners thereof 7and the articles either were paid for or were returned when no longer needed. So acute did the shortage of medicines and medical and surgical supplies become during 1776 and later years that most stringent measures were taken for their economical use and disposition. Regimental surgeons were even required to give oath before receiving them that the medicines so received would be used exclusively for the sick of their respective regiments and that they would account for them upon being discharged from the service.8
The several colonies appear to have done, and at all times showed a desire to do, all they could, as individual colonies, for the medical welfare of their own troops. When such troops passed beyond the borders and control of the respective provinces, it became necessary for the Continental Congress to make provision for them both in hospitals and in supplies.
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When General Washington arrived at the headquarters of the forces of the continent, then at Cambridge, Mass., on July 3, 1775, he began immediately a thorough and searching personal investigation of the condition of the troops, their equipment and supplies, and the organization of the service of supply. Since these forces were made up of colonial troops, organized, officered, and equipped by the respective colonies from which they were sent, the methods of supply in vogue differed, apparently, for every colony represented. Commenting upon these different and at times conflicting methods, General Washington wrote the President of the Continental Congress on July 13, 1775, that “there is a vital and inherent principle of delay, incompatible with military service, in transacting business through such numerous and different channels. I esteem it, therefore, my duty to represent the inconvenience which must unavoidably ensue from a dependence on a number of persons for supplies, and submit it to the consideration of Congress whether the public will not be best promoted by appointing a commissary general for these purposes. Connecticut troops observing this niethod are exceptionally well furnished under the direction of Mr. Trumbull.” 9
General Washington, finding the same centralization of authority and responsibility lacking in the medical service with the troops and the same undesirable results emanating therefrom as in the case of supplies, reported, July 12, 1775, to the President of the Continental Congress that the hospital was in a very unsettled condition; that there was no principal director, or subordination among the surgeons; that disputes and contentions existed among them and would inevitably continue until reduced to system; that the health and lives of both officers and men so much depended upon a due regulation of that department that its immediate consideration was greatly to be desired.10 Congress, however, on July 19, 1775, probably before the receipt of this letter, had begun the consideration of the subject and had appointed a committee “to bring in a plan for an hospital.” The committee’s report was adopted by resolve of July 27, 1775. This resolve prescribed the personnel of the medical establishment, their rank, title, emoluments, and duties. The medical establishment so authorized was based upon and covered the hospital needs of a force of only 20,000 troops, and was, in fact, what it purported to be, “an hospital.” It was called at various times an hospital, the hospital, the Continental Hospital, and the American Hospital.11
Medical and surgical care of individuals who required treatment but did not need hospital care was furnished by the regimental surgeons and mates assigned to duty with the respective regiments.12 Among other duties, Congress required of the director general of the hospital the establishment of hospitals, the providing of the supplies and the subordinate personnel required therein, the disbursements therefor, and the keeping of the accounts thereof.13
The act of July 27, 1775, represents the first attempt on American soil to provide the medical service of the Army with a central organization. It is not clear from the wording of the legislation itself just what Congress contemplated, or how much or how extensive was the authority intended to be conferred upon the director general therein provided, whether it contemplated a single hospital with the director general in command of it, or a number of hospitals with that
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official as the head of a medical department. The act made no provision for any expansion or for coordination with hospitalization in other territorial departments or divisions of the Army. It is noteworthy that the total personnel authorized for the department was inadequate to operate hospitals with combined bed capacity of 1,000 patients.
Although the resolution of July 27, 1775, placed upon the director general the responsibility, and gave authority for providing the necessary medicines and hospital supplies, Congress, possibly because of uncertainty of the authority so granted, possibly because of its keen desire to assist in every way the successful prosecution of the war, shortly thereafter appointed a committee of five of its members to “devise ways and means for supplying the Continental Army with medicines.” 14 This committee came later to be known as the medical committee and continued to have charge in Congress of all matters pertaining to the medical establishment until it was discontinued and its records, duties, and functions were transferred by resolution of May 28, 1781, to the board of war.15 This committee took an active part in procuring medical supplies during the earlier years of its existence.16 As time passed and the activities of Congress broadened, this committee divested itself more and more of its supply functions and devoted its attention to the personnel and duties of the medical establishment.
PROCUREMENT AND DISTRIBUTION OF SUPPLIES
During the first two or three years after the establishment of the medical service with the Army there was considerable confusion and overlapping of function in the procurement of medicines, instruments, surgical supplies, furniture, bedding, and hospital stores, but especially in the procurement of medicines.17 No plan for a systematic and continuing supply had been evolved. Purchases were made, rather indiscriminately, by the director general, deputy director general, surgeons of hospitals, regimental surgeons, and the medical committee. Even the deputy commissary general was called upon to pay for medicines and occasionally (probably on the selection of a medical officer) to purchase and ship them to designated points on instructions from the department or army commander.
The determination of the types and quantities of the various articles required by the medical service of the Army and their procurement and distribution to that service remained the responsibility of the director general until Congress, by resolve of April 7, 1777,18 directed that it be shared with the deputy directors general of military departments, positions created by the same resolve. These deputy directors general, during the absence of the director general from the department, and with the approval of the department commander, were empowered and directed, either personally or through assistant deputy directors also authorized by this act, “ * * * to provide medicines, instruments, dressings, bedding, and other neccessary furniture, proper diet, and everything requisite for the sick and wounded soldiers amid the officers of the hospitals; to pay the salaries and all other expenses of the same.”
The duties of the apothecary general are nowhere described in detail, but it is probable that he received in bulk, medicines, medicinal herbs, and the paraphernalia of his profession. The medicines were compounded under his
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direction and put up in containers suitable for dispensing by the hospitals and by the regimental medical personnel. Issues of these supplies were made in accordance with instructions received from the director general or the deputy director general of the district in which the issues were made. The apothecaries were not purchasing agents but received their supplies from the director or deputy directors general, or the purveyor.
Provisions, forage, and other like articles were purchased, stored, and issued by the hospital commissary, another position created by the act of April 7, 1777.18 This commissary officer was to be guided in his purchases by the prices paid for like articles by the commissary general and the quartermaster general, respectively, with whom he was required to consult freely. Such of these supplies as were needed by general hospitals were delivered to the hospital steward thereof who distributed them to the patients and accounted to the commissary for them. Supplies needed for regimental hospitals were committed to the care of a steward or medical storekeeper appointed for that especial purpose in each army. Such supplies were obtained by this steward from the commissary of the army or a general hospital upon requisitions signed by the director general or one of the deputy directors general. The steward then distributed them to the using organizations upon instructions from the chief physician and surgeon of an army. Since the latter was charged also with the maintenance of a suitable stock of tents, beds, beddings, medicines, and hospital stores which he received on requisition from the director general or deputy director general, it is probable that the same storekeeper or steward was custodian of both provisions and supplies.
The finances of each district or territorial department pertaining to the medical establishment were administered by a clerk in the office of the deputy director general. This clerk kept the accounts of the several hospitals and received and disbursed under the orders of the director general or the deputy director general of the district the funds provided for the use of the ‘medical establishment in that district.
The director general, by resolve of February 6, 1778, was relieved of all duties in connection with the procurement of supplies, and limited in his activities in this line to determining the quantities required and to issuing the necessary instructions for their procurement.19 The deputy directors general, also, no longer were concerned directly in the procurement and distribution of supplies but were required to appoint assistant deputy directors under them to the immediate and sole duty of providing supplies. Supplies and equipment for the hospitals were divided into two main groups and each group was assigned to one or more assistant deputy directors for procurement. The one group consisted of articles necessary for the care and physical comfort of the patients--beds and bedding, ward and office furniture and equipment, mess equipment, hospital clothing, and the like. The other group comprised articles required by the professional services--medicines, instruments, dressings, herbs, etc. By common consent, apparently, and in view of their particular duties, these assistant deputy directors engaged upon the procurement of supplies came presently to be called purveyors, which title was incorporated later into law and continued in use until the close of the war.
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In the reorganization of the medical establishment provided in the resolve of September 30, 1780, the procurement, storage, and issue of supplies devolved upon a purveyor and one assistant purveyor for the entire establishment.20 The purveyor based his purchases upon estimates furnished him by the director general, now called the director, or by a board of two of the deputy directors general, now called chief hospital physicians. The purveyor purchased or procured all articles necessary for the use of the medical service of the army, regimental as well as hospital. While all articles were grouped under one officer for procurement, the channels of distribution differed somewhat. The grouping of articles for distribution conformed to those under the previous organization. Those for the professional service, medicines, instruments, dressings, and the like, were committed to the custody of the apothecary and his assistants, by whom the medicines were prepared for dispensing. All articles committed to his care were distributed by him directly to the hospitals and the army, upon requisitions approved, in writing, by the director, one of the chief hospital physicians, or the chief surgeon of the army. All medical department personnel were forbidden to use for themselves any of the stores provided for the sick.
The remaining articles procured by the purveyor were stored and issued by him or his assistant upon requisitions approved or instructions issued by the director, chief hospital physicians, chief physician and surgeon of the army, or the senior surgeon on duty at any of the general hospitals.
The functions and responsibilities of the hospital steward in connection with supplies underwent very little change in this organization. The scope of his procurements was somewhat extended and included the procurement of any small article needed by the hospital and not in stock.
By resolve of July 10, 1781, the actual procurement of supplies devolved upon the superintendent of finance,2 which function that official continued to exercise until the close of the war.
UNDER THE CONSTITUTION
From the close of the Revolution to April, 1818, the medical service was without a central organization or head except for two brief periods, 1799-1800, and 1813-14.21 Its affairs, both as to personnel and supply, during that period appear to have been administered by the head of the War Department. Its supplies were procured under instructions emanating from his office by the agencies designated to provide those for the remainder of the military forces. A definite sum for the Hospital Department, beginning with 1791, appears in the annual appropriations for the Military Establishment. Beginning with the appropriations for the year 1802, the title of the appropriation was changed to “Medical and Hospital Department,”22 and has so continued in all appropriations for the support of the Military Establishment since that date.
In 1818 the central office of the Medical Department was established by the appointment of a Surgeon General,23 which office continues. It may be noted, in passing, that the act authorizing a Surgeon General did not define his duties, that detail being left to be fixed by regulation. In September, 1818, orders were issued from the War Department prescribing the duties of the Surgeon General, wherein he was made the director and immediate accounting
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officer of the Medical Department, and defining in a fair amount of detail the manner of procuring, receiving, requisitioning, and accounting for the articles needed in the care and treatment of the sick.24 It was directed therein that the apothecary general and his assistants should purchase all medicines, hospital stores, surgical and other instruments, books, and dressings required for the public service of the Army. Issues were to be made of these articles only upon annual requisitions or estimates furnished by the Surgeon General. Issues, under certain exceptional conditions without specific instructions from the Surgeon General were authorized. Whenever an issue was made it was accompanied by an itemized invoice, of which a duplicate was sent to the Surgeon General. 25
The apothecary general and his assistants were directed to render to the second auditor quarterly returns of purchases accompanied by invoices of the articles purchased, for which they thereupon became both responsible and accountable.25 They could be relieved of this accountability by the receipt of the person to whom the supplies were issued or upon a certificate on honor for such articles as had been expended in the apothecary’s department, stating for what purpose. Responsibility for damaged supplies did not cease until they had been sold. The apothecaries were required to render to the Surgeon General annually, on September 30, a return showing the articles purchased by them during the year and the average price paid for each article.
While a supply table for the use of the Medical Department appears to have been compiled during the Revolution and revised during the War of 1812, it appears to have been observed more in the breach than in the keeping, and the several medical officers requisitioned for the articles and in the quantities which appealed to them, with but little regard to any standard.26 One of the early duties to which the Surgeon General turned his attention was the compilation of a supply table containing all articles necessary for the treatment of the sick and wounded in the military service and fixing the quantities of each article thereon which would be sufficient for routine treatment of 100 men for one year. The list was submitted to the various officers of the Medical Department for comment and criticism and finally published to the service March 20, 1819.27
Requisitions were to be based upon this list, to be made annually and forwarded on December 31, of each year.27 If the surgeon needed articles not on the list, or quantities in excess of those enumerated in the supply table, he noted the reasons therefor in the proper column of the requisition for the consideration of the Surgeon General, who approved or modified the request as he deemed the conditions to warrant.
When the requisitions from the various posts had been received, the apothecary general and his assistants compiled the total requirements, made the necessary purchases, filled the requisitions as soon as the supplies were available, and delivered them to the Quartermaster’s Department for shipment to their respective destinations.28
The office of the apothecary general and his assistants was discontinued in the reduction and reorganization of the military establishment which took place in 182129 Purchases of supplies for the Medical Department thereafter,
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for many years, were made by one of the surgeons of the regular establishment detailed thereto in addition to his other duties. In such capacity he was referred to for a number of years as “the apothecary.” At a later period, about 1839, his title was changed to “medical purveyor.” Although this term occurs in the Army Regulations of 1841 and seems to have been in common use in the Surgeon General’s Office for many years, it did not acquire legislative sanction until the act of April 16, 1862, in which the duties of the medical purveyors were defined and somewhat amplified. By the act of July 17, 1862, they were required to give bonds for the faithful performance of their duties in such sums as the Secretary of War prescribed. The act of July 28, 1866, authorized a chief medical purveyor and four assistant medical purveyors, who, when not acting as purveyors, might be assigned to duty as surgeons upon the orders of the President. These titles and requirements relative to medical purveyors were incorporated in the Revised Statutes of 1878, where references to them appear in sections 1168, 1171, and 1173. The last section provides that “the chief medical purveyor shal] have, under the direction of the Surgeon General, supervision of the purchase and distribution of the hospital and medical supplies.” With the retirement in 1897 of the then chief medical purveyor, the position was not filled and the use of the title was discontinued.30 The medical purveying depots came to be known as medical supply depots. The officer performing the duty of medical purveyor was designated officer in charge of the particular depot to which he was assigned. Of later years this title has been changed to medical supply officer and applied to all officers of the Medical Department in charge of medical sections of general and corps area depots, of depots of purely Medical Department supplies, and of the medical property at general and station hospitals.31
So far as can be ascertained the principal depot for Medical Department supplies has been in New York City since the War of 1812. During the years preceding 1861 practically all medical and hospital supplies were purchased at and distributed from this depot. A supplemental depot existed for a number of years, particularly during the Mexican War, in New Orleans. As the upper Mississippi and Missouri Valleys were settled and military posts were established in that region a small distributing depot was maintained at St. Louis. During the years 1862-1866 the number of medical supply depots increased until at the close of the Civil War there were six principal depots in operation: New York, N. Y.; Philadelphia, Pa.; Washington, D.C.; St. Louis, Mo.; New Orleans, La.; and San Francisco, Calif.32 During the years 1867-1897, inclusive, as the strength of the Army diminished the number of depots was reduced to three, New York, St. Louis, and San Francisco. Such were the number and locations of the depots at the outbreak of the Spanish-American War, at which time a depot was reestablished in Washington, D. C.; a subdepot drawing its supplies from St. Louis was established at Chickamauga, Ga.33
The variety of articles purchased at medical supply depots gradually increased as the years passed, the needs of the hospital increased, and the equipment for them became specialized. Army Regulations of 1841 required the medical purveyor to cause suitable medicine chests to be constructed and
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furnished to hospitals, regiments, posts, and garrisons, and to purchase all medicines, hospital stores, bedding, surgical and other instruments, books, stationery, and dressings, required by the Medical Department of the Army. In 1862 the duties of the medical purveyors were extended, under the direction of the Surgeon General, to include the selection and purchase of all medical supplies, including new standard preparations, and of all books, instruments, hospital stores, furniture, and other articles for the sick and wounded of the Army.34 The standard articles to be furnished out of the appropriation entitled “Medical and Hospital Department” have appeared either in Army Regulations, in general orders and circulars of the War Department, or in the Manual for the Medical Department, approved by the Secretary of War, as its supply table, since 1819. This has included, in the main, all movable articles in the hospital required for its effective operation, as distinguished from the permanent fixtures such as plumbing and lighting fixtures and cooking and heating apparatus, which are supplied from another appropriation. Such fixed apparatus as instruments, dressing, and water sterilizers, and apparatus for the disinfection of bedding, clothing, etc., are now and have for many years been purchased out of the appropriation, “Medical and Hospital Department.”
During the decade which preceded the Spanish-American War the list of articles in the standard supply table had undergone little if any change. The equipment and supplies provided, while limited in variety, were always ample in quantity and were believed to include all articles necessary for the military service in time of peace. New remedies of determined therapeutic value were added from time to time to the supply table, but few preparations were supplied for experimentation, or because of more agreeable taste, or to save trouble in compounding.35 Such care was taken in the use and conservation of both expendable and nonexpendable supplies that expenditures of both were kept at a minimum consistent with the service. The number of articles worn out and condemned during the year was correspondingly small. The personnel of the Medical Department, both commissioned and enlisted, trained in the true essentials of economy, were able to make the most out of everything furnished them and to adapt themselves to their environment with a minimum of inconvenience and a maximum of efficiency. The Army, too, was well trained in this respect, was familiar with all the equipment issued, the uses for which that equipment was intended, and the regulations governing its use and replacement; consequently, expenditures were low.36
As a result of this ability of the personnel of the Medical Department in the care, preservation, and utilization of medical and hospital supplies and equipment, the annual appropriations gradually diminished from $200,000 for the fiscal year of 1888 to $135,200 for the fiscal year 1898. The annual expenditures for medical supplies and equipment declined from an average of $133,041.65 for the three-year period, 1888-1890, to an average of $58,624.19 for the three-year period, 1895-1897, although the strength of the Army remained practically the same, about 26,000. During the latter period, of the $461,500 appropriated, $147,566.11 remained unexpended and reverted to the Treasury.36 This economy was manifested in the meagerness of the supplies carried in the medical supply depots. Purchases for replenishment of stock were made semi-
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annually in the spring and fall, and the amount depended largely upon the quantities included in the annual requisitions. This inevitably resulted in small stocks and the absence of any reserves beyond the needs for current issue, and left the Medical Department wholly unprepared for an emergency such as would result from the mobilization of any considerable body of troops in addition to those of the regular establishment.37
It is appropriate here to refer to the equipment for the Medical Department unit on duty with regiments and smaller organizations of the line of the Army. In the early part of the development of this equipment the Army was small and it seemed proper that the equipment for a mobile hospital of 10 beds be provided for each regiment. Such equipment was revised and improved in 1892 and issued to the larger posts for observation, field tests, and report.38 This equipment consisted of a medical chest, a surgical chest, a mess chest, a food chest, a commode chest, a field desk, and a set of folding field furniture supplied by the Medical Department, and the necessary tentage, cooking and heating apparatus, and shovels, rakes, etc., supplied by the Quartermaster Department.39 This unit hospital equipment was improved and augmented from time to time so that by 1898 it had reached such a state of amplification and perfection that the routine care of the sick of a peace-time regiment in the field could be fairly well provided for by it.
THE SPANISH-AMERICAN WAR
The advent of the War with Spain found the supplies and equipment of the Medical Department at a very low ebb. Its field equipment was in the process of evolution. The bulk of the equipment previously acquired was in the possession of the troops. The stock of such equipment in the depots was but little more than sufficient for 20 regiments.40 New pattern medical chests and surgical chests were developed while the war clouds were gathering, and instructions to purchase a sufficient number to equip the troops were issued as soon as funds became available.41 There was, at that time, no official table of equipment for any medical unit larger than a regimental hospital.41 The field hospital organization developed during the Civil War, which provided all the necessary appliances for the proper care of the wounded for a great battle, without delay or confusion, had completely disappeared.42 The tables of equipment for field hospitals, ambulance companies, camp and division hospitals, evacuation and general hospitals, or the units which corresponded to them, had all to he evolved as the need for them arose.43 None of the articles included in these lists appear to have been in stock in sufficient quantities to provide the initial equipment required. They had to be purchased and the units assembled after war was declared.
Although the appropriation for the national defense was made available in the early part of March, 1898, no orders for medical and hospital supplies were placed, pursuant to instructions from the Secretary of War, prior to the first call for volunteers in anticipation of that call.44 Immediately following the President’s proclamation of April 23, 1898, for 125,000 volunteers, instructions were issued by the Surgeon General to the officers in charge of medical supply depots for the purchase of such medicines, dressings, instruments, first-aid
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packets, furniture for field and general hospitals, medical and surgical chests for field use, mess chests, field desks, litters, hospital stores, and other supplies as were considered requisite for the number of troops called into the service.44 Instructions were issued to the surgeons of all Regular troops to take with them to their respective mobilization camps their regimental field medical equipment and sufficient supplies to last for three months, and most of the surgeons complied with the instructions.45
It early became evident that the rate of muster into the Federal service of the Volunteer regiments would outstrip the rate of delivery of the field medical equipment required for them. A telegraphic appeal was sent May 3 to the governors of the several States to utilize the equipment of the National Guard in the service of the State to outfit the regiments of Volunteers being raised in their respective States until Medical Department supplies were ready for issue. This appeal was granted in so far as the medical equipment of the States would permit. Many of the States had no such equipment and the numbers actually furnished fell, for various reasons, greatly below what had been expected.45 To tide over the period between the actual muster into the Federal Service of the Volunteer regiments and the delivery to them of the standard unit equipment, instructions were issued, May 12, 1898,46 to the medical supply depots at New York and St. Louis to assemble a number of modified equipments, called advance regimental outfits, and to report as soon as the assembly of any of them had been completed. These advance outfits consisted of an assortment of the more essential medicines, antiseptics, and hospital stores contained in the standard medical chests. They were packed in a standard packing box provided with suitable hinges, hasp, and padlock. Sufficient folding field furniture, bedding, hospital clothing, ward utensils, and mess equipment to provide for the patients were also included in this outfit. The New York depot reported May 14, 1898, that 5 outfits were ready and that 25 more would be completed during the following week. The St. Louis depot reported on May 21, 1898, the assembly of 5 such sets, but that they were short some articles. Some of these sets, as well as the completed units in storage, were issued direct to regiments. Others, and probably the greater number, were shipped to the local medical depots at the mobilization camps and there issued under instructions from the chief surgeon of the corps or camp. Additional supplies, calculated from the field supply table for 10,000 or 20,000 men, were shipped to the camp depots from time to time on instructions from the Surgeon General’s Office.
The Medical Department supply division, being accustomed to the economical use of supplies by medical officers of the Regular Army and thoroughly familiar with their ability and willingness to get along with the articles on the standard supply table, did not at first appreciate that the demands of Volunteer surgeons in quantities and variety of articles would be so great as experience developed. In view of the low previous sick rate of the Regular Army, the great morbidity which developed in the mobilization camps was not anticipated, nor was the prolonged stay of the troops in those camps.47 An adequate conception of the magnitude of the task of providing the troops and hospitals with adequate supplies and equipment did not obtain during the early days of
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the war, nor, in the absence of definite plans previously worked out and carefully prepared, was the increase in and the adjustment of the medical supply service to the task imposed upon it so great or so rapid as was needed. Some time, also, was lost in adjusting the methods of procurement to war-time conditions. Some time was lost in the beginning by advertising for bids, but this method was soon discarded for the more expeditious, if less orthodox, method of purchase in the open market, contracts being made only when the sums involved required it.48
In the initial establishment of camps and general hospitals the equipment was shipped under instructions from the Surgeon General’s Office and without requisition.49 Purchases of quantities of supplies in Washington, Baltimore, and Philadelphia were made directly by that office to provide for the immediate needs of the troops at Camp Alger, and the general hospitals at Fort Myer, Va.; Washington Barracks, D. C.; and Fort Monroe, Va. 50 Requisitions were made by telegraph and supplies were shipped by express.51 By the midsummer supplies were being issued with great liberality,52 if not prodigality. Long delays were experienced in the delivery of supplies shipped, due largely to railroad congestion in the vicinity of the camps.52
By the end of September, 1898, 11 general hospitals, with a total capacity approximating 7,000 beds, had been fully equipped, in addition to the supplies required for Cuba, Porto Rico, and the Philippines. In some instances cots and bedding were obtained from the Quartermaster’s Department. The hospitals in the various camps, too, had been equipped and these supplies replenished.53 The expedition of 18,000 men for the Philippines had been furnished their unit equipment and six months’ supplies of the expendable articles. Full equipment for the fixed hospitals in Manila required for these troops and a large reserve of supplies accompanied the expedition and replenishments followed.54
The Army had been rapidly mobilized and it was with difficulty that the procurement and delivery of supplies by any of the supply bureaus could keep pace with the mustering in of the Volunteers and the expansion of the Regular organizations. The transportation systems of the country were very poorly prepared to handle the movement of the supplies it became necessary to ship, and great congestion of traffic at points in the vicinity of the mobilization points was inevitable. New problems thrust themselves upon both the military and the civilian personnel involved in the mobilization and supply.
Years of economy, of limited appropriations, of contracted and contracting methods of administration, made rapid expansion difficult. As a result of the many complaints made to and criticisms of the War Department because of these things, the Secretary of War on September 8, 1898, applied to the President of the United States for a thorough investigation, by an impartial board of ernineilt and distinguished soldiers and civilians, of every bureau of the War Department in connection with the mustering, clothing, supplying, and arming of the troops, contracts, transportation, expenditures and all other things pertaining to the Army. The President acceded to that request and appointed a commission of 10, including its recorder, known as the Dodge Commission.
This commission made an exhaustive investigation of the Army and of its conduct during the war and arrived at some very definite conclusions. Those relating to medical supplies were to the effect, briefly, that the Medical Department, at the commencement of hostilities, had few medicines and practically
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no hospital furniture; that the economy with which it had been administered for years had prevented the accumulation of any reserve stores; that no contracts, even provisional, for needed supplies and equipment had been made during March and April because of lack of funds, since, in the absence of a state of war, no part of the national defense fund could be used for this purpose; that if there had been a stock of supplies available for prompt shipment much of the complaints and wants of the sick and the surgeons would have been prevented; that time was lost in having manufactured standard chests of various kinds for drugs, stores, dressings, furniture, etc., the making of which never equaled the demand for them; that the medicines on the supply table were too restricted; that the shortage of supplies was in many instances due to the lack of knowledge on the part of untrained medical officers of how to get the supplies; that because of the methods of administration evolved through years of strict economy it was impossible for the Medical Department to operate largely, freely, and without undue regard to cost; that the demands made upon the resources of the department were very much greater than had been anticipated, and consequently, in like proportion, those demands had been imperfectly met; and that because of its lack of ability to control the shipment of its supplies it had been seriously crippled in its efforts to fulfill the regulation duty of “furnishing all medical and hospital supplies.”55
The commission recommended, with regard to medical and hospital supplies, that “a year’s supply for an Army of at least four times the actual strength, of all such medicines, hospital furniture, and stores as are not materially damaged by keeping, be held constantly on hand in the medical supply depots,” and that the Medical Department have charge of transportation to such extent as would secure prompt shipment and ready delivery of the medical supplies.56
PERIOD 1900 TO 1916
The Medical Department took very seriously the findings amid recommendations of the Dodge Commission and set about correcting the defects and in initiating measures to make effective the recommendations relative to a reserve of supplies. The occupation of tropical territory called for intensive studies in sanitation and the prevention of disease. These studies called for and were followed by studies in equipment, its procurement and distribution. The expanding Army, too, made necessary the development of unit equipment for the organizations which that expansion called into being.
UNIT EQUIPMENT
During the War with Spain the use of the regimental hospital unit of equipment with brigaded or division troops was discontinued and a larger local unit under the title, division hospital, was substituted, following the plan of the latter part of the Civil War.57 This hospital had a capacity of 200 to 250 beds. The regimental hospital continued in use with those regiments which were stationed apart from other regiments. The equipment of the regimental hospitals had been utilized in the establishment of the division hospitals, Consequently when the Regular Army regiments joined their stations they had but
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little medical equipment. Regimental field hospital equipment was again assembled and issued to a number of posts. This number was at first 19, but later was increased to provide one such equipment at the headquarters of every regiment within the continental limits of the United States.58
The Manual for the Medical Department for the year 1898 provided a meager equipment for a brigade or division hospital and for an ambulance company.59 In the revision of the manual, published in 1902, extended study was made of the equipment of this unit, which was given the title, field hospital. The equipment provided for 108 beds instead of the 200 to 250 of the former brigade or division hospital, and included supplies considered to be sufficient for 5,000 effectives for three months. The equipment of this unit was packed in specially designed cases, chests, and field desk. It contained not only medical and surgical supplies, surgical instruments, folding ward furniture, bedding and clothing, and mess and cooking appliances, but also bathtub sets, an acetylene illuminating outfit, microscope and microscopical accessories, and a water sterilizing outfit. A separate equipment especially designed to provide for first-aid treatment and refreshment of the wounded and their transportation to the rear was provided for the ambulance company. The equipment of the regimental hospital was revised and improved and its capacity reduced to six beds.60
The studies on supplies and equipment continued, and a revision of the supply table and tables of equipment appears in the Manual for the Medical Department, 1906, together with a description of the duties and regulations for each unit. In this manual the studies of equipment are carried to units which functioned between the units of the division and the general hospitals established for the definitive and final treatment of the seriously disabled. The equipment of the field hospital remains at 108 beds, but it is considered as a unit of mobility intended for primary treatment only.61 A larger unit intended for more complete and prolonged treatment is provided under the title stationary hospital. This unit has a capacity of 324 beds and is more elaborate than the field hospital. It also is essentially a mobile unit capable of being housed under canvas and moving at short notice. While an effort was made to provide as great comfort as possible for the patients, it was necessary, in order to provide for ready and rapid removal to points needed, to keep the weight and bulk of the equipment at the minimum. The equipment for this unit was supplied in part by the Medical Department and in part by the Quartermaster’s Department. The latter furnished the vehicles, animals, harness, tentage, cooking and heating apparatus, and the implements for policing the hospital area. The Medical Department furnished the remainder. The weight of the articles furnished by the Medical Department, packed and ready for shipment, approximated 40,000 pounds, and that of the articles furnished by the Quartermaster’s Department approximated 18,000 pounds, making the aggregate 58,000 pounds.62
The need for an agency to make prompt delivery of medical supplies to the units at the front also received consideration, and equipment and supplies therefor were provided under the title, advanced supply depot. The weight of this equipment, all of which was supplied by the Medical Department, approximated, when packed for shipment, 12,000 pounds. The equipment of this
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unit was intended to provide a reserve supply of medicines, dressings, hospital stores, stationery, etc., for the division, including the field hospitals.63
The attitude toward the regimental hospital changed materially in the 1906 edition of the manual. A full field hospital equipment was contemplated for regiments serving alone, but the equipment of regiments brigaded in camp, where the facilities of the field hospital or stationary hospital were available, were limited to that of infirmaries giving dispensary service only.64 All cases requiring hospitalization were sent to the camp hospital. The total weight of the infirmary equipment, exclusive of tentage for personnel, rations, and forage, was approximately 1,700 pounds as against 4,161 pounds for the hospital equipment.
At the large camps of mobilization at the base whence military operations were to be undertaken, a larger hospital of 500 beds was contemplated, to be known as a base hospital.65 Ordinarily it was to be housed in suitable buildings, but in the absence of such it might be housed under canvas. The equipment provided for this unit was of the same field type as that for the stationary hospital, but was correspondingly more ample. The weight of the equipment of this unit as packed by the Medical Department was approximately 54,000 pounds. The equipment furnished by the Quartermaster’s Department weighed approximately 24,000 pounds, an aggregate of 78,000 pounds.
The equipment of the ambulance company was but little changed in this edition of the manual.
An equipment was provided for the office of the chief surgeon of a corps, division, or brigade.66 It consisted essentially of folding field office equipment, chairs, desks, tables, typewriters, etc., stationery, record books, and blank forms.
The next revision of the Manual for the Medical Department (1911) contains no new unit equipment. The name of the stationary hospital was changed to evacuation hospital, a title more nearly descriptive of its function. The advanced supply depot became more appropriately “reserve medical supply.” There was a gradual increase and amplification in the equipment of the less mobile units and an improvement in its type. The weight of the field hospital equipment furnished by the Medical Department was reduced to 8,105 pounds. The weight of medical supplies in the evacuation hospital was about the same as the stationary hospital which preceded it but its gross weight increased to 65,960 pounds. The gross weight of the base hospital was increased to 92,143 pounds. The standards for the regimental hospital and infirmary had not been changed. The standard supply table for fixed or stationary hospitals had undergone some change. The dental equipment was revised and the manner of packing improved.67
The whole trend of the period was along the line of improvement in type and quality of supplies furnished. Inspection of supplies delivered became increasingly more careful and rigid although the methods of procurement continued unchanged. As the quality of supplies improved the number of persons bidding increased. Fair dealing and promptness in paying bills engendered a better spirit among the contractors for medical and hospital supplies. Study was given at the depots to the development of tests and analytical methods to
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determine the qualities of the different articles of supply and whether they conformed to the standard samples upon which the invitations to bid were based. Except for the drugs listed in the United States Pharmacopeia there were no detailed specifications for any article purchased. All purchases were based upon sample. In the acceptance of the articles delivered was the matching of wits between the buyer and seller. By applying the general principles of analysis in the examination of all articles the description of or specification for any particular article became, from invitation to invitation, more detailed and more complete. As these specifications grew they were written into the contracts and the contractual stipulations enforced. If the deliveries met the requirements of the stipulations they were accepted. If they did not meet these requirements, the articles were rejected and the requirements were enforced at the expense of the contractor. The bulk of the business at this time was transacted through jobbers or firms which specialized in Government contracts. The manufacturer and wholesaler rarely bid upon textiles, chinaware, furniture, or even medicines. Surgical instruments, operating room and ward furniture and equipment were for the most part from the manufacturers.68
In providing medical supplies for the troops in Cuba, in Hawaii, in the Philippines, and in the Boxer rebellion in China, much valuable experience was gained by the various medical officers having duties in connection therewith. The purchase of the medical and hospital supplies required during the construction of the Panama Canal also added to this experience. An effort was made to train medical officers for the supply service of the department, but the chronic shortage of medical officers prevented this effort from coming to full fruition and the number so trained was pitiably small. Nevertheless they served to form the nucleus of the organization which developed in 1916-1918, and to train and direct the new men called into service during those years.68
The revision of the standard supply table in 1916 introduced new equipment for the medical officer and the enlisted men of the Medical Department. The orderly pouch and the Hospital Corps pouch gave place to a web belt with pockets in it in which were carried the essential articles formerly carried in the pouches. The belt for the medical officer provided him with the medicines and the few simple instruments required in rendering first aid.69 The regimental hospital and regimental infirmary equipment gave way to a regimental combat equipment intended only for first-aid and dispensary treatment and the evacuation of the wounded from the firing line to the regimental aid station.70 A camp infirmary equipment was provided for use in camp. Camp dispensaries were established with these equipment`s. A reserve stock of medicines was provided for these dispensaries. No case was to be hospitalized at these dispensaries; all cases requiring hospitalization were to be sent to the field hospital serving the division for the time being, or to the camp hospital.71
RESERVE EQUIPMENT
While the studies of the articles appropriate to the various unit equipment`s were in progress, procurements were not neglected. The quantity of equipment recommended by the Dodge Commission to be kept in reserve was the goal. For years no specific appropriation was made for this purpose, and every dollar which could be saved in the administration of supplies for post
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and general hospitals was used to purchase the reserve equipment. Being convinced that the system of unit equipment was the correct method of furnishing equipment to new organizations, every effort was made to assemble a given number of such units in proportion to the needs from front to rear. The number of regimental units kept pace with those for the division, the corps, and the army. One field hospital and one ambulance company equipment were provided for a definite number of regiments. Evacuation hospitals had a definite ratio to the units required for the division. In 1908 a special appropriation of $200,000 was made by Congress to enable the Medical Department to procure its needed reserve equipment.72
These unit equipments of every type were assembled complete with every article which would not deteriorate with storage and kept at the supply depots in readiness for immediate issue upon telegraphic instructions from the Surgeon General so to do. So effective did this system prove that, during the Mexican border mobilization in Texas in 1911, the entire medical equipment for 20,000 men was at the mobilization point eight days after telegraphic instructions were sent to the St. Louis depot to ship it. Perishable articles, such as ether, chloroform, and rubber goods, were not stored with the unit equipment but were taken from stock on hand at the time of shipment of such equipment.40 Articles pertaining to the Quartermaster Department were requisitioned by the supply depots and incorporated in the unit equipment as it was assembled.
By the end of 1915 these unit equipments, sufficient to provide for 11 divisions, were in storage at various points within the continental United States. A number of them had been distributed to National Guard organizations,40 and were taken with these organizations during the border mobilization in 1916. Nevertheless, because of lack of funds, it was impracticable to bring the reserve equipment up to the limit prescribed by the Dodge Commission.72
WAR-TIME PROCUREMENT PLANS
Studies on war-time procurement appear to have had their beginning in November, 1902, and to have been instigated by a request from the Army War College board for the quantity of medical and hospital equipment which should be on hand to equip armies of 150,000 and 250,000, respectively, and fit them for field service in the event of sudden and unexpected hostilities.73 The officers in charge of the medical supply depots were called upon for a report of the quantities of articles of war materials habitually carried in stock by manufacturers and dealers, the manufacturing facilities for such articles and the probable period within which contracts therefor could be filled.74 Based upon these reports and upon studies conducted in the Surgeon General’s Office, lists of equipment required by Medical Department units with armies of the strengths given were prepared and transmitted, with the estimated cost of such equipment, to the Army War College the latter part of January, 1903.73 The need for an adequate reserve of such equipment was stressed in this report and its great expense indicated. Such reserve was to be held at the nearest base in the event of hostilities.
These studies continued and a new list and estimate of cost of equipment were prepared in 1906 on the basis of a definite number of organizations and mobilization rate. As material changes in tables of equipment for medical
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units were then in preparation, a revised list was furnished the Army War College the following year.75 In 1908 another list of equipment and supplies for an army of approximately 500,000 as initial equipment and maintenance was prepared.76 The cost of these supplies and equipment for the combatant troops was estimated at $5,545,054.32. Those for the transport columns, line of communications, and general hospitals was estimated at $2,214,924.66, making a total estimated cost, on the basis of the then tables of equipment and allowances, of $7,759,978.98.
The National Guard of the several States was provided with unit equipment for divisional units whenever requested by the governor of the State. The Medical Department was reimbursed for the equipment so issued out of funds appropriated annually for arming and equipping the militia, and apportioned among the several States for that purpose.77 The moneys received by the Medical Department from these reimbursements were promptly reinvested in similar supplies for stock and new unit equipments assembled to replace those issued to the National Guard. Some of the National Guard organizations were equipped in this manner.
Considerable study was devoted in 1913-14 to the preparation of comprehensive and definite plans for the procurement of medical and hospital supplies in time of war. These plans were submitted to the Chief of Staff for consideration and file in the War College. They were approved July 21, 1914.78 These plans contemplated that the unit system of supply whereby a definite unit of organization could be furnished with its proper unit of equipment with a minimum loss of time would be observed and that as many as possible of these completed units would be assembled and stored in the various medical supply depots where they would be available immediately for issue. It was assumed (1) that the Regular Army would be increased to its maximum strength; (2) that the Organized Militia at war strength would be mustered into the service in advance of any Volunteer forces; (3) that all troops, Regulars, Militia, and Volunteers, would be fully equipped with the necessary sanitary units at mobilization or concentration camps, before their departure for the scene of operations; (4) that all the sanitary equipment on hand with the Regular Army and the Organized Militia would be accounted for in the mobilization, and the Medical Department would consider only the completion of imperfect units or the supply of new units where necessary; and (5) that the Volunteer forces to be organized would be supplied from medical supply depots, advantage being taken of the interval elapsing between the declaration of war and the mustering in of the Volunteers to replenish depleted stock and assemble new sanitary units where necessary.
Studies on requirements were continued from time to time. On June 12, 1915, estimates were furnished the Secretary of War of the materials required, in addition to those on hand, to equip 21 Infantry divisions, 7 Cavalry divisions, and the requisite army troops, and the approximate cost thereof required for equipment and maintenance of the Medical Department units therein.79 These estimates indicated a cost of $2,308,635 for unit equipment, $1,401,546 for maintenance of the field force, and $2,128,000 for base hospital equipment.
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In furnishing additional information to The Adjutant General, August 20, 1915, on the quantities of field supplies required to equip one Infantry division and one Cavalry division, respectively, under the heads of (a) those obtainable in the market at any time; (b) those obtainable on 15 days’ notice; (c) those obtainable on three months’ notice; and (d) those not obtainable within three months, the following principles were stated by the Surgeon General: That a limited quantity of every item on the supply table could be purchased in less than 90 days; that in every field unit there were components which could not be purchased in any considerable quantities within three months, such as special cases and containers, because they are not common articles of commerce and must be manufactured to order; that after the receipt of the containers at the supply depots, a considerable time would be required in which to fill them with their component articles and pack them for shipment.80 These principles again were stressed in a letter from the Surgeon General to The Adjutant General, September 8, 1915, in response to a request for a list of the articles of equipment which could not be procured with reasonable quickness and should be kept in reserve.80
DEPOTS FOR RESERVE SUPPLIES
The question of storage space for the reserve equipment was one of considerable moment on account of the expense involved in the rental of the necessary buildings. The space in Government-owned buildings was very limited, and the expense of construction considerable. An intensive study was given this question in 1910-11, and the requirements of the several supply bureaus in the amount of storage space required for reserve equipment were determined.81 The storage requirements of the Medical Department were found to approximate 23,000 cubic feet per division. In this study, unit assemblage was urged by the Surgeon General, who reported that the Medical Department was prepared to furnish complete field equipment for 10 divisions of troops. The plan eventually approved by the Secretary of War contemplated the establishment of depots of reserve supplies within those areas in which troops would be mobilized in the event of war. These depots were to be known as field supply depots and located at strategic points. Field supply depot No. 1 was to have been established at Philadelphia, Pa. In it were to be stored all kinds of supplies required to equip and maintain the troops, Regular Army, Militia, Volunteers, to be organized in the then Department of the East. The depot was to he commanded by an officer of the Quartermaster Department especially selected therefor by the Secretary of War. An authoritative list of supplies, to be known as the standard list of field supplies, was to have been furnished this depot commander by the various supply bureaus using the depot for storage purposes. It was not contemplated that issues to meet current needs would be made from this depot. If, and when, mobilization was ordered, the necessary supplies were to be shipped in bulk to mobilization points and there distributed to the troops. At later dates, as appropriations became available, it was contemplated that other depots of like character would be established--No. 2 at Jeffersonville, Ind.; No. 3 at Atlanta, Ga.; No.4 at Omaha, Nebr.; No. 5 at San Francisco, Calif.; and No. 6 probably at
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Springfield, Mass. The articles of medical equipment which it was at first intended to store at field supply depot No. 1, Philadelphia, under this policy were 25 field hospital, 22 ambulance company, 13 evacuation hospital, 7 reserve medical supply, and 80 regimental hospital equipments. For various reasons the supplies actually ordered to that depot were limited to litters, brassards, and first-aid packets.81 The articles, however, eventually were returned in July, 1916, to the Field Medical Depot, Washington, D. C.82 No measures looking to the establishment of the contemplated field supply depots Nos. 2 to 5 were taken. Only such changes were made in depot arrangements, prior to April 6, 1917, as were required from time to time by the military situation along the Mexican border.
The total number of unit equipment`s available at the end of December, 1915, were:
Evacuation hospitals................. 24 Base hospitals...................................... 3
Field hospitals......................... 46 Ambulance companies (less
Medical reserve supply............ 15 transportation)..................................... 45
Ambulances............................ 180 Regimental infirmaries........................... 101
Brassards...............................30, 000 First-aid packets.................................562, 000
MEXICAN BORDER MOBILIZATION
Because of the political unrest in Mexico which followed the fall of the Diaz régime, in 1911, a large part of the mobile forces of the United States was assembled along the Mexican border, so that by 1916 more than 40,000 of our troops had occupied that area.83 Temporary stations or camps were established at various strategical points, such as Eagle Pass, Marfa, and Harlingen, Tex.; Columbus and Hachita, N. Mex.; Douglas, Nogales, and Yuma, Ariz.; and Calexico, Calif.84 The hospitals at these posts were provided with standard medical post and field equipment and supplies commensurate with their needs. These supplies and equipment the senior medical officers with the commands obtained upon requisitions in the prescribed form forwarded at the customary periods to the department surgeon. The greater part of their supplies and equipment came from the medical supply depot at St. Louis, Mo., but special articles were sent directly from the medical supply depots at New York and Washington from time to time as occasion required. Each principal camp had essentially the equipment of a regimental hospital which, being compact and limited in amount, could be packed for transportation in a very short time. To minimize the delay in delivering to Medical Department personnel with these troops supplies needed in emergencies which were liable to arise from sudden and unexpected movements of the troops, and to care promptly for any casualties should hostilities actually occur, reserves of medical field equipment and supplies were kept at convenient points along the border. Thus, two evacuation hospitals, a reserve unit of medical supplies, and 10 modified regimental infirmaries were stored at the hospital at Fort Sam Houston, Tex.; a reserve unit of medical supplies was kept at the hospital at Fort Bliss, Tex., and another at the hospital at Fort Huachuca, Ariz.85 These units were kept replenished and in complete readiness for immediate use. No medical supply depot was maintained in the Southern Department, except for short periods at Fort Sam Houston, Tex., during the mobilization of the provisional division at that
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place in 1911, and at Galveston, Tex., in 1913-1915, during the mobilization at Texas City, Tex., and the expedition to Vera Cruz, Mexico.86
The sending of the punitive expedition into Mexico immediately following the memorable raid by Francisco Villa and his followers upon the town of Columbus, N. Mex., March 9, 1916, with the subsequent mobilization of the National Guard on the border, marks the beginning of the expansion for the supply bureaus of the War Department, which, in so far as supplies were concerned, merged imperceptibly into the greater expansion of 1917-18. The experiences gained by the supply service of the Medical Department in 1916 proved of inestimable value in 1917-18, and demonstrated the correctness of the principle of unit equipment.
A medical officer was ordered to Fort Bliss in April, 1916, 87 to look after the increasing volume of supplies and issues from the augmented reserve unit of medical supplies at Fort Bliss, and to make the disbursements of Medical Department funds in that locality which it was anticipated would he required. The supplies of this reserve unit were stored in the basement of the hospital at that post. This hospital had been designated a base hospital and was being rapidly expanded to take care of the sick from the troops in that locality and the more serious cases from the punitive expedition and needed all the available storage space for its own supplies and equipment. It was anticipated that this reserve unit would make frequent issues to the punitive expedition.88
The storage space at Fort Bliss did not exceed the immediate and urgent needs of the post. None could be spared for the medical supply depot. The location of the post was inconvenient and unsuitable for a rapid and expeditious distribution of supplies. It was necessary, therefore, to find quarters for it in El Paso and to obtain authority for its rental. An ideal fireproof warehouse could not be found, but a fairly satisfactory two-story and basement brick building of loft type and mill construction was secured.89 The supplies of the reserve unit were promptly transferred to the new depot. Requisitions for stock were forwarded through the usual channels May 6 and 29 and June 16 and 20 and subsequently thereto as the needs required. 90
In addition to the supplies requisitioned by the medical supply officer, there were shipped to this depot, upon the requests of the department surgeon of July 5 and 14, the equipment of 1 complete base hospital with 500 iron bedsteads and hair mattresses, 9 evacuation hospitals, 4 reserve medical supply units, and 4 division surgeon’s offices.91 Thirty-eight ward units and a number of motor ambulances were received under instructions from the Surgeon General 92 and properly stored. The base and evacuation hospitals and reserve units of medical supplies were held in reserve against a possible intervention and resultant hostilities in Mexico.91
At the request of the surgeon of the Southern Department the establishment of a medical supply depot at the base hospital at Fort Sam Houston, Tex., was authorized June 1, 1916, and a medical officer on duty at that hospital was detailed in charge of it.93 Reserve medical supply unit No.11, then in storage at that point, was utilized for the initial equipment of this depot. These supplies were augmented from time to time by requisitions from the medical supply officer through usual channels.
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With the prospect of the early mobilization of National Guard troops in the Southern Department it became evident that the storage space available at Fort Sam Houston for the use of the medical supply depot would be wholly inadequate. Steps were taken during the latter part of June to obtain suitable office and warehouse space for the depot in San Antonio. A nucleus of trained depot employees was transferred to this depot from other medical supply depots.94 Upon telegraphic request from the department surgeon, the medical supply depot at Washington was directed, on July 18, to ship by freight to the San Antonio depot five times the quantities of expendable articles for a base hospital listed in the Manual for the Medical Department (1916, par. 891), to expedite the shipment, to make open-market purchases if necessary, and to purchase the most satisfactory substitutes if the standard articles were not available. On the same date similar instructions were wired to the medical supply officer at New York to ship twenty-five times the annual allowance of expendable post supplies for posts of 1,000 as listed (pars. 843 to 848, inclusive, M. M. D. 1916) and ten times the annual allowance of nonexpendable post supplies (pars. 844, 845, and 847, same manual), excepting certain articles.95
Two calls for the mobilization of the National Guard were issued in 1916. The first call was issued May 9, and was limited to the National Guard of the States of Texas, Arizona, and New Mexico.96 The mobilization points for these troops were designated by the commanding general of the Southern Department under the terms of the call. The second call was issued June 18, designated units and mobilization points, and included all States except Texas, Arizona, and New Mexico. The object in specifying the units in the respective States to be included in the second call was to exclude units which up to that time had failed to receive Federal recognition. Such of these units as later received recognition were called into the Federal service.97 The mobilization points for the several States had already been determined, and although a few of them were changed later to more suitable localities, the mobilization occurred as previously planned. In order that adequate medical supplies and facilities might be available for the organizations as they arrived, under instructions of June 19, from the Surgeon General, a field hospital equipment was sent to camps where it was known that no organized and equipped field hospital of the National Guard was present. Every regiment of the National Guard was presumed to have with it a regimental hospital or infirmary equipment and its regimental medical personnel. Upon this personnel and the supplies in the regimental equipment these troops were expected to depend until the arrival of the field hospital equipment. Under verbal instructions from the Surgeon General the Army Medical School at Washington, D. C., forwarded on June 20, by mail or express to the various mobilization camps, sufficient quantities of typhoid vaccine to immunize the number of men expected to report at the respective camps. Additional quantities of this vaccine were forwarded from time to time upon the request of the camp surgeons. Smallpox vaccine was supplied to these camps as needed upon requests by the camp surgeon to the surgeon of the department in which the camp was located.97 At camps where a shortage of medicines occurred pending the arrival from the medical supply depots of the field hospital equipment, authority was granted the camp surgeon for the
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local purchase of such medicines as might be required. Replenishment of supplies in the regimental equipment was obtained upon requisitions initiated by the regimental surgeon and forwarded through the camp surgeon. If the articles were not available in the camp hospital such requisitions were forwarded through the department surgeon to the Surgeon General, who directed the issue from the appropriate depot.97 As rapidly as the organizations completed their physical examination, equipment, and muster into the Federal service, they were forwarded to their designated station in the Southern Department. Thereafter they received their medical supplies in the manner already described. As rapidly as the mobilization camps were emptied of troops the medical equipment pertaining to the camp hospital was shipped to the depot from which it originally came.97
Some items of field equipment were listed in the Manual for the Medical Department, 1916, which had not appeared in the previous edition and consequently were not available for issue to sanitary units upon the distribution of the 1916 Manual. Being new items, the sources of supply had to be developed. Shortages of materials and parts contributed to the difficulties of contractors in completing their contracts. This was particularly true of packmule boxes, ambulance boxes, and the boxes for the venereal prophylaxis units. Surgical and dental instruments were difficult to obtain, as will be discussed in detail in the chapters devoted to those subjects. While these articles were not in themselves particularly essential to the treatment of the sick, since their contents were readily obtainable on requisition, the unit equipment of the sanitary organizations could not be completed without them. The inability of the depots to furnish these articles gave rise to a great number of back orders, a large amount of correspondence, and some dissatisfaction.
The expansion of the base hospital at Fort Sam Houston had taken place before the arrival of supplies at the San Antonio depot, and the equipment of that hospital was obtained on requisitions, formal and telegraphic, forwarded to the Surgeon General. The bulk of its equipment was shipped from the New York medical supply depot. After August, however, requisitions from that hospital were referred by the department surgeon to the San Antonio depot for issue for such articles as were carried by it. Requisitions for large quantities of supplies and for articles not stocked by the local supply depot continued to be sent to the Surgeon General for reference to other depots for issue.98
MOTOR AMBULANCES
Motor ambulances were utilized for the first time in the field service of our Army during this mobilization. Abundant opportunity offered in which to determine the value and limitations of such transportation. The conditions under which they were required to operate were as severe as could well have been devised. They traversed a desert country where roads were either absent or at best were mere trails; sand and deep chuck holes filled with dust frequently were encountered. Patients had to be evacuated great distances over these seemingly impassable roads. The strains to which the vehicles were put over the route from Columbus, N. Mex., to Namiquipa and El Valle, Mexico,
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and the experiences gained thereby proved of great advantage in the later developments of the motor ambulance as it finally evolved during the participation of the United States in the World War.
Almost as soon as it was known to the Surgeon General that an expedition was to be sent into Mexico, a telegram was sent to the department surgeon of the Southern Department inquiring whether motor ambulances were needed for Mexico and if so to whom they should be sent.99 It may be stated here, in passing, that the appropriation for the support of the Army for the fiscal year ending June 30, 1916, approved March 4, 1915, contained authority, under the title of “Medical and Hospital Department,” for the purchase of motor ambulances, and at the request of the Surgeon General, a board of three medical officers was appointed at Washington, D. C., in July, 1915, for the purpose of investigating and reporting upon the motor ambulance best adapted for use in the military service.100 The department surgeon desired that six motor ambulances each be sent to Ambulance Companies Nos. 3 and 7, at Columbus, N. Mex.99 Telegraphic instructions were sent March 11, to a medical officer at Fort Leavenworth, Kans., to purchase five Ford motor ambulances and trailers.101 One such ambulance and trailer designed by this officer, previously had been purchased, examined, and tentatively accepted by the ambulance board, and was in use at Walter Reed General Hospital, Washington, D. C. This machine was at once shipped to Columbus, N. Mex., for Ambulance Company No. 3. Of the five ambulances purchased and shipped to Columbus, N. Mex., April 7, two were consigned to Ambulance Company No. 3 and three to Ambulance Company No. 7. 101
The medical supply officer at Washington was instructed, on March 13, to purchase in open market as an emergency measure six motor ambulances and trailers conforming to specifications which he would receive from the ambulance board. These instructions were supplemented by further instructions of March 18, to purchase 10 more motor ambulances with trailers in accordance with specifications from the motor ambulance board. These instructions to the medical supply officer were followed March 24 by instructions to ship 6 of the motor ambulances and trailers to Columbus, N. Mex., consign 3 to Ambulance Company No. 3, and 3 to Ambulance Company No. 7, 4 ambulances and trailers to the surgeon, base hospital, Fort Bliss, and 6 to the surgeon, base hospital, Fort Sam Houston.102 The surgeon, medical base group, Columbus, N. Mex., reported the arrival of the 6 motor ambulances at that base on April 18, and the trailers and spare parts on April 20.103 The ambulances and trailers for Fort Bliss were shipped from Philadelphia, Pa., on April 28; those for Fort Sam Houston, May 5. 104 The Ford ambulances having been found too light and otherwise unsuited to the heavy service in Mexico, no more of them were purchased at that time.105 Further purchases of ambulances of the large type were made from time to time until the end of July, when such purchases were suspended by the Secretary of War pending a decision upon the policy of motor equipment for division trains.106 This was brought up by a request of the commanding general, Southern Department, for touring cars for use of the commanding officer’s of motorized ambulance companies and for the substitution
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of two motor trucks of 1½ ton capacity for the wagon transportation of ambulance companies and eight motor trucks of equivalent capacity for the wagon transportation of field hospitals. This motor equipment was allowed Field Hospital Company No. 7 and Ambulance Company No. 7, as an emergency measure on account of the exceptional conditions under which they were operating.107 Approximately 200 motor ambulances had been purchased or were in the process of being purchased at the time the suspension of purchase was directed by the Secretary of War. Some of these vehicles were issued to camp and station hospitals, to the Philippine and the Hawaiian Departments, and the remainder were placed in storage at the medical supply depots at St. Louis, San Antonio, and El Paso.108 Some of the ambulances were released later for issue to Ambulance Company No. 1 at El Paso, Tex.109
The majority of the chassis purchased during 1916 were model 15, ¾-ton truck, built by the General Motors Truck Co., of Pontiac, Mich. While this G. M. C. chassis had a few defects, it proved on the whole to be satisfactory and the experiences gained on the border enabled that company to perfect their model 16, ¾-ton truck chassis, which ultimately became the standard chassis for the large motor ambulance.
DEFICIENCY APPROPRIATIONS
The funds available to the Medical Department for the performance of its mission during the period of the border mobilization were included in the annual appropriations for the support of the Army during the fiscal years ending June 30, 1916, and June 30, 1917, under the title Medical and Hospital Department, and urgent deficiency appropriations were made as the mobilization progressed. These funds were available for the immediate use of the sick and wounded, including motor ambulances for their transportation when necessary. The funds with which to provide shelter or housing for the sick and wounded, in short for hospitals, were contained in another appropriation under the title, “Construction and repair of hospitals,” listed among the appropriations for the Quartermaster Department, in the same annual appropriations for the support of the Army.
The appropriation, “Medical and Hospital Department”, for 1916 was $750,000, based on a total military force of 100,000 officers and men.110 This sum was equivalent to an allowance of $7.50 per man per year. This figure had been the approximate basis of appropriations under the title for several years. This appropriation for the fiscal year 1916 included, for the first time, among the purposes for which it might be used, a provision for the purchase of motor and other ambulances, their maintenance, repair, and operation. It was under this authority that the purchase of motor ambulances already noted was made.
Immediately following the entry of the expeditionary force into Mexico, Congress passed a joint resolution authorizing the filling of existing organizations of the Army to war strength.111 This contemplated an increase of approximately 20,000 men. To cover the expenses of the Army incident to this increase a deficiency appropriation act was passed on the last day of March in which was included the sum of $37,500 under the title, “Medical and Hospital
35
Department,” and applicable to the same purposes as the annual appropriation act for the then current fiscal year.112 This sum was determined upon the needs of 20,000 men for three months at the rate of $7.50 per man-year.113
The circumstances which led to the calling of the National Guard into the Federal service in June, under the provisions of the national defense act, made it immediately imperative to incur large obligations for which no funds had been appropriated, specifically for motor ambulances for the proper equipment not only of the mobile troops of the Regular Army but also of the Militia when mustered into the Federal service. Because of the manifest urgency of the need, the Surgeon General on June 22, requested authority to incur a deficiency of $1,584,000 for medical and hospital supplies to cope with the situation. The number of ambulances estimated as necessary to equip three of the four ambulance companies for each division at the rate of 12 ambulances and 1 repair car per company, less the number of ambulances already purchased, was 792. The estimated cost per ambulance complete was $2,000. This request was approved by the Secretary of War on June 24 and deficiency estimates in the sum of $1,584,000 were forwarded the same day. The Surgeon General was informed on July 11 that the funds were available.114
In response to an inquiry of June 15, 1916, from The Adjutant General for the amount of funds which would be needed by the Medical Department immediately upon the outbreak of War for an army of 500,000 men, including the Regular Army and the National Guard, the Surgeon General reported on June 19 that, for the initial equipment of this force, there would be required 207 combat equipments, 150 infirmaries, 103 ambulance companies, 68 field hospitals, 44 divisional medical supply units, 36 evacuation hospitals, 27 base hospitals, 100 general hospitals (on the basis of 10 per cent of the strength of the Army), 2 hospital ships, and 10 hospital trains (equipment only).115 This initial equipment, it was estimated, would cost $6,535,632.55, without any provision for maintenance. Maintenance for a year would add $4,000,000 more. The total of these two sums, less $2,000,000 included in the annual appropriation bill for 1917 for the support of the Army and the $1,584,000 in the urgent deficiency bill, both of which were then pending, would leave $6,951,632.55 to be provided. Before the annual appropriation bill was passed the amount allowed the Medical and Hospital Department was increased to $4,500,000, of which $500,000 was for hospital construction purposes.116
PORTABLE DENTAL OUTFITS
Following the passage of the act of February 2, 1901, (31 Stats. 752), authorizing the employment of contract dental surgeons, a section of dental supplies and equipment was added to the standard supply table of the Medical Department. Since an insufficient number of such dental surgeons had been authorized to provide one for every one of the established military posts, it became necessary, if the troops everywhere were to receive dental attention, to assign to many of the dental surgeons a number of military stations which they would visit on itinerary, spending so much time at each as the immediate needs of the command indicated. It was also impracticable to provide at all these stations, and particularly those of small size, a dental outfit such as was
36
used in civil life and authorized for the large stations where the services of a dental surgeon were continuously required. No good reason could be seen why the individual dental surgeon should not have a portable outfit of such character and completeness as would enable him to perform all emergency work, extractions, filling, and the less complicated artificial dentures. Such an outfit was developed and issued under the title, “portable dental outfit.”117
This outfit consisted essentially of a foot-power dental engine, capable of being sufficiently dismounted to permit being packed in a small case about the size of and somewhat resembling an ordinary suitcase; a folding dental chair with canvas seat and back, and provided with a suitable adjustable headrest, all packed in a wooden case which became the base of the chair when set up; two fiber covered chests with compartments and trays in which were carried a suitable assortment of tooth extracting forceps, hurs, and other dental instruments; and a fiber-covered supply chest of sufficient size and divided into compartments suitable for the apparatus, dressings, and other articles necessary for a fairly complete dental office. The complete list of contents of such outfits may be found under appropriate titles in the Manual for the Medical Department for the years 1911 and 1916. One complete outfit was issued the dental surgeon upon entry into the service and accompanied him upon on his itinerary wherever he went. To insure that the outfit would be available upon arrival at a station on this itinerary it was customarily shipped by express. Because of the character of the chests and the great variety of articles included in the set a considerable time was required in which to purchase the articles and assemble the unit. Consequently the issue of such equipment, unless already assembled when request for it was received, was slow, and unless complete it was of but little value.
WARD UNIT a
Since the unit system so greatly facilitated communications by telegraph, relative to equipment, the officer in charge of the reserve medical supply depot at Fort Bliss, at the suggestion and with the collaboration of the surgeon of the base hospital at that post, prepared a list of articles commonly used in hospital wards and designated it a ward unit. Copies of this list were filed in the offices of the Surgeon General, the department surgeons, and the purchasing medical supply depots. The list included equipment for a 50-bed ward, or its equivalent in smaller wards.”118 This ward unit was freely used in issuing instructions for procurement of supplies amid the shipping of equipment to new hospitals during the years 1916-1918, inclusive.”119 The contents of this unit follow:
A 50-bed ward unit
Bedsteads, white enamel
50
Bed pans, white enamel
4
|
Blankets, white |
100 |
|
Cups, spit, white enamel |
10 |
|
Chairs: |
|
|
Cushions, rubber, open center |
2 |
|
Arm |
10 |
|
Cuspidors |
6 |
|
Folding |
20 |
|
Eye shades: |
|
|
Invalid, rolling |
2 |
|
Single |
6 |
|
Rocking |
6 |
|
Double |
4 |
|
Close stools |
4 |
|
Gowns, convalescent, summer |
50 |
________________________________________
a This ward unit commonly was referred to as the "Wolfe unit" during the World War. - Ed.
37
|
Looking glasses |
2 |
Shirts, cotton |
50 |
|
Mattress covers |
76 |
Sheets, cotton |
150 |
|
Mattresses, hair |
50 |
Tables, bedside folding |
50 |
|
Pajama suits |
120 |
Towels: |
|
|
Pillows: |
|
Bath (dozen) |
12 1/2 |
|
Feather |
20 |
Hand (dozen) |
20 |
|
Hair. |
50 |
Tubs, foot |
2 |
|
Pillowcases, cotton |
200 |
Urinals, agate ware or white enamel |
6 |
|
Racks, for urinals and bedpans |
2 |
Back rests |
4 |
|
Rubber sheeting (yards) |
4 |
Thermometers, bath |
2 |
PORTABLE DISINFECTING APPARATUS
Disquieting reports of the prevalence of typhus fever in some of the larger cities of Mexico at no great distance from the border had been received from time to time for many months by the United States Public Health Service. Measures had been taken by that service for the inspection at the various ports of entry along the Mexican frontier of all immigrants and refugees coming into the United States from Mexico. These inspections covered railway conveyances as well as the persons and the baggage of such immigrants and refugees. Inspection of freight cars coming into some ports of entry from Mexico showed them to be teeming with bedbugs and pediculi. Reports indicated that freight cars had been commonly used in Mexico in troop movements owing to the destruction of passenger coaches.120
To provide against the infestation of our troops in camps along the border, the department surgeon, Southern Department, requested, July 17, that one disinfestation apparatus each be sent to Brownsville, Eagle Pass, Laredo, and Fort Bliss, in Texas, and Douglas and Nogales in Arizona.121 For greater utility it was necessary that this device be readily transportable.
In all probability, too, other infectious diseases common to camp life, particularly those of the respiratory tract, would make their appearance in such prevalence as would require extensive disinfection of bedding and clothing to limit their spread. An autoclave of size sufficiently large to admit mattresses had been devised by the United States Public Health Service and had been in use for a number of years at its various immigration stations. It consisted essentially of a double-walled rectangular or cylindrical steel chamber of large dimensions, capable of using steam under high pressure. It had a swinging door provided with a radial arm type of locking device at one or both ends. This permitted the ready admission and removal of infected material and facilitated operation. It was connected with a high-pressure steam boiler and provided with safety valve, steam, and vacuum gauges. All those in use by the Public Health Service were, from the nature of the service required, of the fixed or stationary type. Some work in developing a portable type of this apparatus had been done by one of the large firms making disinfecting apparatus for hospital use.120 Collaborating with the officers at the New York medical supply depot, this firm made a number of improvements and developed an apparatus sufficiently mobile for field use. This apparatus as finally developed was a self-contained unit consisting of a disinfecting chamber and a steam boiler mounted on a steel chassis with ball-bearing wheels and capable of being animal drawn or used as a trailer behind a truck. The disinfecting chamber
38
was a double-walled shell having inside dimensions 44 inches high, 36 inches wide, and 84 inches long, with a single door at the front end. It was provided with a suitable valve device by which a vacuum of 2 atmospheres could be readily developed. The steam boiler of the submerged head vertical type and suitable size was mounted in rear of and in series with the disinfecting chamber and connected to it with suitable steam pipes. The boiler was designed to burn coal and was capable of generating within 20 minutes sufficient steam to raise the pressure in the disinfecting chamber to 40 pounds. The apparatus was provided with a device whereby formaldehyde could be admitted into the sterilizing chamber when desired and later he neutralized by ammonia. The adequacy of the sterilization effected by this apparatus was carefully checked by suitable bacteriological tests. It was found that subjection of the contents of the sterilizing chamber, even when it was completely filled, for one-half hour to a steam pressure of 15 to 20 pounds was sufficient to kill the most resistant bacteria, their spores, and the ova of vermin, when the infected material was placed in the center of the mass in the chamber.122 The performance of this apparatus on the border proved to be wholly satisfactory and led to its purchase during 1917 and 1918 in large numbers for use at the various training camps at home and for use at the hospitals overseas.
MANNER OF PROCURING SUPPLIES
The method of determining the quantities of medical supplies required during this mobilization followed the same general lines as had been utilized during the preceding years. In the Surgeon General’s Office, calculations were made for new equipment required by the troops and the amount of equipment for prospective new troops to be called into service. The quantities of the articles on the standard supply table which it would be necessary to purchase at each semiannual procurement were determined in the Surgeon General’s Office for each period from estimates submitted by the four medical supply depots in the United States. These estimates, in turn, were based upon previous issues of those items during a six months’ period. The quantities on such estimates usually represented one-fourth of the total issues of the particular articles during the two years just preceding the date of the estimate. From the quantities indicated by these figures no deductions were made unless the stock on hand of any item exceeded the average six months’ issue of that time, the object being to have a six months’ stock in the depot and to be purchasing those required for the second ensuing six months. Issues to other depots in the United States were not considered in making up these estimates, the net issues to troops being desired. Issues to the depots supplying troops in Panama, Hawaii, the Philippine Islands, and China were not included because of the distances of such depots from Washington and delay incident to receiving their estimates. Since most of the issues were post supplies, the principal purchases were for post medical supplies. The purchase of field supplies and equipment was for the most part to enable the assembling of new unit equipment.
Since the total additions to the Regular Army prior to July, 1916, did not exceed materially the 20,000 men needed for the expansion of organizations to their full authorized strength, no special measures were initiated for the pro-
39
curement of additional supplies other than motor ambulances, X-ray and sterilizing apparatus. With the issuing of the second call of National Guard troops into the Federal service in 1916 procurement activities became greatly augmented. Requisitions from the medical supply depots in the Southern Department for initial stock and replenishment came in with a rush and were referred to the appropriate depots for issue, with authority to purchase in emergency. If the standard articles could not be readily obtained the most suitable substitutes were purchased. The time on circulars inviting proposals was reduced to seven days. Medical supply officers were authorized in making contracts to erase the article requiring approval by the Surgeon General and approve the contracts themselves, “By order of the Surgeon General.” 123
The medical supply officer at New York was directed, on June 28, to purchase 100 portable dental outfits and send 40 to the medical supply depot at El Paso and another 40 to the depot at San Antonio.124 On June 30, instructions were telegraphed to the medical supply officer at New York to accumulate 100 ward units and such other articles not included in the ward unit as would be necessary to provide for 5,000 patients.125 The medical supply officer at St. Louis was instructed by telegram on the same date to accumulate 100 ward units and additional supplies for 5,000 patients.126 These instructions contemplated advertising by a seven-day circular, incorporating in the contracts provisions for 100 per cent increase and the purchase from satisfactory samples if standard articles were not readily available. By prior instructions of June 24, the New York depot had been directed to purchase 2,000 bedsteads and the same number of mattresses.127
As in previous years, difficulties and delays were experienced in placing orders and securing deliveries of articles contracted for. Bedsteads and mattresses were still coming in at the end of October on contracts placed early in July. Nevertheless shipments of the principal items in the ward units were started to the border July 20 from the New York depot and August 1 from the St. Louis depot, and continued in a steady stream as fast as deliveries were made by the contractors until the shipment of 37 units to San Antonio and 38 units to El Paso had been completed by the end of August.128
While the experiences in the procurement of supplies for the border mobilization were frequently annoying and far from satisfactory, they proved to be invaluable from a developmental standpoint and as a preparation for the conditions which obtained during the stress of the months of war which followed. The observance of peace-time restrictions had been supplanted, in a measure by independence of action and fertility of expedient so necessary for action under stress of war conditions. New methods of procurement had been tried out and proved successful. Those in charge of the work had come to think in terms of figures that a year previous would have been astounding. The plans for procurement and distribution evolved during this period were broader, more comprehensive and flexible. The contracted horizon of peace-time economy in procurement had broadened perceptibly and rendered the transition into the war period less difficult.
40
REFERENCES
(1) American Archives. Compiled by Peter Force, Washington, Clark & Force, 1843-1853. Fourth Series, Vol. III, 1897.
(2) Journal of the Continental Congress, Library of Congress edition, Vol. XIX, 126, 180, 432; Vol. XX,721, 734; Vol. XXI, 948-951.
(3) Public Records of the Colony of Connecticut, from October, 1706, to October, 1716.Compiled by Charles J. Hoadly, LL. D., Hartford, Mass., Case, Lockwood & Brainard, 1870, Vol. XV, 15.
(4) American Archives. Fourth Series, Vol. IV, 1026
(5) Ibid. Fourth Series, Vol. IV, 1026; Vol. V, 263; Fifth Series, Vol. I, 282, 314, et seq
(6) Public Records of the Colony of Connecticut, from October, 1706, to October, 1716: Vol. XV, 522-523.Also: American Archives: Fourth Series, Vol. II, 748, 1355, 1434, 1440; Fifth Series, Vol. III, 455.
(7) American Archives. Fourth Series, Vol. II, 756
(8) Ibid. Fifth Series, Vol. I, 282
(9) Ibid. Fourth Series, Vol. II, 1625
(10) Ibid. Fourth Series, Vol. II, 1706
(11) Journal of the Continental Congress, Library of Congress edition, Vol. II, 209; Vol. IV, 284; Vol. V, 556, 568, 673.
(12) American Archives. Fifth Series, Vol. I, 108-109.
(13) Ibid. Fourth Series, Vol. II, 1893.
(14) Journal of the Continental Congress, Library of Congress edition, Vol. II, 211; Vol. III, 261.
(15) Ibid., Vol. XX, 570.
(16) Ibid., Vol. III, 261, 344; Vol. IV,180, 188, 197, 348; Vol. V, 453, 463, 528, 622, 633, 661, 781, 998; Vol. VII, 34, 91.
(17) American Archives. Fourth Series, Vol. III, 1880.
(18) Journal of the Continental Congress, Library of Congress edition, Vol. VII, 231-237.
(19) Ibid., Vol. VII, 197-200; Vol. XVIII,878-888; Vol. XIX, 103, 118, 292-294, 375; Vol. XXIII, 759.
(20) Ibid., Vol. XVIII, 878-888.
(21) Act of March 2, 1798 (1 Stats. 721). Also: Act of Marcia 3, 1813 (1 Stats. 819-820).
(22) Act of May 2, 1802 (2 Stats. 183).Also: Subsequent acts making appropriations for Military establishments.
(23) Act of April 14, 1818 (3 Stats. 426).
(24) Military Laws, Rules, ar, d Regulations for the Army of the United States, January, 1820, 102.
(25) Ibid., 105.
(26) Letters from the Surgeon General to the Secretary of War, November 1, 1818, and May 1, 1819. On file, Record Room, S. G. O., Old Records,
Reports Book, 1818-1832,1-7, 43-50.
(27) Circular letter from the Surgeon General to all surgeons of the Army, October 14, 1818. Record Room, Old Record Room, S. G. O., Records, Letters Sent Book, 1818-1822, 15. Also: Circular letter from the Surgeon General to all surgeons of the Army, March 22, 1819, transmitting new supply table Record Room, S. G. O., Old Records, Letters Sent Book, 1818-1820, 48.
(28) Military Laws, Rules, and Regulations for the Army of the United States, January, 1820, 112-113
(29) Act of March 3, 1821 (3 Stats. 616).
(30) Official Army Register, 1898, 228.
(31) Letter from the Surgeon General to The Adjutant General, May 16, 1898. Subject: Medical Supply Depot, Washington, D. C. On file, Record Room, S. G. O., 38405-A (Old Files). Also: Supply Letter No. 4, 1920, S. G. O.
(32) Annual Report of the Surgeon General, U. S. Army, 1866, 2.
(33) Annual Report of the Surgeon General, U. S. Army, 1897, 9; 1898, 105-106.
(34) Act of April 16, 1862 (12 Stats. 378).
(35) Manual for the Medical Department, U. S. Army, 1896, par. 77; 1898, par. 67.
(36) Annual Report of the Surgeon General, U. S. Army, 1888-1898, inclusive, Medical and Hospital Supplies.
(37) Ibid., 1898, 103. Also: Commission to Investigate Conduct of War Department in War with Spain. Washington, Government Printing Office, 1900, Vol. I, 172-174.
(38) Annual Report of the Surgeon General, U. S. Army, 1892, 5-6.
(39) Manual for the Medical Department, U. S. Army, 1896, par. 271-276, 279.
(40) Lecture on preparedness of the Medical Department for war. Delivered, October 22, 1914, at the Army War College, by Lieut. Col. Henry C. Fisher, Medical Corps. On file, Finance and Supply Division, S. G. O., 11709-E (Old Files).
(41) Annual Report of the Surgeon General, U. S. Army, 1898, 103.
(42) Commission to Investigate Conduct of War Department in War with Spain, Vol. I, 571. Also: Lecture on preparedness of the Medical Department for war. Delivered November 16, 1916, at the Army War College, by Lieut. Col. Henry C. Fisher, Medical Corps. On file, Finance and Supply Division, S. G. O., 11709-G (Old Files).
(43) Manual for the Medical Department, U. S. Army, 1898.
(44) Letter from the Surgeon General, June 9, 1898, to the honorable the Secretary of War. Subject: Medical and hospital supplies for Volunteers. On file, Record Room, S. G. O., 39964 (Old Files).
(45) Commission to Investigate Conduct of War Department in War with Spain, Vol. VI, 2797.
(46) Ibid., Vol. VIII,27-28.
(47) Ibid., Vol. VI, 2836.
(48) Ibid., Vol. V, 1918.
(49) Ibid., Vol. VI, 2798,2801.
(50) Ibid., Vol. V, 1919; Vol. VI, 2803.
(51) Ibid., Vol. VI, 2828.
(52) Ibid., Vol. III, 435; Vol. IV, 842; Vol. VI, 2827.
(53) Ibid., Vol. V, 1,937-1,938.
(54) Ibid., Vol. V 1,935.
(55) Ibid., Vol. I, 172-174, 188.
(56) Ibid., Vol. I, 189.
(57) Ibid., Vol. I, 571.
(58) Correspondence between the Surgeon General, The Adjutant General, and the Quartermaster General, during the years 1903 to 1906, inclusive.
Subject: Regimental hospitals. On file, Record Room, S. G. O., 97275-A to J (Old Records).
(59) Manual for the Medical Department, U. S. Army, 1898, par. 272, 290.
(60) Ibid., 1902, par. 288, 338.
(61) Ibid., 1906, par. 553, 582-590.
(62) Ibid., 1906, par. 559, 582-590.
(63) Ibid., 1906, par. 562, 582-589, 596.
(64) Ibid., 1906, par. 505, 592, 593.
(65) Ibid., 1906, par. 560, 582-589.
(66) Ibid., 1906, par. 531-532, 597.
(67) Ibid., 1911, par. 805-809, 836-844, 847-879.
(68) Observations and experiences of the writer as medical supply officer, 1907-1911, inclusive.
(69) Manual for the Medical Department, U. S. Army, 1916, par. 864, 907.
(70) Ibid., 1916, par. 866.
(71) Ibid., 1916, par. 657-666, 869-871, 886.
(72) Act of May 11, 1908 (35 Stats. 123).
(73) Letter from the Surgeon General, January 22, 1903, to the president, Army War College. Subject: Medical Department field equipment for an army
of 150,000 to 250,000. On file, Record Room, S. G. O., 93360 (Old Files).
(74) Telegrams from the Surgeon General, January 24, 1903, to the officers in charge, medical supply depots, New York City, St. Louis, Mo., and San Francisco, Calif. Subject: Report of field supplies in stock. On file, Record Room, S. G. O., 93360A, A-1, A-2 (Old Files).
(75) Letter from the Surgeon General to the Chief of Staff, February 16, 1906. Subject: Medical field equipment. On file, Record Room, S. G. O., 93360-G, G-1, 2, 3, 4, 5, 6 (Old Files).
(76) Letter from the Surgeon General to the Chief of Staff, March 13, 1908. Subject: Supplies and equipment of an army of 437,144 combatants. On file, Record Room, S. G. O., 93360-H (Old Files).
(77) Memorandum from the Surgeon General to the Chief of Staff, October 20, 1913. Subject: Medical equipment for certain divisions. On file, Record Room, S. G. 0., 93360-I (Old Files).
(78) Memoranda from the Surgeon General, for the Chief of Staff, April 11, 1914 and for The Adjutant General, July 21, 1914. Subject: General war plans, Medical Department. On file, Record Room, S. G. O., 93360-I (Old Files).
79) Letter from the Surgeon General to The Adjutant General of the Army, June 12, 1915. Subject: Material for equipment of a field force. On file, Record Room, S. G. O., 93360-K (Old Files).
(80) Memorandum from the Surgeon General to The Adjutant General of the Army, August 20, 1915. Subject: Field supplies necessary to equip one division and one Cavalry division. On file, Record Room, S. G. O., 93360-M (Old Files).
(81) Correspondence between the Chief of Staff and the Surgeon General, November 9, 1910, to December 23, 1912. Subject: Depots of supplies for mobilization purposes. On file, Record Room (Old Files, 134777-A to J, incl.), S. G. O.
(82) Indorsement, Depot Quartermaster, Philadelphia, Pa., to The Adjutant General, November 21, 1916. Subject: Transfer of field equipment in Field Supply Depot No. 1. On file, Record Room, S. G. O., 134777-M (Old Files).
(83) Annual Report of the Surgeon General, U. S. Army, 1916, 20.
(84) Army List and Directory, January, 1916.
(85) Correspondence under respective station Nos. 11447, 11562, and 12516. On file, Finance and Supply Division, S. G. O. (Old Files). Also: Letter from the department surgeon, Southern Department, to the Surgeon General, April 10, 1916. On file, Record Room, S. G. O., 156267-D (Old Files).
(86) Correspondence under appropriate heads. On file, Record Room, S. G. O., 136, 186, 240, and Finance and Supply Division, S. G. O., 12,413 (Old Files).
(87) S. O. No. 91, W. D., April 18, 1916.
(88) Letter from Colonel Fisher to Colonel Clayton, April 11, 1916. On file, Finance and Supply Division, S. G. O., 12,998-S. Also: Telegram from the surgeon, Southern Department,
to the surgeon, Cantonment Hospital, Columbus, N. Mex., March 18, 1916. On file, Finance and Supply Division, S. G. O., 12,998-N-1 (Old Files).
(89) Telegram from the medical supply officer, El Paso, Tex., to the Surgeon General, May 17, 1916. On file, Finance and Supply Division, S. G. O., 12,808-K-1.
(90) References to action taken on these requisitions. On file, Finance and Supply Division, S. G. O., 12,808-J, -P, -V, -W (Old Files).
(91) Correspondence between the Surgeon General and the department surgeon, Southern Department, various dates. On file, Finance and Supply Division, S. G. O., 13,256-179 and 211, 13,707.
(92) Correspondence between the Surgeon General and the department surgeon, Southern Department, on ward units and motor ambulances. On file, Finance and Supply Division, S. G. O., 11,220 and 12,805.
(93) Correspondence between the Surgeon General and the department Surgeon, Southern Department, in May, 1916, relative to the need of an additional depot in the Southern Department. On file, Finance and Supply Division, S. G. O., 13,451.
(94) Correspondence of various dates between the Surgeon General, The Adjutant General, and the headquarters, Southern Department, in 1916. On file, Record Room, S. G. O., 157,818, A, B, C, E, H, and I.
(95) Telegram to the Surgeon General, July 16, 1916, for additional supplies, and the action of the Surgeon General thereon. On file, Finance and Supply Division, S.G. O., 13,431-J.
(96) Report on Mobilization of the Organized Militia and the National Guard of the United States, 1916, 10. Government Printing Office, 1916.
(97) Correspondence under title of the several States. On file, Finance and Supply Division, S. G. O., 13,530.
(98) Correspondence between the Surgeon General and Base Hospital, Fort Sam Houston, 1916. On file, Finance and Supply Division, S. G. O., 13,242, parts 1-4, inclusive.
(99) Telegram from the Surgeon General to the department surgeon, Southern Department, March 11, 1916, and reply thereto. On file, Finance and Supply Division, S. G. O., 13,256-42.
(100) Letter from the Surgeon General to The Adjutant General, July 10. 1915, requesting the appointment of the board. On file, Record Roomn, S. G. O., 153,155.
(101) Correspondence of March 11 and April 7 between the Surgeon General and Maj. Kent Nelson, M. C., relative to this transaction. On file, Finance and Supply Division, S. G. O., 13,256-42-2.
(102) Correspondence between the Surgeon General and the officer in charge of Medical Supply Depot, Washington, D. C., on the dates given. On file, Finance and Supply Division, S. G. O., 13,256-42-3 and 5-2-3.
(103) Telegram from Col. Frick at Columbus, N. Mex., to the Surgeon General, April 20, 1916. On file, Finance and Supply Division, S. G. O., 13,256-42-13.
(104) Telegram from the Surgeon General to the department surgeon, Southern Department, April 22, 1916. On file, Finance and Supply Division, S. G. O., 13,256-42-15.
(105) Letter from the department surgeon, Southern Department, to the Surgeon General, April 5, 1916. On file, Finance and Supply Division, S. G. O. 13,256-72.
(106) Letter from the Surgeon General to the department surgeon, Southern Department, August 10, 1916, relative to equipping other ambulance companies with motor ambulances.
On file, Finance and Supply Division, S. G. O., 11,220-6-71.
(107) Correspondence between the commanding general, Southern Department, The Adjutant General, the Quartermaster General, and the Surgeon General, on providing motor trucks and touring cars for motorized ambulance companies, April and May, 1916. On file, Record room, S. G. O., 148,945-P (Old Files).
(108) Correspondence between the Surgeon General, the Medical Supply Officer, Washington, and the surgeon, Southern Department, from July to December, 1916. On file, Finance and Supply Division, S. G. O., 11, 220-52-54-59-60-78.
(109) Telegram from The Adjutant General to the commanding general, Southern Department, September 22, 1916. On file, Finance and Supply Division, S. G. O., 11, 220-80-1.
(110) Act of March 4, 1915, chapter 143 (39 Stats. 1079-1080).
(111) Joint resolution of Congress, of Marcia 17, 1916, chapter 46 (39 Stats. 36).
(112) Act of March 31, 1916, chapter 56 (39 Stats. 46).
(113) Letter from the Surgeon General to The Adjutant General, on the needs of the Medical Department for 20,000 additional men. On file, Record Room, S. G. O., 155,943.
(114) Letter from the Surgeon General to The Adjutant General, June 22, 1916, and subsequent action thereon. On file, Record Room, S. G. O., Old Files, 157,549-X. Also: Act of July 1, 1916, chapter 210 (39 Stats. 338).
(115) Letter from The Adjutant General to the Surgeon General, June 15, 1916, and the latter’s reply thereto. On file, Record Room, S. G. O., Old Files, 157,549.
(116) Act of August 26, 1916, chapter 418 (39 Stats. 640).
(117) Manual for the Medical Department, U. S. Army, 1916, par. 854.
(118) Letter from the medical supply officer, El Paso, Tex., to the Surgeon General, May 8, 1916, and the various indorsements thereon. On file, Finance and Supply Division, S. G. O., 13,707.
(119) Correspondence between the Surgeon General, the medical supply officers at New York and St. Louis, and the surgeon, Southern Department, at various dates. On file, Finance and Supply Division, S. G. O., 13,707.
(120) Letters from the Surgeon General, U. S. Public Health Service, to the Surgeon General of the Army, June 6 and 11, 1915, and the district surgeon, El Paso, Tex., September 9, 1916, to the Surgeon General on this subject. On file, Record Room, S. G. O., Old Files, 152, 859-A-C.
(121) Letter from the department surgeon, Southern Department, to the Surgeon General, July 17, 1916, requesting disinfestation apparatus. On file, Finance and Supply Division, S. G. O., 13,256,219-1-3.
(122) Letter from Col. F. M. Hartsock, M. C., New York, to Col. Edwin P. Wolfe, M. C., September 7, 1920, on the history of sterilizers and disinfeetors. On file, Finance and Supply Division, S. G. O. 414-4-6.
(123) Correspondence between the Surgeon General, the department surgeon, Southern Department, and the medical supply officers, New York, St. Louis, and Washington. On file, Finance and Supply Division, S. G. O., files 13,217, 13,256, 13,241, at various dates between June 15, 1916, and December 31, 1916, relative to issues.
(124) Telegram from the Surgeon General to the medical supply officer, New York, June 28, 1916. On file, Finance and Supply Division, S. G. O., 13,217-49.
(125) Telegrams of June 30, 1916, and subsequent instructions relative thereto, from the Surgeon General to the medical supply officer, New York, directing purchases. On file, Finance and Supply Department, S. G. O., 13, 217-52.
(126) Telegram of June 30, 1916, and subsequent instructions relative thereto, from the Surgeon General to the medical supply officer, St. Louis, directing purchases. On file, Finance and Supply Division, S. G. O., 13, 241-31-1.
(127) First endorsement of the Surgeon General’s Office upon recommendations of medical supply officer, New York, of June 22, 1916, for the purchase of these articles. On file, Finance and Supply Division, S. G. O., 13, 217-42.
(128) Reports to the Surgeon General of shipments made from New York and St. Louis depots to depots in the Southern Department. On file, Finance and Supply Division, S. G. O., 13, 256-185-2, and 13, 247-28-2.
