CHAPTER III
Medical Supplies for Civil Health Programs
Thomas B. Turner, M.D.
GENERAL CONSIDERATIONS
The average civilian physician in the United States takesmedical supply largely for granted; pharmaceutical houses are usually able andeager to supply all needs and the shelves of the corner drugstore are abundantlystocked. In a war-devastated country, however, even the finest program for therehabilitation of health services cannot succeed if certain basic medicalsupplies are not available.
During World War II, there was a steady depletion of medicalsupplies in enemy and enemy-occupied countries, especially in Italy and in thePhilippines and, to a lesser extent, in Germany. To this were added thedestruction of hospitals, the treatment of military and civilian casualties, andthe difficulties of distribution caused by the breakdown in transportation.While the War Department was aware of the situation, the necessities oflogistical planning and a lack of appreciation of the importance of medicalsupply on the part of civil affairs health officers often combined to render thecivilian medical supply system less effective than it might have been.
Moreover, in the earlier operations, particularly in Italy,the importance of stockpiling medical, sanitary, and other supplies for civilaffairs and military government purposes was only partially recognized. Thegreat value of specialists in medical supply to the civil affairs program wasnot appreciated so that supplies, both those locally available and thoseimported, were not handled and distributed in the most efficient manner.
As in other aspects of the civil public health program,valuable lessons were learned during the initial Italian operations, anddeficiencies were quickly corrected.
EARLY PLANNING
Committees
The Inter-Allied Committee on Post-War Requirements wasconstituted under a resolution adopted by the Allied Governments at a meetingheld at St. James's Palace in London on 24 September 1941.1
1Report to Allied Governments by Inter-Allied Committee on Post-War Requirements, London, England, June 1943.
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According to the terms of this resolution, the common aim wasto insure that supplies of food, raw materials, and articles of prime necessitywould be made available for the postwar needs of the countries liberated fromNazi oppression. While each of the Allied Governments was to provide for theeconomic needs of its own people, their respective plans were to be coordinatedfor the successful achievement of the common goal. They would prepare estimatesof their requirements and indicate the order of priority in which they desiredsupplies to be delivered.
As a first step toward planning for the reprovisioning ofEurope after the war, the committee resolved that a bureau should be establishedby His Majesty's Government in the United Kingdom with which the AlliedGovernments and authorities would collaborate in preparing estimates of theirrequirements. After collating and coordinating these estimates, the bureau wouldthen present proposals to a committee of Allied representatives under thechairmanship of Sir Frederick Leith-Ross.
The Soviet Government, while accepting most of theresolution, made a reservation as to the bureau's constitution and suggested afurther meeting of the Allied Governments to settle the arrangement definitely.Further discussions might have cleared this point, but the Soviet Government didnot appoint a representative to the committee nor did they submit any estimateof Soviet requirements.
The other European Allied Governments and authoritiesappointed representatives to the committee, and the U.S. Government, which hadat first appointed only an observer, accepted full membership in January 1942.The governments of all the British Dominions and of India were also represented.The Chinese Government, although not formally associated with the St. James'sPalace resolution, showed continuous interest in the work of the Inter-AlliedCommittee, and was represented by an observer at the committee's meetings. TheBrazilian Government requested that it be more closely associated with thecommittee's work and was also represented by an observer. In addition, theInternational Labour Office was invited to appoint an observer, and all thecommittee's papers were made available to that office.
Another committee involved in this early planning was the oneon medical supplies and services, under the chairmanship of Dr. MelvileMackenzie of the United Kingdom; Dr. Hugh H. Smith, of the RockefellerFoundation, and Dr. Kenneth B. Turner, of the Office of Scientific Research andDevelopment, were the United States representatives. This committee, basingtheir estimates on the requirements for 100,000 people for 1 month,2determined that in Western Europe alone 37,000 metric tons of drugs and 52,000metric tons of hospital supplies would be required in the first 6 months afterliberation. Special attention was given to supplies for ma-
2Medical Department, United States Army. Medical Supply in World War II. Washington: U.S. Government Printing Office, 1968, p. 375.
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ternity and infant welfare, typhus fever control, malaria,and tuberculosis; and to biologicals for the control of epidemics of entericinfections, including dysentery, cholera, and diphtheria. These requirements,with modification, were used as the basis for all subsequent planning for civilpopulations.
Planning in the Surgeon General's Office
European area.-Supply planning for the EuropeanTheater of Operations, U.S. Army, began early in 1943. On 2 February, Col.(later Brig. Gen.) James S. Simmons, MC, and Col. Ira V. Hiscock, SnC, discussedwith the Director, Supply Service, Surgeon General's Office, the Army'sresponsibility for providing medical and sanitary supplies for civilian useduring the early stages of military occupations. This was the beginning of aseries of conferences and interviews which led to the establishment, on 28 June1943, of a board, known as the CAD (Civil Affairs Division) Board (p. 15),"to prepare, develop, and implement the medical portion of the WarDepartment's program for aid to civilian populations in liberatedcountries."3
In response to a request from the International Division,Army Service Forces, on 2 July 1943, as modified by a memorandum of 11 September1943, the CAD Board drew up an estimate of the amount and variety of medical andsanitary supplies necessary to provide for civilian populations during theinitial period of military occupation in the Netherlands, Belgium, France,Corsica, Italy, Sardinia, Yugoslavia, Albania, Greece, Bulgaria, Norway,Denmark, Finland, Romania, Czechoslovakia, Poland, Austria, and Germany.
The CAD Board estimate was submitted to the InternationalDivision on 30 September 1943. The list of recommended supplies included basicmedical units, supplementary tropical units, obstetrical bags, biologicals,quartermaster sanitary andantimalarial supplies, and engineer sanitary and antimalarial supplies. Thenumber of each unit allotted to any country was based on the amount ofdestruction expected, the state of depletion of medical supplies, and the prewarstandard of medical care in the country in question. It was not War Departmentpolicy to attempt to provide a level of medical care above the country'sprevious standard.
About 1 November 1943, the International Division requestedthe board to meet with representatives of the British Supply Mission to bringthe U.S. and British supply programs into agreement. A detailed comparison ofthe two programs was made during several conferences over a period ofapproximately 6 weeks. The estimate of 30 September 1943 was revised andresubmitted to the International Division on 23 December 1943.4 Several minorchanges had been made and some new units had been added
3Office Order No. 419, Office of the Surgeon General, U.S. Army, 28 June 1943.
4Memorandum, Brig. Gen. R. W. Bliss, Chief, Operations Service, Office of the Surgeon General, for The Director, International Division, Headquarters, ASF, 23 Dec. 1943, subject: Civilian Supplies in Occupied Territories-Medical Supplies, with 18 enclosures: lists of "CAD Medical and Sanitation Units."
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The revised list contained the following units: (1) BasicMedical Unit, consisting of drugs, dressings, surgical accessories, andconfinement supplies; (2) Supplemental Tropical Unit; (3) SupplementalBiological Unit; (4) Obstetrical Bag; (5) Tracheotomy Set;(6) Hospital Units; (7) Basic Laboratory Unit; (8) Malaria Survey LaboratoryUnit; (9) Sanitation Supply and Equipment Units; (10) Antimalaria Supply andEquipment Units; and (11) Typhus Unit (including items suggested by the UnitedStates of America Typhus Commission).
In February 1944, in response to a request from theInternational Division, an estimate of veterinary requirements was submitted,adding to the civilian supply program the Basic Veterinary Unit, consisting ofdrugs and dressings, and veterinary surgical, laboratory, and biological units.
In a memorandum of 26 January 1944, the InternationalDivision requested a breakdown of requirements by departments in France and byprovinces in the Netherlands. This breakdown was submitted on 20 February 1944.In attempting to forecast the requirements for medical supplies for the variousareas, the following basis of calculation was used:
Basic Medical Unit: The distribution of this unit was basedon four factors: (1) the number of hospital beds per 1,000 population in thearea to be cared for, as compared with the number of hospital beds per 1,000population for Norway, which was 8.5, the highest medical standard in Europe;(2) depletion, which depended upon the estimated depletion of expendable medicalsupplies; (3) the estimated segment of population in need of and accessible tomedical care, expressed in numbers per 100,000 persons to receive medical care(one basic medical unit was equipped to furnish medical care to 100,000medically destitute persons); and (4) situation, which depended on theanticipated conditions under which a territory would be liberated. In a "noscorch" situation, the factor was one; in a "limited scorch"situation, the factor was two; in an "operational" situation, thefactor was three.
The result of the multiplication of the above factors was thenumber of basic medical units required by the area for 1 month. For example, acountry of more than 12 million total population, of which 3 million might beinaccessible, would contain 9 million persons to be supplied. If the country had1.2 hospital beds per 1,000 population before the war, was to be liberated under"limited scorch" conditions, and was to be considered 80 percentdepleted as far as medical supplies were concerned, the calculation of therequired number of basic medical units would be 20 per month or 120 for 6months.
Obstetrical Bag: four bags per 100,000 population to be caredfor (four bags per basic medical unit).
Malaria Survey Laboratory Unit: one laboratory per 20,000cases of treatable malaria.
Sanitation Equipment Unit: sufficient quantity to furnish 1 gallon ofwater per day per person of urban populations having prewar public watersupplies.
Sanitation Supply Unit: one per month for each equipment unit.
Antimalaria Equipment Unit: one per 6,000 cases of malaria.
Typhus Unit: for distribution and content of this unit, The Surgeon Generalrelied on the advice of the Typhus Commission as to where epidemic typhus mightoccur.
For the other units, calculation was based on the most recent informationavailable to The Surgeon General concerning the existing and anticipateddestruction of medical equipment in the areas concerned.
The composition of each supply unit was established only after long andelaborate planning which began in London in 1941. Revisions were made asexperience suggested, but the final composition of each unit remainedessentially as issued in December 1943.
Pacific area.-Civil health planning for the Pacific area did notbegin until early 1944. The nucleus of a plan which also included supplies forcivil health was discussed at a conference held on 18 March 1944 between membersof the Civil Affairs Division, War Department Special Staff, and the CivilPublic Health Division of the Preventive Medicine Service, Surgeon General'sOffice.
The situation regarding civilian populations in most of the Far Easterncountries differed substantially from that in Europe. The level of medical carewas much lower and diseases were more prevalent and more varied. Since thestrategic and tactical projections were not firm in the early stages ofplanning, a number of countries which were never invaded by Allied Forces wereincluded in the estimates. Although the same civil affairs units were to beused, calculation of needs for each unit was based on the most recentinformation then available to The Surgeon General. Because the area of the FarEast included in the planning was so vast and the need could be so urgent butlimited geographically, it was decided to establish a reserve pool ofbiologicals such as vaccines, immune serums, and diagnostic antigens.
STORAGE AND DISTRIBUTION IN ITALY
As in so many other aspects of civil affairs activities, the pattern ofdistribution of medical supplies was largely formed in the Italian campaign,slowly, haltingly, in the hard school of experience.5
As originally planned, medical supplies were supposed to reach theoperational area in preassembled supply units directly from the Zone of Interioror from the base of operations. In actual operations in Sicily, the plan failedand the burden of medical supply and supply planning for
5Letter, Col. Thomas B. Turner, MC, Director, Civil Public Health Division, Preventive Medicine Service, Headquarters, North African Theater of Operations, Office of the Surgeon, to The Surgeon General, U.S. Army, 21 Feb. 1944, subject: Report of Civil Affairs Public Health Activities in the North African Theater of Operations, enclosure 3 thereto.
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civil public health fell largely upon Allied ForceHeadquarters, at whose insistence a well-qualified medical supply officereventually was assigned to the Allied Control Commission (later AlliedCommission). Working with the medical supply section of North African Theater ofOperations, U.S. Army, this officer developed a supply system, the principalfeatures of which were: (1) assignment of a well-qualified medical supplyofficer to the top operating staff level to maintain close liaison with themedical supply officer of theater headquarters, establish a central stockcontrol agency, screen all requisitions for medical supplies for Allied ControlCommission and Allied Military Government, and establish a central depot, underhis direct control, and subdepots as required; (2) routing of requisitions formedical supplies, and the supplies themselves, through military governmentmedical supply channels rather than through general civil affairs or Army supplychannels; (3) obtaining emergency supplies from Army supply depots in theCommunications Zone, when approved by theater headquarters; (4) experiencedpersonnel for key positions in central and sub-depots to be supplied by militarygovernments, and all other personnel were to be procured locally; (5) usingmedical supply units, such as civil affairs units, only in the initial phases ofan operation; (6) early inauguration of an item supply requisition supplysystem; (7) preparing an inventoryof local medical supplies and facilities for production of medical items tointegrate them with supplies to be furnished by military government; and (8)using the central stock control agency to insure maximum use of local resources,equitable distribution of imported supplies, and editing of requisitions toeliminate items which were either produced locally or available in adequatequantities in another area.
Problems
Medical supplies.-In a report for Region IV of theAllied Control Commission for Italy, Col. Thomas N. Page, MC, regional publichealth officer, described the civil affairs medical supply situation which hesaid was not good.6 Hecited the reason as a breakdown in rail transport between Naples, the locationof the civilian medical depot, and Rome, the site of the regional warehouse(fig. 5). Approximately 10 civil affairs units were received: one was broughtforward by the transport of Region IV, five were shipped by schooner to Gaeta,and the balance were picked up from Rome Region. An additional 30 civil affairsunits, although they had been ordered on 14 July and were due to arrive in Romeabout 1 August, actually were not expected to arrive until 31 August becausethey had been sent by ship to Anzio and by truck from there. Some capturedGerman and Italian supplies, turned over by an American unit moving forward,helped to fill the gap.
Two civil affairs units were delivered to each of the fiveprovinces
6PublicHealth Report, 1 July 1944-31 July 1944, Region IV, Allied Control Commission.Section I, Public Health, pp. 14-16. Prepared by Col. Thomas N. Page, MC, on 1August 1944.
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FIGURE 5.-Regionalmedical supply warehouse, Rome, Italy, 1944.
(Rieti, Viterbo, Littoria, Frosinone, and Terni)under the control of Region IV (see map 9) and, while these were not sufficient,they did make it possible to keep medical units operating. Other small amountswere furnished to Rome Region hospitals, displaced persons at Foggia, and to theFifth U.S. Army and the British Eighth Army.
Food.-Because of the lack of transportation, theamount of food distributed to hospitals was insufficient. Provincial supplyofficers reported, however, that supplementary rations put at their disposalwere made available to hospitals, orphanages, and welfare institutions.
In Rieti Province, a highly agricultural area which hadsuffered very little damage, the situation was not so serious as in otherprovinces. Fruits were abundant, the grain harvest was good, the olive harvestassured an ample supply of olive oil, and when the sugar beet factory wasrepaired, the province had a minimum supply of sugar. The greatest problem wasthe difficulty in transporting food from one commune to another over damagedroads.
Viterbo Province, too, was remarkably well supplied withfood. Their greatest need was sugar and salt, and powdered milk for the childclinics and orphanages.
Pharmacies.-In Littoria Province, many of thedrugstores were completely destroyed. Some of them were set up in temporarylocations but were badly in need of even the simplest items, such as alcohol,gauze, bandages, and iodine.
Every town in Frosinone Province had one or more drugstores.All druggists were requesting medicines, mostly sulfonamide drugs and Italianspecialties, to fill prescriptions.
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Many pharmacies in Rome Province werecompletely destroyed and others were partly damaged. Most of them had reopened,either at new sites or in damaged buildings that had been repaired, and theywere functioning even though their supplies were greatly depleted. Somepharmacists purchased medicines independently to augment their stocks; otherscarried on as well as they could with what stocks they hadon hand. The greater part of the two civil affairs units was received anddelivered to the Medico Provinciale for distribution, first to hospitalsaccording to the population they served, then to hospital pharmacies, and thento private pharmacies, thus relieving some of the shortages.
In the entire province of Rieti, there were 133 pharmacies ofwhich 70 were located in the larger communes and 63 were dispersed among theother communes. All these pharmacies had limited medical supplies as it had beena long time since their stocks had been replenished.
Pharmacies in Viterbo and Terni Provinces werenumerous and, in general, had suffered little damage. Stocks, while notabundant, were sufficient for normal needs for a short period.
Regional Warehouses
General.-Regional warehouses were established, anddetailed instructions for their operation were issued. The instructions, similarto those contained in a memorandum from Colonel Page to the provincialcommissioners, dated 18 May 1944, stated that regional warehouses, under thedirection of the regional public health officer, would receive, store, anddistribute to the provinces all supplies coming from the Central Depot.
Items purchased by a province would be distributed throughoutthe province under the direction of the provincial public health officer, orMedico Provinciale, with the approval of the regional public health officer. TheMedico Provinciale was permitted to hire the personnel necessary to operate hisown wholesale establishment, operating it on provincial funds without profit.
Responsibilities.-The provincialcommissioner was responsible for carrying out the operating instructions and fordelegating duties and responsibilities, as indicated, to the regional publichealth officer or to the provincial public health officer.7
The provincial public health officer was responsible forestablishing, staffing, equipping, and operating a provincial storehouse,including the maintenance of accounts and submission of reports as required bythe operating instructions.
He submitted requisitions to the regional public healthofficer by the first of each month for supplies to cover the following month.Long term
7Executive Memorandum No. 34, 1 Mar. 1944, subject: Instructions for Handling Medical Supplies. Published by Allied Control Commission, Italy, in "Instructions for the Guidance of Officers of the Commission, vol. I," pp. 61-64.
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requirements were presented semiannually forthe periods 1 July to 31 December and 1 January to 30 June; the regional publichealth officer then consolidated requisitions for the entire region.
The provincial public health officer was alsoresponsible for obtaining supplies at the regional warehouse and distributingthem throughout the province, by his own method, but with the approval of theregional public health officer, in the following order of priority: (1)hospitals and clinics, (2) doctors and midwives, and (3) pharmacists and otherretailers.
Funds for purchasing the supplies were deposited with thelocal sub-accountant or in a bank to the credit of the Allied Finance Agency,each region being assigned an Allied Finance Agency account number.
Accounting.-Supplies would be segregated by types and sources,both physically in the storehouse and on all accounting records and documents.The following code letters, combined with U.S. nomenclature and placed after theitem number, were used to identify the supplies by types and sources:
Type of source Code letter
U.S.A. imports A
U.K. (United Kingdom) imports B
U.S. Army X
U.K. Army Z
Captured or confiscated, Italian H
Captured or confiscated, German G
Purchased (specify source) P
Miscellaneous (other Allied Nations) Specify
Example: 10110-B Acid, Boric, USP, indicated U.K. import.
Requisitions (indents).-Requisitions (indents) forsupplies would contain only items shown on the civil affairs list; would beprepared in English, in triplicate, on ordinary stationery; and would give thefollowing information: where and how supplies were to be shipped; basis for therequisition (such as population of province); and item number, nomenclature,unit, and quantity.
The original and one copy were to be forwarded to theregional public health officer; the triplicate copy was to be retained by theoriginating agency.
Sales.-Records of sales, based on approvedrequisitions, were to be prepared, in triplicate, on issue voucher F/F 18,showing the item number, nomenclature, unit, quantity, unit and total salesprice, and instructions for making payment. To facilitate the preparation ofmonthly reports, separate issue vouchers would be prepared for sales from eachsource of supply in instances where a single requisition was filled from morethan one source. Each issue voucher was to be paid separately, the payment beingmade into a bank for the Allied Finance Agency, with a notation that thecollection was on the account of Public Health Division. Copies of the bankdeposit
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slips were attached to the monthly report of sales. Thepurchaser or his representative was required to present a signed copy of a bankdeposit slip and sign the receipt certificate; the warehouse officer signed theissue certificate on the duplicate and triplicate copies. In forward areas wherethis procedure might not be possible, payment could be made to the nearestfinance officer or subaccountant with the manner of payment noted on theduplicate and the triplicate copies of the issue voucher.
For any free issues of supplies in emergency cases, issuevoucher F/F 18 contained the following certificate over the signature of theissuing officer: "Emergency free issue-No organized local government unitin vicinity."
ESTABLISHMENT OF ENDIMEA
As the Italian Government began to assume responsibility forliberated Italy, an organization known as ENDIMEA (Ente Nazionale DistribuzioneMedicinali degli Alleati) came into existence for the distribution of medicalsupplies. The directive establishing this organization included the followinginstructions.
In conjunction with representatives of Headquarters, AlliedControl Commission, a system of payment was established so that the regionswould not be required to handle payments when supplies on hand had beendistributed.
A new set of prices for imported Allied supplies would bepublished by ENDIMEA under rules and regulations set by the Italian Government.Prefects of provinces would be notified about the new organization by theItalian Government. Institutions which formerly received supplies free, or at awholesale price, were to apply to the public health officer of the provinceconcerned, who would make the necessary arrangements for payments.
ENDIMEA would act as the sole distribution agency for medicalsupplies furnished by the Allies for the civilian population in liberated Italy.In those parts of Allied Military Government territory which the senior civilaffairs officers of the Fifth U.S. Army and the British Eighth Army mightindicate, this same organization would be responsible for distribution. In thoseprovinces in which the senior civil affairs officers of the Fifth U.S. Army andthe British Eighth Army did not desire this organization to function, theprovisions of Executive Memorandum No. 348 wouldremain in force.
So that ENDIMEA might function properly, regionalcommissioners had to close all regional warehouses within 10 days; sell allsupplies on hand to recognized outlets and send in a complete final statementfor all supplies by 31 October 1944; assist ENDIMEA representatives by advisingthem of the dealers that had been set up at provincial level and in obtainingthe necessary transport permits for distribution within their regions; and
8See footnote 7, p. 52.
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advise all provincial public health officers to submitrequisitions either to ENDIMEA representatives or to the Public HealthSubcommission, Headquarters, Allied Control Commission, once each month startingwith November. These requisitions were to be submitted not later than 31October. For provinces which were to be taken care of by Allied MilitaryGovernment of the Fifth U.S. Army and the British Eighth Army, there was noprocedural change.
In Allied Military Government territory of the Fifth U.S.Army and the British Eighth Army, stocks on hand as of the date of receipt ofthe directive would be distributed as indicated in Executive Memorandum No.34. Stocks received after that date would be shipped on an issuevoucher from the Allied Control Commission Medical Depot, and show that thesesupplies were being issued to an area where "no organized localgovernmental unit exists."
Civilian supplies of a finished status (thatis, completely manufactured and packaged) would not be frozen but would remainin the owner's hands for sale to the public within the region. No civilianmedical supplies, except those in excess, would be allowed to leave the regionin which located without the approval of the regional commissioner; however,biologicals could be distributed to other provinces.
Raw or unfinished medical supplies would be frozen, andHeadquarters, Allied Control Commission, was to be advised of the location andthe inventory of such materials.
Regional commissioners in Allied MilitaryGovernment territory and senior civil affairs officers of the Fifth U.S. Armyand the British Eighth Army might still requisition required civilian medicalsupplies when such action was considered necessary to protect the health of thecivilian population or to assure proper distribution within their areas.
CONTROL OF NARCOTIC DRUGS
Another complex and extensive problemconcerned the control of narcotic drugs. The files of the Bureau of Narcotics,U.S. Treasury Department, are replete with correspondence showing thecooperation between that bureau and the War and Navy Departments. Anotherexample of this cooperation is the lecture series given by the Commissioner ofthe Bureau of Narcotics and other highly trained and experienced officers of thebureau to students in the schools of military government. The purpose of thetraining was to acquaint the officers and men who would be in charge of militarygovernment in occupied countries with the narcotics laws of those countries, togive them general information about narcotic drugs, to acquaint them withexisting conditions relative to narcotic drugs, particularly in the Far East,and to teach them how to cope with narcotics addicts.
The War and Navy Departments received the full cooperation ofthe Bureau of Narcotics also in the enforcement of military government orders
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related to narcotics in occupied countries. The bureauadvocated, and the military authorities agreed to, the destruction of allfactories manufacturing narcotic drugs in previously Japanese-occupiedcountries, and the seizure of all such drugs. Several narcotics agents who wereserving in the Armed Forces were assigned to the Pacific theater specifically toestablish proper narcotics control in Japan and Korea. Experts in theenforcement and administration of narcotics laws were assigned from the bureaufor limited periods to assist in this work. With the help of these experts, itwas possible to locate quantities of opium and of narcotic drugs which had beencached by the Japanese. Records of the Japanese Opium Monopoly were seized, andsome Japanese officials cooperated by revealing the locations of drug factories.All narcotic drugs which had no medicinal value, or which had been adulterated,were destroyed.
In addition to approximately 100 former employees of theBureau of Narcotics who entered military service, many of whom were assigned tonarcotics work, the Army requested and received for special duty several highlytrained experts to assist in establishing control measures in all countriesoccupied by U.S. Forces.
SUMMARY
On the whole, the general concept of a basicmedical unit (or "brick," as the British Forces called it) seems tohave been valid; and in actual use, the unit served the purpose for which it wasintended. Usually, when these 20-ton units arrived at supply depots in occupiedcountries, they were rearranged on an item basis for peripheral distribution.This fact, however, does not minimize the usefulness of the unit concept.
One might question the necessity of a dual supply system,military and civilian, operating side by side. But one of the main purposes ofcivil affairs was to free the combat forces of the burden of the care of thecivilian population in the territory in which military operations were inprogress. To a considerable extent, military medical supply channels wererelieved of this burden through the civil affairs units. In some instances,military supply was called upon for emergency items before the arrival of theunits, but these were the exception rather than the rule.
In the operation of civil public health supplychannels, the importance of having key personnel who were trained in medicalsupply became apparent and was soon recognized as essential to the civil affairssupply operation. Also, the importance of medical supplies in the civil publichealth program cannot be overemphasized. Adequate planning and effectiveoperation are essential. No program, however well conceived, can functionwithout the necessary medical items and the transportation to distribute them.
