History

CHAPTER I

The Medical Supply System

MEDICAL SUPPLY BETWEEN WARS

The disruption of the national economy and the delay indelivery of military supplies which developed during World War I convincedCongress of the wisdom of industrial preparedness. The National Defense Act of1920 charged the Assistant Secretary of War with the "supervision of theprocurement of all military supplies and other business of the War Departmentpertaining thereto and the assurance of adequate provision for themobilization of materiel and industrial organizations essential to war-timeneeds." The italicized phrase conveyed authority for the far-reachingprocurement planning program which began in 1920 and continued until ourentrance into World War II.

Organization for Procurement Planning

The administrative organization for the accomplishment andsupervision of Medical Department procurement planning was established on threelevels: the Office of the Assistant Secretary of War, the Surgeon General'sOffice, and the depots of the Medical Department. The overall responsibility ofthe Secretary was delegated to a Procurement Division established in the WarDepartment late in 1921. On the second level, a procurement planning section wasset up in the Finance and Supply Division of the Surgeon General's Office, inJune 1922. Designated variously as 'section,' and 'subdivision,' thiselement of the Finance and Supply Division was charged with "the collectionof information and compilation of data pertaining to sources of [medical]supply." It began its work with only one full-time officer.¹

The field organization for procurement planning wasdetermined by the location of Medical Department depots and was affected to alesser extent by the establishment in 1923 of 14 War Department ProcurementDistricts. These 14 districts were combined into 4, with headquarters at NewYork, N.Y., Chicago, Ill., St. Louis, Mo., and San Francisco, Calif. The choiceof cities was determined largely by the location of depots handling medicalsupplies and by the distribution of the industries concerned. Reorganization ofWar Depart-

¹(1) Memorandum Orders No. 1, Office of the Assistant Secretary of War, 25 Oct. 1921, subject: Procurement Division, Office of the Assistant Secretary of War. (2) Annual Report of The Surgeon General, U.S. Army, 1922. Washington: U.S. Government Printing Office, 1922. Series cited hereafter as Reports of TSG, with appropriate dates. Monthly progress reports on Procurement Planning were submitted to the Assistant Secretary of War, beginning in 1924. In April 1925 quarterly reports were substituted, and in 1931 these were replaced by annual reports.

ment procurement activities in 1933 had little or no effectupon the procurement planning activities of the Medical Department. Although anadditional center was established at Birmingham, Ala., it remained comparativelyinactive and was abolished in 1939. For all practical purposes, procurementplanning activities of the Medical Department were confined throughout thisperiod to the four cities designated in 1923.²

Personnel engaged in procurement planning in the field alsohandled current procurement. In St. Louis and San Francisco, the procurementofficers of the depots were assigned procurement planning as an additional duty.The medical supply officer at the Chicago Quartermaster Depot doubled as theprocurement planning officer. Only in the medical section of the New YorkGeneral Depot, which handled the overwhelming bulk of Medical Departmentprocurement, were personnel assigned exclusively to procurement planning, thenumber of officers varying from one to six.³

Accomplishments in Procurement Planning

If the difficulties, delays, and embarrassments that hadhampered Medical Department operations in World War I were to be avoided, it wasclearly necessary to determine in advance (1) what supplies and equipment wouldbe required in the event of war, (2) in what quantity, and (3) from whatmanufacturing facilities they could be obtained. The preparation ofspecifications and tables of equipment, and the computation of requirements,were carried out in Washington, D.C.; the location and survey of facilities, andthe preparation of production schedules, were the responsibility of the fieldoffices.

The determination of requirements involved, first of all, thepreparation of specifications for medical supplies and equipment. The usefulnessand military serviceability of the items to be procured were given primaryconsideration, but experience in World War I had made it apparent that exclusiveattention to these aspects would hamper the procurement effort. To describecharacteristics which would be ideal might easily result in specifying an itemwhich could not be manufactured in sufficient quantities. "The best is theenemy of the good" applies with special force to wartime procurement. Itwas the policy of The Surgeon General, therefore, to bear constantly in mind thedesirability of making Medical Department specifications conform to the bestcommercial practices in size, quality, and packaging. Close contact wasmaintained with national trade associations and the Federal SpecificationsBoard, as well as with the Bureau of Medicine and Surgery of the NavyDepartment.⁴

In 1928, a total of 3,712 items in the supply catalogrequired specifications. By the end of that year, specifications for 1,213 ofthese items had been prepared and had received the approval of the WarDepartment. This number

²(1) Memorandum, The Adjutant General to The SurgeonGeneral, 9 Mar. 1933, subject: War Department Procurement Zones. (2) The Storyof Medical Department Procurement Planning, 1920-1940. [Official record.] (3)Annual Report of Procurement Planning, Medical Department, 1 July 1934.
³Reports of TSG, 1923-39.
⁴Reports of TSG, 1925-27.

was increased to 1,494 by 1932. In 1933, however, a newpolicy was adopted, which slowed down the process of preparing specifications,but which injected a large element of realism into those which were approved.All specifications prepared during 1933 and subsequent years were subjected tothe test of purchasing before they could be approved as official U.S. Armyspecifications. Until such approval was received, they were described as"Medical Department tentative specifications." By 1937, the test ofpurchasing had been applied to such an extent that 1,062 items of medical supplywere covered by Army specifications. This number was increased to 1,137 in 1938and to 1,570 in 1939. The Medical Department Supply Catalog in the latter yearlisted a total of 4,652 items, 3,018 of which comprised the component parts ofindividual equipment, organizational equipment, and equipment of fieldhospitals, known collectively as "war items."

Estimating requirements.-In the meantime, the procurementplanning section of the Finance and Supply Division had been steadily engaged indetermining the quantities of medical supplies which would be needed in theevent of war. Of all the tasks connected with procurement planning, none wasmore tedious, complicated, and uncertain in its accomplishment than thecomputation of requirements. Although not primarily guesswork, as the critics ofprocurement planning occasionally charged, the process did involve considerableprophecy, which was almost as hazardous. Requirements figures, moreover, weresubject to frequent change and revision to keep abreast of medical andpharmacological advances and to reflect changes in mobilization plans. Withinthese limitations, requirements figures were a necessary part of procurementplanning. Questionable though they might be, they offered the only comparativelystable goal towards which procurement efforts could be directed.

In the computation of requirements, the first importantelement to be determined was the "troop basis"-the size andcomposition of the Army which was to be raised if war should come. Thisinformation was provided by general mobilization plans prepared by the GeneralStaff and approved by the Secretary of War. In the fall of 1921, the firstmobilization plan in the Nation's history was prepared, calling for a total of1.5 million men. This plan was revised in 1928 and again in 1933, when aconsiderably larger force was contemplated. In 1938, the Protective MobilizationPlan was approved. This included an "Initial Protective Force" ofapproximately 400,000 and authorized successive augmentations, if the emergencyrequired it, to an aggregate strength of 4 million men.⁵

Tables of equipment and allowances constituted the nextimportant element entering into the computation of requirements. These tablesindicated the types and quantities of medical supplies and equipment to befurnished to each troop unit in the mobilization plan. From 1925, the SurgeonGeneral's Office intermittently prepared and revised tables of equipment andallowances. By

⁵(1) Letter, The Adjutant General to The Surgeon General andothers, 13 Oct. 1921, subject: Computation of War Requirements and the Determination ofSurplus. (2) Tyng, Lt. Col. F. C., MC, "Speech for Advanced Class, CarlisleIndustrial Mobilization," 19 Oct. 1938. [Official record.]

1927, tables had been prepared for the most important typesof Medical Department field installations, including general, surgical,convalescent, evacuation, and station hospitals of various sizes; hospitaltrains, convalescent camps, and Army dispensaries; expansion equipment for fieldhospitals; and medical regiments, which were then the most important troop unitsfor the evacuation and treatment of battle casualties. In common with otheraspects of procurement planning, these tables were subject to frequent change; athorough revision, begun in 1930, was practically completed by the end of 1931.⁶

Mobilization plans and equipment and allowance tables madepossible the computation of initial supplies and equipment which would be neededby various troop units, but they provided little information as to thequantities that would be consumed in training or in battle. Additionalinformation was necessary before maintenance requirements could be computed.To predict the future by an examination of the past, the Procurement PlanningSection resorted to the supply and medical statistics of World War I.Maintenance factors thus developed, indicated probable rates of use for eachitem of supply and equipment, both in the Zone of Interior and in the theatersof operations.⁷

The revised mobilization plan of 1933 made it necessary torecompute all requirements figures, a task completed for the Medical Departmentlate in 1935. By this time also the cubic volume and the weight of nearly halfthe medical items had been determined, thus providing valuable information forthe preparation of shipping schedules. Beginning in 1936, the monthly cost ofmedical supplies to be procured in the event of war was estimated for each item,and the total cost of each month's requirements for mobilization was computed.The Protective Mobilization Plan of 1938 forced still another sweeping revisionof Medical Department requirements figures, a revision which had not beencompleted when German divisions crossed the frontier into Poland.⁸

Locating manufacturing facilities.-While the SurgeonGeneral's Office was estimating the quantities of medical supplies which wouldbe required in time of war, the procurement planning sections of medical depotswere locating and surveying the manufacturing facilities which could producethese supplies. Potential producers were located by various means: contacts withtrade and manufacturing associations; references to Thomas' Register; andby use of the Bidders' List, which was maintained in the purchasing section ofall depots and which contained the names of all manufacturers and dealers whohad bidden on Medical Department contracts. When a summary appraisal of afacility indicated its probable usefulness to the Medical Department, theprocurement district informed The Surgeon General, who asked the AssistantSecretary of War to allocate the facility to him. This device gave the MedicalDepartment a virtual

⁶Reports of TSG, 1927 and 1931.
⁷(1) Strong, Maj. E. R., MC, "Procurement PlanningII." [Official record.] (2) Speech, Maj. Gen. Robert U. Patterson to ArmyIndustrial College, September 1931.
⁸(1) Reports of TSG, 1931, 1934-36, and 1939. (2) Letter,Col. H. K. Rutherford, Director, Planning Branch, to The Surgeon General, 27Mar. 1939, subject: Acceleration of Procurement Planning.

monopoly of the military production of the factory affected.By 1928, a total of 1,294 facilities, nearly half of them located in the areaextending from Philadelphia, Pa., to Boston, Mass., had been earmarked in thisway for the Medical Department. Numerous changes reduced the number of singleallocations to 467 by 1937, a number which remained virtually unchanged through1939.⁹

After a manufacturing plant had been allocated to the MedicalDepartment, it was surveyed to determine its capacity and to evaluate itsequipment, its sources of power and raw materials, the adequacy of itstransportation, and the number and quality of its employees. The surveysthemselves, however, were of widely differing reliability. If the procurementplanning officer lacked interest or ability, the survey was hasty andsuperficial; if the management of a plant cared little for governmental ordersor was skeptical of procurement planning, not enough information could beobtained.¹⁰In too many instances, moreover, restrictions upontravel funds forced reliance upon correspondence instead of on personalinspection.

While the procurement planning officers in the field weremaking these surveys, medical supply officers in Washington examined the datacollected and apportioned Medical Department requirements directly to theallocated facilities. Tentative schedules of production were prepared andpresented by the appropriate district procurement planning officer to eachmanufacturer concerned. The schedule, when approved by the manufacturer, wastermed an "accepted schedule of production"¹¹ and was filed in theSurgeon General's Office. While these schedules obligated neither party, theydid serve to inform the manufacturer of the Medical Department's probableneeds, and to give The Surgeon General an estimate of a plant's ability tosatisfy the needs. It was expected that the schedules would enable procurementofficers, upon the outbreak of war, to place contracts promptly for all medicalsupplies and equipment required in mobilizing a large army.

Between 1923 and 1939, considerable progress was made in thepreparation of these schedules. By 1930, a total of 1,713 items had beencovered; by the end of 1935, the number had grown to 2,985. In 1938, the taskwas virtually completed although numerous revisions were expected as changes inMedical Department requirements and the capacity of manufacturing plants becameevident. Indeed, the schedules of production, as guides to procurement, couldhave little value if they were not constantly revised. No manufacturer could besure of producing a stated quantity of items after the outbreak of war unless heknew that raw materials, tools, and labor would be available, and

⁹(1)Allocation of Facilities, 1928. [Official record.] (2)Progress Report of Medical Department, Supply Branch, 30 June 1932. (3) Report of TSG, 1937. Inaddition to the single allocations, there were 6 joint allocations, 54 allocations for the Army and NavyMunitions Board, and 3 for the Office of the Assistant Secretary of War.
¹⁰(1) Statement of Col. Earle G. G. Standlee, MC, to Lt.(later Capt.) Richard E. Yates, MAC, 9 Jan. 1945. (2) Letter, Capt. Earle G. G. Standlee, MC, toMedical Supply Officer, New York General Depot, 15 Oct. 1936, subject: Survey ofFacilities.
¹¹Before 1926, the term "war order" was used todescribe these schedules. In that year, however, use of the term wasdiscontinued because the schedule was not in fact an "order" in anylegitimate sense. It was no more than an estimate of capacity to produce a givenitem.

naturally, this assurance could not be given far in advance.At best, therefore, the schedules merely indicated quantities which could beproduced under favorable conditions; at worst, they represented hasty,ill-considered estimates rendered by a busy factory manager who wished to ridhimself of the procurement planning officer and to return to more agreeabletasks.¹²

Throughout these years, procurement planning officers wereestimating the quantities of strategic, critical, and essential raw materialsthat would be needed if the United States went to war. For those materialsthat were the exclusive procurement responsibility of the Medical Department,specific procurement plans were prepared, including the quantities required,sources of production, and studies of substitutes. Raw materials which were notprocured by the Medical Department, but which entered into the manufacture ofmedical supplies, received less extensive study. Estimates of Medical Departmentrequirements were submitted to the Assistant Secretary of War and thenforwarded to the technical service having procurement responsibility, which thenconsolidated the requirements of all services and prepared specific procurementplans.

Training supply personnel.-A final phase of procurementplanning, which engaged the attention of the Medical Department during the twodecades preceding World War II, involved the training of Regular Army andReserve officers for the supply responsibilities of a great war. During WorldWar I, the Medical Department had approximately 400 officers in its supplyservice, a majority of whom held temporary commissions and promptly returned tocivilian life after the conflict ended. When procurement planning began, adetermined effort was made to commission in the Sanitary Corps Reserve a numberof executives in the industries producing medical supplies. This would have madeavailable to the Medical Department highly skilled men who could, withefficiency and economy, carry on the extensive procurement operations which warwould entail.

The prospective Reserve officers proved surprisinglyreluctant. They objected to the 15 days of active duty or the enrollment in acorrespondence course, required of Reserve officers each year, and they fearedthe provisions of the penal code which described heavy penalties for agents ofcorporations who, while employed by the Federal Government, transacted businesswith their own firms. By 1924, only 62 of these executives had acceptedcommissions. The number increased to 106 in 1926, and leveled off at 110 in1927. Increases, if any, during subsequent years are not recorded, but it isprobable that the Medical Department considered this element of the SanitaryCorps Reserve to be sufficiently large. The training program for Reservepersonnel, although not extensive, was steadily pursued from 1925 until theoutbreak of war. Each year from 5 to 16 Reserve officers were called to active duty for 2 weeks. During this time, they served in the Surgeon General'sOffice, the Office of the Assistant Secretary of War, the New York GeneralDepot, the St. Louis Medical Depot, or other field installations. Whatever theirassignment, they were given opportunity to become familiar with Army practices,with the needs of the

¹²(1) Reports of TSG, 1930, 1935, and 1938.(2) See footnote 10(1), p. 5.

Medical Department, and with the specific procurement planswhich had been prepared.¹³

The training of Regular Army officers for procurement andsupply duties was far more intensive. In 1922, a Medical Supply Training Schoolwas established at the New York General Depot, and six officers were enrolled.The instruction was intended to convey a general familiarity with all supplyfunctions of the Medical Department and with a detailed knowledge ofprocurement. This school functioned until February 1924, when the establishmentof the Army Industrial College in Washington rendered it inadvisable for theMedical Department to maintain a separate school. Supply officers, however,continued to receive an important part of their instruction in the MedicalSection of the New York depot.

Operating directly under the Office of the AssistantSecretary of War, the Industrial College instructed supply officers from alltechnical services in the many-sided problems of industrial mobilization. Inaddition, each student officer prepared a plan for the procurement of animportant item with which his own technical service was concerned, and the plansthus prepared by medical supply officers were incorporated into the plans of theSurgeon General's Office.

The Army Industrial College soon became the capstone of theMedical Department's training program for supply officers. A 2-year tour ofduty in the New York General Depot was normally followed by 1 year in theSurgeon General's Office and a 1-year course at the Army Industrial College.During the 1920's from three to five medical officers finished this curriculumeach year, and were assigned to procurement planning and supply duties in theSurgeon General's Office or in one of the medical depots in the field. In the1930's, only 2 medical officers each year were enrolled in the Army IndustrialCollege, but, by the end of that decade, 41 had been graduated. In addition, anumber of officers who never attended the Industrial College had receivedextensive procurement training in Medical Department field installations.

War Reserves and Stockpiles

Shortly after the end of World War I, the Medical Departmentexamined its surplus supplies and made plans to establish an adequate WarReserve. In April 1924, The Surgeon General submitted to The Adjutant General adetailed statement, elaborating the necessity for reserves of medicalsupplies and listing the types and quantities which should be stored. "TheMedical Department," he declared, "becomes upon mobilization,responsible for the immediate provision of adequate hospital facilities andcare. There is no training period. Sickness and injury wait for no man." Ifthe necessary supplies and equipment were not readily available, "sufferingand loss of life would

¹³(1) Memorandum, Col. Edwin R. Wolfe, MC, to the AssistantSecretary of War, 9 Mar. 1922. (2) Procurement Plan of the Medical Department, 31 Dec. 1922.[Official record.] (3) Reports of TSG, 1924, 1926, and 1927. (4) In 1929, theMedical Department estimated that it would need 95 reserve officers forprocurement duties in the event of war. "Personnel on Procurement Planning,Fiscal Year 1930." [Official record.]

result and a storm of criticism would be engendered. Not toprovide it is to neglect the lessons of the Spanish-American and World War andto reverse the practice of the Medical Department for the last twenty-fiveyears, a policy which has been successfully defended before and approved byCongress." The Surgeon General then listed supplies and equipment whichshould be stored as unit assemblies for a large number of field hospitals,hospital trains, medical laboratories, medical regiments, and otherinstallations. In addition, he requested authority to hold in reserveconsiderable quantities of strategic and critical drugs, field dressings, andsurgical instruments.¹⁴

In September 1924, The Surgeon General was authorized tostore as war reserves a portion of the assemblies and items which had beenrequested. Much of the material was assembled from World War I surpluses. Someunit assemblies were sharply reduced in number, and others were eliminatedentirely; the strategic and critical drugs were approved without change; allfield dressings were struck from the list, except 1 million first aid packets;and the quantities of surgical instruments were greatly reduced. "You arefurther directed," The Adjutant General concluded, "to initiate aprogram extending over four years for building up the existing shortages at therate of $25,000 a year."¹⁵

The War Reserve thus approved by The Adjutant General wasestimated to be sufficient, when shortages were eliminated, to supply two fieldarmies, or 1 million men, for 2 months. The production lagtime of most items farexceeded 2 months, but there were other, more serious deficiencies in the WarReserve. The stocks of medical supplies were not in the proper depots, nor werethey suitably assembled. The total value of the authorized War Reserve,including the Quartermaster items in the unit assemblies, was slightly over$24 million, but the value of the stocks actually on hand in February 1926 wasless than $9 million. Thus, there was a deficiency of some $17 million,¹⁶and the only authorized provision for filling this large gap was the program tospend $25,000 a year for 4 years. Repeated efforts to obtain additional fundsbrought no result. In 1933, a new authorized War Reserve provided a smallerquantity of medical supplies and equipment, but 2 years later, The AdjutantGeneral was informed that even the smaller requirements could not be fulfilled.Among the more serious shortages were hospital assemblies, medical kits, andveterinary kits.¹⁷

In the accumulation of strategic drugs, the MedicalDepartment's efforts attained a larger measure of success when authority wasgranted in 1925 to establish stockpiles containing 113,000 pounds of opium,13,000 pounds of nux

¹⁴Letter, Maj. Gen. M. W. Ireland to The AdjutantGeneral, 18 Apr. 1924. This letter was examined by Capt. Richard E. Yates, MAC,in the preparation of the original draft of the Zone of Interior portion of thisvolume, but has since been lost or destroyed.
¹⁵(1) Letter, Maj. Gen. H. H. Tibbetts to The SurgeonGeneral, 6 Sept. 1924. (2) See footnote 14, above.
¹⁶Includes a surplus of approximately $2 million in twounits.
¹⁷(1) See footnote 7(1), p. 4. (2) Letter, Col. Edwin P.Wolfe, MC, to The Adjutant General, 21 Dec. 1925, subject: Status of WarReserve, and 1st indorsement thereto. (3) War Reserves-Prepared in Responseto Letter of February 11, 1926. [Official record.] (4) Letter, Lt. Col. T. J. Flynn, MC, to The Adjutant General, 4 Nov. 1935, subject: Revision of StatusReports Required by AG 381.4.

vomica, and a quantity of cocaine sufficient for 2 years.This program entailed very little expense for the supplies of opium and cocaine,seized by the Federal Narcotics Control Board, were transferred to the MedicalDepartment without cost. By the end of 1938, the stockpile of opium had beenincreased to 192,000 pounds, and 133,200 pounds of quinine were in the reserve.Largely at the instigation of the Medical Department, additional supplies ofboth drugs were procured over the next 3 years.¹⁸

TRANSITION TO WAR, 1939-42

From the outbreak of the war in Europe in September 1939until the attack on Pearl Harbor, the United States gradually called into beinga portion of its great potential military strength and prepared to enter theconflict if necessity should so dictate. This period of more than 2 years wasmarked by a succession of important developments abroad, each of which served asa warning to the United States and influenced Congress and the President toincrease the pace of military preparations. From the standpoint of the supplyofficer, this 2-year period was a difficult one. It was neither peace nor war,but a frustrating mixture of both. The hypothetical "M-day" on whichprocurement plans were to be invoked never came. Mobilization took placepiecemeal, but was nevertheless far advanced by the time Japanese bombs struckPearl Harbor.

Organizational Changes

Until a major reorganization in the summer of 1942, thesupply functions of the Surgeon General's Office continued to be performedwithin the Finance and Supply Division, of which Lt. Col. (later Col.) FrancisC. Tyng, MC (fig. 1), became chief in May 1939. Neither was there anysignificant change in responsibilities during this period, except for theelimination of the Procurement Planning subdivision late in 1941 and thetransfer of the planning activity to current procurement. The period was markedprimarily by expansion to keep pace with the needs of the expanding Army. The 7officers and 27 civilians who made up the Finance and Supply Division inSeptember 1939 had grown to 16 officers and 201 civilians by December 1941. Thedepot system by the latter date had 125 military and 2,700 civilian employees.

To administer the growing medical supply organization, experienced men were brought in from civilian life, and Regular Army officers were given special training. A few days before the German invasion of Poland, a number of individuals "especially suited to industrial preparedness" were commissioned and assigned to the Finance and Supply Division. Plans were made for their training in the offices of the Assistant Secretary of War and The Surgeon Gen-

¹⁸(1) Memorandum, Lt. Col. R. D. Harden, MC, to Col. E. E. MacMorland, Ord C, Office of the Assistant Secretary of War, 21 Nov. 1938. (2) CivilianProduction Administration, Industrial Mobilization for War, vol. I, p.75. (3) Study SR-428-326, "Stockpiles of Strategic and CriticalMaterials. Part I. Opium: Probable Source and Cost of a Postwar Stockpile,"August 1944. Foreign Economic Administration, Office of Economic Programs,Supply and Resources.

FIGURE 1.-Col. Francis C.Tyng, MC, Chief, Financeand Supply Division, 1939-43.

eral and in Medical Department field installations. The ArmyIndustrial College continued to train a number of Medical Corps officers. ThreeRegular Army officers were graduated in 1940. In 1941, 4 Regular Army officers and 8Reserve officers finished the course, bringing to 56 the number ofmedical officers who received training at the Army Industrial College during theyears 1924-41. In addition, special efforts were made to provide training forReserve officers who had not relinquished their civilian occupations. In 1940,23 of these officers took a course of instruction in procurement at the MedicalSection, New York General Depot, for which they had been prepared by acorrespondence course given a few months earlier.¹⁹

Planning for Procurement

The supply activities of the Surgeon General's Officeduring this period were largely of a planning and supervisory nature. TheFinance and Supply Division maintained close contacts with the Office of theAssistant Secretary

¹⁹(1) Memorandum, Lt. Col. R. E. Murrell, MC, to theExecutive Officer, OTSG, 31 Aug. 1939, subject: Procurement Planning, SGO. (2)Reports of TSG, 1940. (3) Memorandum, Lt. Col. C. F. Shook, MC, to Col. CharlesHines, Secretary, Army and Navy Munitions Board, 20 Feb. 1940.

FIGURE 2.-Maj. Gen. James C. Magee, The SurgeonGeneral, U.S. Army, 1939-43.

of War, and later, with the Under Secretary of War. As therearmament program gained speed, these agencies of the War Department observedthe procurement progress made by the technical services and enunciated broadpolicies for their guidance. The Finance and Supply Division received thesedirectives, interpreted them to its field installations, and compiled the manyreports required by higher authority. In addition, the division rendered aid todepots, procurement officers, and manufacturers who needed help in obtainingpreference ratings, component parts, labor, machine tools, transportation, andother essentials in the fabrication of medical supplies.

Closely connected with procurement planning, and of criticalimportance in supply preparedness, was the Medical Department War Reserve.Hastily assembled from unbalanced stocks at the conclusion of World War I, theWar Reserve was inadequate during the 1920's and 1930's; it was stillinadequate, both in quantity and quality, when the United States wasprecipitated into the war. The reserve was poorly assembled and packed,contained obsolete items, and was not large enough to provide for even modestwartime needs. Maj. Gen. James C. Magee, The Surgeon General (fig. 2), commentedbluntly on the matter to the General Staff in May 1940."Theoretically," he declared, referring to the

unit assemblies of the War Reserve, "there areavailable 54,750 fixed beds. But it must be clearly understood that the suppliesand equipment are of 1918 vintage, incomplete in modern operating roomequipment, wholly deficient in essential laboratory equipment, totally lackingin X-ray, physical therapy and hydrotherapy equipment, and stocked withscientific items" already obsolete or rapidly becoming so. This state ofaffairs had been caused by lack of money, for which, in turn, a generalindifference to any kind of military expansion was responsible. "No fundsfor medical preparedness were allotted the Medical Department since the closeof the World War until 1940 when the sum of $295,000 was appropriated and usedin the replacement of obsolete items and modernization of combat equipmentrequired for the I.P.F. [Initial Protective Force]." In November andDecember 1939, estimates were submitted to the Budget Officer, War Department,of funds needed to complete the shortages for the Protective Mobilization Plan($2,696,685) and to provide essential items for an enlarged Regular Army andNational Guard ($5,327,000). Both programs, however, were disapproved by higherauthority. The Surgeon General then presented a detailed statement of thehospital assemblies urgently required upon mobilization and which, because ofdelay in procurement, should be built up before the war. "I have not,"he concluded, "at the War Department's disposal for any emergency onecomplete, modern 1,000 bed general hospital for instant dispatch."²⁰

A year later, thanks in part to the limited mobilizationinspired by Hitler's success in Europe, but more immediately to General Magee'sefforts, there were more than 30 properly equipped general hospitals in the WarReserve, together with half as many 750-bed evacuation hospitals and a number ofsmaller units.²¹

Procurement of Medical Supplies

Although procurement planning and additions to the WarReserve continued during this period, the most important duty of the Finance andSupply Division was the procurement of medical supplies and equipment for anexpanding Army and National Guard. On 8 September 1939, the President authorizedthe Regular Army to increase its strength to 227,000 enlisted men, with aproportionate increase in officer personnel. At the same time, authority wasgranted to augment the National Guard to 235,000 men. Additional increases inthe Regular Army and National Guard were made during 1940, and in the summer ofthat year, the National Guard was called into the Federal service. On 1 July1940, the Medical Department was procuring supplies and equipment for a MilitaryEstablishment of 800,000 men. The largest peacetime Army in the Nation'shistory, 1,650,000 men, was gradually mobilized; but,

²⁰Letter, Maj. Gen. James C. Magee to The Adjutant General,10 May 1940, subject: Status of Medical Department for War.
²¹Hearings Before the Subcommittee of the Committee onAppropriations, House of Representatives, 77th Congress, First Session, on theMilitary Establishment Appropriation Bill for 1942, p. 491 (8 May 1941).

even so, the great increase in Army strength placed severe burdens upon a procurement service which had been geared to a much lowerlevel.

Purchasing officers at the New York General Depot (whichprocured 90 percent of the medical supplies during this period) and in otherdepots maintained a Bidders' List including the names of all knownmanufacturers and dealers capable of filling Medical Department orders. Thenames of all contractors who had previously filled Medical Department orderswere placed on the list; others were added as they were able to convince theMedical Department that they could supply the items needed. Manufacturers ordealers who wished to be included were given lists of standard items purchasedby the Medical Department and were notified of future purchases of those itemsin which they expressed an interest. Prospective bidders were also found inother ways. The Federal Reserve System, for example, undertook to uncovermanufacturing sources in its various districts and suggested many names to theFinance and Supply Division in Washington. The Office of Production Managementalso exerted itself to acquaint manufacturers with the needs of the Army, and,through its Division of Contract Distribution, obtained the names ofmanufacturers who had idle machinery and were thus able to accept eithersubcontracts or prime contracts. Prospective subcontractors were referred toprime contractors, and the latter were brought to the attention of thepurchasing officers of the Army.²²

Procurement planning, during the 1920's and 1930's, hadbeen conducted upon the assumption that the technical services would placepractically all their contracts with facilities allocated to them. It was hopedby this device to avoid the kind of interservice competition that had delayedprocurement and rendered it more costly during World War I. The assumption wasquickly abandoned when the rearmament program of 1940-41 got well underway.Neither the President nor the Congress established the economic controlsnecessary to put the allocations system into effect. The Bidders' List of theMedical Department was not restricted to allocated facilities; it contained thenames of all manufacturers and dealers who could furnish medical supplies,regardless of allocation. Of the 253 facilities used, only 172 (or 68 percent)had been allocated to the Medical Deparment.²³

The system of allocations had not kept pace with the needs ofthe technical services. New factories had been established, old factories hadbeen converted to war production, and the Medical Department, in common withother technical services, had developed or adopted new items. These changes hadnot been matched by a thorough revision of the allocations, and thus theallotted facilities were not adequate for War Department needs. Neither were therequirements estimates of the procurement planning days adhered to. Pro-

²²(1) Letter, Lt. Col. F. C. Tyng, MC, to Mr. H. C.Timberlake, 14 Dec. 1940. (2) Letter, Col. John W. Meehan, MC, to SenatorFrancis Maloney, 26 Sept. 1941. (3) Letter, Maj. M. E. Griffin, MC, to 12District Offices of the Defense Contract Service, Office of ProductionManagement, 20 Oct. 1941.
²³Memorandum, Lt. Col. C. F. Shook, MC, to Lt. Col. F.C. Tyng, MC, 1 Mar. 1941, subject: Report Upon Senate Resolution 71.

curement officers distrusted the requirements figures andconsidered them to be unrealistic. They had been computed in anticipation of anM-day, when the Nation would spring to arms and a deluge of war orders wouldissue from the Army. But the slow and steady increase in procurement during 1940-41did not fit into this pattern. It was very difficult to determine whatproportion of the planned requirements should be procured at any particulartime.²⁴ Indeed, when procurement reached floodtide in 1942 and 1943, it wasstill difficult to tell what part of the anticipated requirements had, in fact,been met.

Instead of relying upon computed requirements figures, theFinance and Supply Division, until 1942, placed its trust in the "depotreplenishment system." Each depot submitted to the Surgeon General'sOffice a stock report showing the receipts and issues of each MedicalDepartment item. Semiannual reports were submitted for nondeteriorating items,while deteriorating items were reported quarterly. These reports, coveringapproximately 4,500 items, were posted to consolidated stock cards in theSurgeon General's Office; from this information, the probable issues duringthe next reporting period were calculated. To the probable issues in each itemwere added the initial supplies and equipment needed to equip new units whichwere being formed. Thus were obtained the "normal" quantities of eachitem which should be procured. Although initial equipment could be calculatedwith fair accuracy, it proved impossible to evolve a satisfactory formula fordetermining replacement needs. The "normal" quantities of each itemwere simply increased by an amount deemed sufficient to satisfy needs that weregrowing at a rapid, but undetermined, rate. It was, in a word, a matter ofjudgment, but judgment that proved in the sequel to have been generally sound.This "hit and miss" method, as it was described by some supplyofficers, continued to characterize procurement until July 1942, when the ArmySupply Program went into effect.²⁵

Estimated procurement requirements were transmitted to thepurchasing depots in the form of purchase authorizations. Invitations were thenissued to all qualified firms on the Bidders' List, after a lapse of 15 to 60days, depending upon the urgency of the purchase; the bids were opened, and acontract was made with the lowest bidder. This system had been employed duringthe unhurried times of peace. It had provided sufficient supplies at the timethey were needed and at the lowest possible prices; but it was not adapted towar, nor to hasty preparation for war. Under these conditions, price becomes asecondary factor, and time of delivery and quantity of supplies become primeconsiderations. This period was marked, therefore, by departures fromcompetitive bidding and by the adoption of negotiated contracts which weredesigned quickly to obtain from industry the vast quantities of supplies andequipment needed. In July 1940, an act of Congress gave the technical services

²⁴(1) Procurement Planning, 1939-41. [Official record.] (2)Letter, Lt. Col. F. C. Tyng, MC, to the Assistant Secretary of War, 28 Nov.1940, subject: Review of Organization, Procedures and Methods Pertaining toProcurement.
²⁵(1) Memorandum, Lt. Col. John J. Pelosi, MC, to Lt. RichardE. Yates, MAC, 7 Dec. 1944. (2) Memorandum, Col. Paul I. Robinson, MC, to Chief, SupplyService, 11 Aug. 1944, subject: Purchasing Policy.

enlarged authority to make open market purchases, and thus tonegotiate contracts without competitive bidding.

One of the first steps was to establish liaison with themanufacturers of medical supplies. As early as 1939, The Surgeon Generalestablished industry advisory committees on drugs, surgical instruments, andother types of supplies and equipment, and received valuable advice from them onthe problems of large-scale procurement. These advisory committees continued tofunction as advisers to The Surgeon General until September 1940, when they wereabsorbed by the Army and Navy Munitions Board with a commensurate broadening ofresponsibilities.

Although purchase authorizations issued in midsummer of 1939were two and one-half times as large as those issued in the previous summer, itwas believed that industry could easily carry the load, except for surgicalinstruments and a few other items in which trouble had long been expected. Formany years, the United States had been largely dependent upon Germanmanufacturers for surgical instruments. This dependence was interrupted by theexpansion of domestic manufacturers during World War I; but early in the 1920's,Germany once more captured the U.S. market and held it until the Britishblockade was established in September 1939. The few surgical instrumentfactories in the United States were thus presented with an increasing demand,from both military and civilian hospitals, and for export to France, England,and Latin America, which they could not satisfy; nor could production be quicklyexpanded. Machine tools were difficult to procure; forgings were not availablein the large numbers required; and, even more serious, the skilled laboremployed in the manufacturing processes could not be quickly trained. Theconversion of silver and jewelry manufacturers to the production of surgicalinstruments offered only limited relief.

It was inevitable that the purchase requirements for theperiod 1939-41 should be considerably greater than deliveries. This produced acondition of chronic shortages which constituted the most serious problem withwhich the Finance and Supply Division was faced. In this period of unprecedentedexpansion, the huge requirements were not fully anticipated and procurementwas often initiated too late to produce the supplies when they were needed. Thedifficulty was further aggravated by the "procurement lag"-theinterval of time elapsing between the acceptance of a contract and the deliveryof the supplies-which became longer as shortages of labor and raw materialsbecame more acute.

Storage and Distribution

When the Army began its expansion late in 1939, facilitiesfor storage and distribution of medical supplies were geared to serve a smallMilitary Establishment in the quiet days of peace. The main depot of the MedicalDepartment was located in Brooklyn, N.Y. This was the Medical Section of the NewYork General Depot, which was the distribution point for all overseas garrisonsand for all states east of the Mississippi River except Tennessee and Mis-

FIGURE 3.-Building No. 40, St. Louis Medical Depot.

sissippi, which were supplied from St. Louis. The only branchdepot belonging exclusively to the Medical Department was the one in St. Louis(fig. 3), which served most of the Midwestern and Rocky Mountain States. Themedical sections of the San Antonio, Tex., and San Francisco General Depotswere the distributing points respectively for the Southwest and the Pacificcoast. Depots for the storage of the War Reserve were located at Columbus, Ohio,New Cumberland, Pa., and Schenectady, N.Y.

Into the active depots of the Medical Department, thesupplies and equipment were shipped by manufacturers and dealers, who wereinformed of the

proper destination by the contract or purchase order. Whenreceived at the depot, the supplies were physically inspected to determine ifthe proper quantity had been received and if they conformed with other terms ofthe contract. A mere tally-in accomplished the former purpose, but inspectionsto determine quality, especially of drugs and biologicals, required laboratoryexaminations. Samples were forwarded to the laboratory of the Medical Section,New York General Depot; and, until results of the examination were received, theshipments being tested were withheld from issue.

Supplies and equipment, after being accepted by the depot,were stored according to item number, and were issued on the basis ofrequisitions received from the medical supply officers of posts, camps, andstations of the depot's distribution area. These requisitions, normallysubmitted through Corps Area Headquarters, were of three types. Semiannualrequisitions were received on 31 March and 30 September. Quarterly requisitions,generally confined to deteriorating items such as drugs and rubber goods, weredue on the first day of January, April, July, and October. Emergencyrequisitions were submitted as required, but, even these, unless they were basedupon dire need, were first cleared through Corps Area Headquarters. A period of3 months was required to process the semiannual requisitions because they wereall received at the same time, and only a limited number of packers wereavailable in the depots. Posts, camps, and stations maintained sufficient stocklevels, however, to last until the beginning of the next requisitioning period.The emergency requisitions were filled quickly, sometimes in a single day; andthe quarterly requisitions for deteriorating items were also processed promptly.²⁶

It will be observed that the storage and distributionfunctions of the Medical Department, at the beginning of the rearmament program,were conducted on a small, economical scale. Indeed, economy was a mostimportant feature, for appropriations were not generous, and it was necessaryto effect all possible savings. The number of civilian employees was kept verylow, depot upkeep expenditures were maintained at a minimum, and shippingmethods and routes were selected with economy as the foremost criterion. But, asthe size of the Army grew during the period 1939-41, and as the procurement ofmedical supplies markedly increased, it became necessary to expand the depotfacilities of the Medical Department. Although the most important part of thisexpansion occurred in 1941, it began in 1940. By the end of 1940, the MedicalDepartment had a total of 1,203,387 square feet of storage space, of which575,899 square feet was used for current operations and 537,428 for storage ofthe unit assemblies in the War Reserve. Aggregate storage space had more thanquadrupled by December 1941, when 5,690,028 square feet was so used.²⁷

The heavy load which the expanding Army placed upon theMedical Department's storage and distribution facilities brought about otherchanges in addition to the increase in depot space and operating personnel.Methods

²⁶History of the St. Louis Medical Depot, 1936 through1939. [Official record.]
²⁷(1) The Depot Facilities Program of the MedicalDepartment. [Official record.] (2) Memorandum, Maj. D. A. Peters, SnC, to Brig.Gen. Albert G. Love, 23 Nov. 1942.

and procedures which had been adequate for the modest work ofthe depots during prior years could not cope with the vastly augmented tasksimposed by the rearmament program. Electrical accounting machines wereinstalled, both in the Surgeon General's Office and in the depots, in 1941,although they were not fully mastered for another year. Materials-handlingequipment, which so greatly added to the speed and economy of storageoperations, also originated before Pearl Harbor. Improvements in the collectionand packing of stock, to fill requisitions, were necessary as soon as theworkload increased; and by the use of the assembly line system, these tasks werebetter performed. Inventories were taken more frequently and in a manner whichinterfered less with current operations.

Helpful though they were, however, these improvements did notfully solve the immense problem of distribution that confronted the MedicalDepartment during 1941. As the Army expanded through voluntary enlistmentsand the action of Selective Service, training camps multiplied throughout thecountry; and each camp had its station hospital and its group of regimentaldispensaries. In addition, an increasing number of medical troops were beingtrained for service with tactical units. These installations and troop unitsneeded great quantities of medical supplies, and the medical supply officer ofeach post looked to his distribution depot to supply the need. In July 1940,there were 110 station and general hospitals, having a total of 22,000 beds. ByJuly 1941, the number of hospitals had grown to 180, and the total beds hadincreased to 80,000,²⁸ necessitating shipment of large numbers of hospitalassemblies and great quantities of maintenance supplies to posts, camps, andstations. During this early period, stocks were inadequate to supply the largenumber of hospitals then being constructed. Both the procurement lag and theinadequacy of the War Reserve rendered shortages inevitable. Although the depotsmade emergency purchases from local sources, many assemblies shipped to thehospitals were only 50 to 60 percent complete. Old 1918 hospital assemblies weretorn down and rearranged to meet modern needs, but shortages of medical suppliesin the hospitals continued. It is improbable, however, that the scarcity ofmedical supplies seriously hampered the professional work of doctors andsurgeons, who fortunately did not have to cope with any major epidemic.

MEDICAL SUPPLY FOR GLOBAL WAR

Organization of the Medical Supply Service

Supply organization in the Surgeon General's Office.-Asweeping War Department and Army reorganization early in 1942 brought theMedical Department under ASF (Army Service Forces), for a short time calledServices of Supply. The reorganization as it affected the Medical Department asa

²⁸Magee, J. C.: Activities of the Medical Department inAugmentation of the Army. Army M. Bull. 56: 1-10, April 1941.

whole need not concern us here.²⁹So far asmedical supply was concerned, the closer relationship with the Service Forcesinevitably meant a streamlining of the supply organization in the SurgeonGeneral's Office to conform more closely to the overall pattern. The neworganization went into effect on 1 July 1942. The supply functions wereseparated entirely from fiscal activities, and a new Supply Service was createdwith five divisions under it: Production Planning, Requirements, Purchases,Distribution, and an International Division. By September 1942, there were 41officers and 431 civilians on duty in the Supply Service, compared with the 16officers and 201 civilians who had operated the combined Finance and SupplyDivision when the United States entered the war. The number had grown to 94officers and 591 civilian employees by 1 March 1943, when the service was againreorganized.³⁰

The March 1943 reorganization divided the Supply Service intotwo branches concerned respectively with Supply Personnel and Office Management,and seven divisions: Requirements, International, Resources, Procurement, PriceAnalysis and Renegotiation, Specialties, and Distribution. Among the neworganizational units, the Resources Division devoted its attention toalleviating the raw material shortage which, during this period, was hamperingthe production of medical supplies and equipment. The Price Analysis andRenegotiation Division was established to analyze contract prices submitted bymanufacturers and to carry out the terms of the renegotiation statutes whichhad been enacted by Congress in 1942 and 1943. The Specialties Division, whichincluded an Optical Branch, Laundry Branch, and X-ray Service Branch, was not anoperating division. Rather, its function was to study the peculiar problemsencountered in the procurement and distribution of certain specialized items andto make this information available to the other divisions. It had administrativeand coordinating functions almost entirely.

This reorganization had been recommended by Mr. EdwardReynolds, former president of the Columbia Gas and Electric Corp. of New York,and then Special Assistant to The Surgeon General. When Maj. Gen. Norman T. Kirkbecame The Surgeon General in June 1943, Colonel Tyng, Chief of the SupplyService, was relieved and Mr. Reynolds became Acting Chief. In the spring of1944, he was commissioned a colonel, Medical Administrative Corps, and wasappointed Chief of the Supply Service (fig. 4). A further reorganization,meanwhile, had eliminated the separate branches and reduced the seven divisionsto five: Supply Planning and Specialties, International, Renegotiation,Procurement, and Distribution and Requirements. Thus were eliminated theResources and Requirements Divisions, while the functions of the latter weremerged with those of distribution. This trend toward simplification was carrieda step further in September 1943, when the Supply Planning and SpecialtiesDivision was abolished; but in November 1943, it was

²⁹For more detailed treatment, see (1) Medical Department,United States Army, Organization and Administration in World War II. Washington:U.S. Government Printing Office, 1963, pp. 72-93. (2) Millett, John D.: U.S. Army in World War II. The ArmyGround Forces. The Organization and Role of the Army Service Forces. Washington:U.S. Government Printing Office, 1954, pp. 36-42.
³⁰Memorandum No. 1, Supply Service, OTSG, 1 Mar. 1943,subject: Organization of Supply Service.

FIGURE 4.-Col. Edward Reynolds, MAC, Chief, SupplyService, Surgeon General's Office, 1943-46.

reinstated as the Supply Planning Division with expandedfunctions. In addition to its administrative and coordinating duties inprocurement of optical equipment and supplies, this division had theresponsibility of preparing and distributing the Medical Department SupplyCatalog and Equipment Lists and with aiding in the development of new items.³¹

This last reorganization, however, was marked by a far moreimportant change and by the beginning of a trend which continued until the endof the war. The Procurement Division was renamed the Purchase Division, and wastransferred to the Army Medical Purchasing Office, successor to the New YorkProcurement District. A liaison branch of the Purchase Division was establishedin the Supply Service in Washington, which maintained close contacts with theArmy Medical Purchasing Office and independently performed certain functionsrelated to procurement. The movement of the Purchase Division to New Yorkreduced the number of officers assigned to the Supply Service from 94 to 75. Atthe same time, the Reports and Records Branch was set up as a separate unit tocompile the many reports required by the staff divisions of Headquarters, ASF,and to keep the Chief of the Supply Service

³¹Memorandum No. 1, Supply Service, OTSG, revisions of 16June and 29 Nov. 1943.

constantly informed of the progress made in the procurementand distribution program.

The largest and least cohesive part of the Supply Service, atthis date, was the Distribution and Requirements Division. Staffed by 33officers and a substantial civilian group, this division was composed of fivebranches: Storage, Requirements, Issue, Maintenance, and Inventory Control, thelatter being attached to the Army Medical Purchasing Office in New York. Whenone considers this division's important duties in computation of purchaserequirements, control of stock levels, operation of depots, repair of medicalequipment, and distribution of medical supplies, it is apparent that its effortswere spread over a large area and included many parts of the entire supplyprogram. The largest task which yet remained for administrative reorganizationwas to break down this unwieldy division and to assign its duties to separatedivisions on a functional basis.

A slight reorganization in March 1944 reduced the number ofdivisions to four by eliminating the Supply Planning Division; and increased theseparate branches to three by the addition of the Materiel Demobilization Unitand the Catalog Branch. These new offices assumed some duties of the abolishedSupply Planning Division; the remainder were lodged in the Liaison Branch,Purchase Division. A more thorough reorganization was effected in June 1944,when the Distribution and Requirements Division was abolished. In its place wereestablished the Stock Control Division, Issue Division, and Storage andMaintenance Division. The Renegotiation Division was transferred to the ArmyMedical Purchasing Office, and a liaison unit of that division was establishedin Washington. The Inventory Control Branch, a part of the Stock ControlDivision, remained in New York. At this time, also, the offices of the DeputyChief for Supply Control and the Deputy Chief for Storage Operations wereestablished as consulting agencies for the Chief, Supply Service, and werestaffed by qualified civilians.³²

As the war neared its end, the movement of Supply Serviceunits to New York continued. In November 1944, the remaining branches of thereorganized and enlarged Stock Control Division were transferred to the ArmyMedical Purchasing Office. The single exception was the Requirements Branchwhich retained its Washington location until July 1945. In the meantime, inMarch 1945, the independent Catalog Branch went to New York. Shortly before theGerman surrender in May 1945, plans were made to move other parts of theSupply Service to the Army Medical Purchasing Office, but these plans wereabandoned when it became apparent that the procurement and distribution programswould soon be sharply curtailed.

Field organization for medical procurement.-When the UnitedStates entered the war, the actual purchase of medical supplies and equipmentwas divided between the Medical Section, New York General Depot, and the St.Louis depot, an arrangement dictated by fear that sabotage or even enemy bombingmight knock out the New York facility. The St. Louis depot had pur-

³²OTSG Manual of Organization and Standard Practices, Organization Chart 3.09, 24 June 1944.

chase responsibility for drugs, chemicals, and stains (class1); X-ray equipment and supplies (class 6); furniture, physiotherapy equipment,mess equipment and supplies (class 7); veterinary equipment and supplies(class 8); and field equipment and supplies (class 9). The Medical Section ofthe New York General Depot purchased the remaining medical items, which includedsurgical dressings, surgical instruments, laboratory equipment, and dentalsupplies and equipment.

Early in 1942, the New York Medical Depot was established asthe successor to the Medical Section, New York General Depot. In August 1942,the New York Medical Depot was moved to Binghamton, N.Y., but its Purchasing andContracting Section remained in the city to become the nucleus of a newlyactivated New York Medical Department Procurement District. This purchasingoffice was divided into four Buying Sections, a Conservation and ProductionControl Section, and an Operations Section, which was concerned withadministrative matters.³³Each Buying Section (later calledPurchasing Branch) procured items in a single commodity group, thus permittingprocurement officers to specialize on a particular class of items and to becomefamiliar with the capacities and problems of the producers. As procurementoperations expanded, personnel steadily increased. In December 1942, the NewYork office had 58 officers and 338 civilian employees; by June 1943, the numberof officers had increased to 74 and civilian employees to 413.³⁴

The St. Louis Medical Department Procurement District,established in August 1942, had an organization similar to that of the New Yorkoffice. Originally there were three Purchasing Branches: Drugs and Chemicals;X-ray and Physiotherapy Equipment; and Miscellaneous Equipment and Supplies. Toobtain greater clerical efficiency, the second and third branches wereconsolidated in April 1943, the new unit being designated the Hospital EquipmentBranch. As the procurement load increased, other departments were establishedto perform functions involved in production control, inspection, publicrelations, renegotiation, and office administration. During calendar year 1943,personnel increased rapidly. The number of officers rose from 12 to 63, and thenumber of civilian employees from 161 to 241.³⁵

These two purchasing offices, first as depots and later asprocurement districts, contracted for practically all of the medical suppliesused by the Army during the war. The St. Louis depot lasted throughout the war,but the procurement district was abolished in September 1943, when it wasconsidered safer and more economical to consolidate all Medical Departmentprocurement in New York as the Army Medical Purchasing Office. In the words ofthe ASF circular³⁶ which activated the new unit, the office was"responsible for the actual procurement of medical supplies, includingproduction control,

³³Annual Report of Activities, New York Medical DepartmentProcurement District, fiscal year 1943.
³⁴Annual Report of the Supply Service, OTSG, 1943.
³⁵See footnotes 33 and 34, above.
³⁶Army Service Forces Circular No. 79, 15 Sept. 1943.

issuance of priorities, survey of facilities, and inspectionof supplies." At this time, branches were established in Chicago and St.Louis, the main duties of which were to aid contractors in procuring rawmaterials, component parts, and labor. At this point, the Purchase Division ofthe Supply Service was transferred to New York, where it became an integral partof the Army Medical Purchasing Office. Thereafter the Supply Service, for allpractical purposes, centered in New York rather than in Washington.

Personnel and training.-By mid-1943, the Medical SupplySystem, exclusive of the overseas theaters, had expanded its personnel to 800officers and 15,050 civilians on duty, both in Washington and in the field.Turnover of personnel was caused largely by the constant drain upon the SurgeonGeneral's Office and the depots to fill the personnel requirements of a globalsupply system. At the same time, however, The Surgeon General was able to drawupon the service of many keymen from civilian industry. Among those most helpfulwere Mr. Herman C. Hangen of J. C. Penney Co., Mr. Mead M. Messick of MontgomeryWard & Co., Mr. C. W. Harris of Butler Brothers, and Mr. W. A. Hower of VanRaalte Silk Co.

For training medical supply personnel, various courses wereprovided during the war years, both by ASF and by the Surgeon General'sOffice. The Medical Supply Officers Orientation Course provided training inmilitary customs, courtesy, procedure, and medical supply for the new officersreporting to the St. Louis Medical Depot for duty in medical supply work. Inearly 1943, ASF established a three-phase course for training of commissioneddepot personnel. This was known as the ASF Depot Course. The first period wasconducted at the Quartermaster School, Camp Lee, Va., and covered alloperational phases of Army warehousing, organization of the Army for supply,handling and transporting of supplies, property accounting, packaging andcrating, and open storage. The second period, conducted at the St. Louis MedicalDepot, was identical with the Medical Supply Officers Orientation Course. Forthe third phase, student officers were assigned to one of the medical supplydistribution depots to gain experience in previously studied supply activities.³⁷

In June 1943, two courses-Phase II of the ASF Depot Courseand the Maintenance Course-which were conducted at the St. Louis MedicalDepot, were designated "The Medical Supply Service School." Trainingof units organized under tables of organization and equipment was added to theMedical Supply Service School curriculum during 1944. This training consisted offunctional employment in the St. Louis Medical Depot, orientation as to overalltraining in the supply field, and field training. Medical Supply Platoons(Aviation) were trained during 1943-44 at Savannah Medical Depot to preparethem for ready use overseas.

³⁷Annual Report, Training Division, Operations Service, OTSG, fiscal year 1943.

Role of the American Red Cross

Relationship between ARC (American Red Cross) and the SupplyService increased in scope during the war period. Major ARC activities in thearea of supply for the Army were the blood program³⁸ and the surgical dressingprogram. The Army, however, furnished or purchased medical supplies required byARC for various purposes and supported its war relief program logistically.

Blood program.-Plasma units were compact, and possessedlong keeping qualities not true of whole blood, which was good for use only upto 21 days after collection (fig. 5). These favorable characteristics of driedplasma permitted ease of use and handling in the combat areas. Throughcooperation of Army, Navy, National Research Council, ARC, and commercialbiological manufacturers, a blood plasma procurement program calling for theproduction of a minimum of 700,000 units of dried plasma for the Army wasinstituted in fiscal year 1942. The Surgeon General considered the plasmaprogram to be of such significance by February 1943 that he appointed Col.Charles F. Shook, MC, as Liaison Officer, OTSG, responsible for contact withARC, and for furtherance and proper management of this vital program. WhenColonel Shook was transferred to the Mediterranean theater as Surgeon, Servicesof Supply, Maj. Frederic N. Schwartz, MAC, took charge of the program andremained in that capacity until termination of the war.

Until August 1943, plasma was manufactured in units of 250cc. At that time, the size was changed to 500 cc. because this was the normalamount administered, and this larger unit conserved shipping space and reducedthe total amount of critical materials (rubber, steel, and tin) required. Theblood plasma program progressed to a grand total of 3,070,806 small units, and3,115,877 large units by 1945.³⁹ Although blood banks were established inoverseas combat areas, sufficient quantities of whole blood for treatment ofcasualties could not be obtained, and by August 1944, supplemental shipmentsfrom the United States became imperative. The Army Medical Department providedfor the needs of the European theater for type "O" blood through theservices of ARC via facilities of the Air Transport Command. The Navy used asimilar method in providing for needs in the Pacific. After V-E Day, the ARCceased collecting blood for military services from all except the major citiesof the United States. On 10 August 1945, the ARC was advised that the Army wouldnot require blood for processing into dried plasma as soon as V-J Day wasannounced officially.

Surgical dressing program.-During the expansion periodbefore the entry of the United States into the war, it was discovered that theArmy Medical Department had grossly underestimated its need for surgicaldressings. Frustrated because industry was too deeply involved in other forms ofwar production to cooperate, The Surgeon General turned to the Red Cross

³⁸For further details, see Medical Department, United StatesArmy. Blood Program in World War II. Washington: U.S. Government PrintingOffice, 1964, pp. 101-137.
³⁹Hornbacher, Arthur: Blood Plasma. [Official record.]

FIGURE 5.-Chest, Plasma, Complete, consisted of MedicalDepartment chest, plain, and 20 units of plasma, normal, human, dried, 250 cc.

for help. The response was overwhelming, resulting in theaccumulation of large stockpiles of dressings between 1941 and 1944. The MedicalDepartment reciprocated by furnishing the Red Cross with needed supplies.Several medical assemblies were furnished as well as stocks, such as bloodplasma, drugs, dressings, and surgical instruments for prisoners of war on bothsides, and supplies for Allied countries.

Following V-E Day, the Army reevaluated its requirementsand assets to release, before V-J Day, as much excess material as possible tocivilian channels. Basing action on the Surplus Property Act of 1944, items inexcess of Army requirements, such as blood derivatives and surgical dressings,were first reported as excess, then obtained in large amounts to be used incivilian

emergencies or for charitable purposes throughout the UnitedStates and overseas areas.

Demobilization Planning

Planning for demobilization began in the Surgeon General'sOffice in August 1943. The early stages of the demobilization program werecarried out under several officers progressively: Col. Paul I. Robinson, MC,Col. Stuart G. Smith, MC, Col. William L. Wilson, MC, then back to ColonelRobinson. On 5 February 1944, the Commanding General, ASF, advised the chiefs ofTechnical Services that materiel demobilization planning was a commandresponsibility at each echelon in the chain of command. The Surgeon General hadalready established a unit for this purpose directly under the chief of theSupply Service. By the end of fiscal year 1944, a series of plans for period I(redeployment, readjustment, and demobilization between the defeat of Germanyand that of Japan) had been developed which reflected current procedure andpolicy changes set forth in the ASF Materiel Demobilization Plan. The SurgeonGeneral's plan directed action regarding inauguration of the revisedprocurement program for period I; determination of contracts to be terminated;methods of receiving, storage, caring for, and disposing of finished andunfinished products; review of research and development projects; revision ofspare parts lists; and efficient handling of military lend-lease shipments.

Special studies were made on potential requirements formedical items sought by outside agencies such as the Red Cross, United NationsRelief and Rehabilitation Administration, and Civilian Relief in LiberatedAreas. Also, the stockpiling of a peacetime war reserve was essential. Disposalof medical property needed careful handling. To flood the market with surplusGovernment stocks at the conclusion of the emergency would have adverselyaffected small business. The plan proposed that certain items be distributed toeligible federal, state, county, and municipal health institutions and sanitaryhealth agencies on a grant basis under a control system to establish the factthat these institutions could not afford to purchase health articles requiredfor their missions.

The objectives of this proposal were to get the maximumnumber of surplus medical items into worthwhile use and out of Governmentstorage in the shortest possible time; to cause minimal impact on industry; tocause minimal tax burden for accomplishment of important health advances; andto effect improvement in medical care throughout the United States, thusreducing the number of persons physically ineligible for military service.

Many actions of the Materiel Demobilization Plan were placedin effect as operating procedures before V-E Day arrived. Agencies werealerted, and on V-E Day, the remaining actions of the plan were placed ineffect. A specific plan was devised to furnish units in the Far East withmedical equipment from stocks available in the European theater.

The plan for readjustment and demobilization after V-J Daywas prepared by the Supply Service under Col. Jenner G. Jones, MC, and Maj.Richard J. White, Jr., MAC. Specific activities and responsibilities of theSupply Service were outlined as follows:

1. Review procurement objectives for the balance of 1945 and1946 for all medical items; compute procurement programs to reflectdemobilization phasing; determine War Reserve requirements and a peacetime ArmySupply Program based on the appropriate troop basis; cancel and rescheduleprogrammed procurement to meet period II procurement objectives; terminate allcontracts approved for termination and expeditiously settle all such contracts;determine and report quantities which were surplus to the War Reserve andpeacetime army requirements for periods II and III.

2. Discontinue security inspections except at privatelyoperated facilities having highly classified information which was believed torequire continued personnel security protection against espionage.

3. Redistribute military property excess in overseas theatersand bases for period II, as well as in the Zone of Interior; initiate andimplement policies and procedures for redistribution of all property declaredsurplus.⁴⁰

Supplies en route to the Pacific and Asiatic theaters had tobe diverted and disposed of, and all requisitions canceled. Space for storage ofthese items had to be provided on a continuous basis. Civilian supplies had tobe procured and shipped as scheduled, and surplus property had to be disposed ofor stored.

On V-J Day, these plans were placed in operation.

LOGISTICAL SUPPORT OF COMBAT AREAS

Because logistics is designed to support the tactical effort,it is not surprising that marked differences developed in different theaters ofoperations. The war in the Pacific was largely an island-hopping war withmultiple and repeated naval, air, and amphibious operations. On the other hand,the war in Europe and Africa was largely ground warfare over more expansiveareas. Naval and amphibious combat operations were preludes to ground warfareinvolving large numbers of troops on broad fronts resulting in large numbers ofcasualties. Operations in the Mediterranean, a combined British and Americantheater, were an alternating combination of amphibious and landmass fronts thatbegan with the landings in North Africa, then shifted north into theMediterranean Islands and on to the European Continent. Because of the widelyseparated landings and areas of combat, a decentralized type of supply systemprevailed until forces were concentrated on the Italian Peninsula.

⁴⁰Memorandum, Brig. Gen. Edward Reynolds, to Director,Industrial Demobilization, ASF, and others, 6 Aug. 1945, subject: Supply Service-InterimPlan-Period II (Readjustment and Demobilization).

Medical Supply in Europe

Many factors influenced the evaluation of the medical supplysystem in the European theater. One of the early problems was the constantchanging of operational plans and priorities for the theater as the fortunes ofwar, worldwide, ebbed and flowed. The operations were mounted in England, astrong and industrialized ally. There was no language barrier. Even though theUnited Kingdom and its industry were already burdened with prosecuting the waragainst the Axis, our Government believed that the British could supply U.S.forces with large quantities of material through "reverse lend-lease"and thus conserve shipping space.

Another important factor was that the war was fought on alarge landmass with relatively good rail and road networks, and with existingtelephone and telegraph systems providing a basis of rapid communication. As thewar progressed, more and more hospitals and depots were established on theContinent, although throughout the war hospitals and depots in the UnitedKingdom continued to support the operations.

Maj. Gen. Paul R. Hawley (fig. 6) was not only chief surgeonof the theater, but he also headed the medical service of the CommunicationsZone. As the war progressed, he had tremendous medical resources-personnel andmaterial-under his control. General Hawley, a man of great ability and drive,was strong enough and wise enough to use them effectively. The fact that theentire medical service for the U.S. forces in the European theater was under onechief aided immeasurably in the successful medical support of the war.

From the outset, professional influence was strong. GeneralHawley surrounded himself with prominent and outstanding specialists in everyclinical field, who actively influenced the techniques and the quality ofmedical and surgical care. These consultants were of great value in developingsupply policies, advising on requirements, and especially in teaching theirprofessional colleagues in hospitals some of the rudiments of Army supply.Many medical officers, most of them fresh from civilian life, had no concept ofwhat was available, of Army supply terminology, or of how to go about obtainingwhat they needed. Frequently the weakest link in the supply chain was betweenthe hospital or unit medical supply officer and the doctor, both of whom werefrequently inexperienced in Army supply. The needed item was in the supply roomor warehouse but the supply officer did not know its use and the doctor did notknow it was there, what it was called, or how to get it.

Identification was often a serious problem. Doctors werefamiliar with drugs by their common or trade names whereas the Army carried themunder their official U.S.P. or N.N.R. titles. Likewise, surgical instruments andother equipment, not infrequently, were known in different sections of theUnited States by various names, which were dissimilar to Army nomenclature.General Hawley's consultants were given an orientation and each becamefamiliar not only with the supply items of his specialty, but also withmechanics of the

FIGURE 6.-Maj. Gen. Paul R. Hawley, Chief Surgeon,European theater.

overall medical supply system. Time and again on theirvisits, they were able to bridge the gap to medical installations and see thatthe item was put in the hands of the professional man.

The long evacuation policy-120 days during most of the war-resultedin a large patient load and much definitive treatment within the theater. At theheight of the operations, the medical service in the European theater had192,000 beds⁴¹ occupied by patients. This was reflected in huge requirementsfor medical supplies.

A favorable factor was the availability of prisoner-of-warlabor. In the United Kingdom, both Italians and Germans were utilized, whereason the Continent only Germans were available. Many were skilled or semiskilledmen, accustomed to hard work. Usually employed under their own noncommissionedofficers, prisoners proved to be a valuable adjunct to the medical service.

Because of the above-mentioned factors, plus many others, the medical supply system in the European theater developed along strongly centralized lines, and was ultimately patterned closely after the Zone of Interior system. The Supply Division of the Chief Surgeon's Office closely controlled all opera-

⁴¹Monthly Progress Report, Army Service Forces, 28 Feb. 1945, Section 7.

tions. It enunciated policies and procedures, determinedtheater requirements, requisitioned supplies from the United States, distributedstock among the depots, and supervised depot activities. Although the theater,behind Army boundaries, was divided into advance, intermediate, and basesections, these geographic commands exercised little influence beyond assistanceto the medical supply operation. In other theaters of operations wheregeographic commands were widely dispersed, the reverse tended to be thesituation, resulting in decentralized systems in which the real authority restedwith the geographic area commanders.

Medical Supply in the Pacific

In the Pacific, in addition to vast distances and small,scattered land areas, there were extremes of climate ranging from the cold, dampconditions of the Aleutians to the tropical islands of the central Pacific.Tropical diseases called for special drugs and the hot, damp atmosphere of theSolomons and other island groups demanded special equipment. At the same time,shipping space was at a premium while central depots were necessarily remotefrom the scenes of combat. Until the final stages of the war in the Pacific,scarcity was the rule so far as medical supplies were concerned.

One contributing factor in this situation occurred evenbefore the war itself. By way of preparation for the emergency that appearedclearly in the making, a substantial portion of the Medical Department'sreserve supplies had been sent to the Philippines. Equipment for four generalhospitals and quantities of dressings, drugs, and instruments were on hand.Personnel was inadequate for combat, but commendable progress had been made intraining Filipino physicians and enlisted men to augment U.S. military medicalpersonnel. Plans for deployment were complete. Medical leadership was presentand there is every indication that excellent medical teamwork was exercised inthe preattack period. A medical supply depot was functioning and a medicalregiment was available. Additionally, in accordance with plans, the equipmentfor one general hospital was in storage at Limay, Bataan.

When the Philippines were attacked, Sternberg GeneralHospital (fig. 7) became a medical center in a matter of days and acceptedevacuees from the station hospitals at Clark and Nichols Fields. But, on 24December, according to plan, movement of troops to the Bataan Peninsula wasbegun and medical personnel, supplies, and hospitals had to be moved. These werethe experiences that our troops were to face in other areas of the South Pacificand Southwest Pacific over the next 4 years: poor roads or none at all,jungle, insectborne diseases, infectious diseases, scanty foods, ferociouscombat, mud, rain, dust, discomfort, refugees, and the necessary improvisationsto cope with all of these problems.

In December 1941, Maj. O.V. Kemp, MAC, an aggressive medicalsupply officer (for Col. Wibb E. Cooper, MC, Department Surgeon) with foresightand intelligence had purchased many consumable medical supplies from themerchants in Manila-antimalarial drugs, instruments, gauze, and cotton.

FIGURE 7.-Sternberg General Hospital, Manila, PhilippineIslands, 1940.

These were stored in Bataan and Corregidor and, withoutdoubt, augmented the ability of medical troops to carry on. During the combat onBataan, many medical chests had to be abandoned during the retreat. One generalhospital was captured by the Japanese and, consequently, available medicalsupplies were depleted.

The fall of the Philippines was inevitable because the UnitedStates was unable to reach them with the necessary augmentation force. But thiswas not fully realized by our troops, and their performance was exemplary. On 9April 1942, medical personnel were caring for 7,000 patients in Hospital No. 1which was captured on that day. Progressively, quinine and Atabrine (quinacrinehydrochloride) had been depleted until these drugs were not available formalaria prophylaxis, and only limited amounts could be used for treatment.Reinfections were almost immediate to those who obtained temporary cure. Foodbecame a serious problem, and from 1 April 1942 until surrender, the allowablecalories per man had been reduced to no more than 900. There were no vitaminsand no gas bacillus serum. From 9 April until 10 May 1942, Corregidor (ourremaining garrison) carried on. The medical units with the troops rendered asmuch medical care as possible and the serious cases were

transported to the Malinta Tunnel Hospital. This tunnelwas 1,400 feet long and at intervals twenty-five 400-foot laterals branched outfrom the main tunnel. The tunnel was strengthened with reinforced concrete andequipped with a ventilation system. It served well in these last days to givesuch medical care as could be rendered under the continuous bombardment by theJapanese.⁴²

In the Visayan Islands and Mindanao, the same shortage ofantimalarial drugs was recorded. Food, however, was plentiful. One well-suppliedhospital, earmarked for storage at Cebu and which was intended to be the nucleusfor a large general hospital, was lost when the U.S.S. Corregidor wassunk. This was somewhat of a disaster to medical supplies, particularly sincethe hospital was stated to be so well stocked.

Nothing but praise can be recorded for the medical supplypersonnel in the Philippines during the presurrender days. Requirements had been anticipated. Stocks were on hand and stored in strategic locations. Othershad been requisitioned. Most serious shortages were in antimalarial drugs. Butthese were strategic items in world supply and, in situations such as theBataan defense, determination of what is enough of these drugs and thediscipline to enforce their proper use present most difficult problems. Thecivilian Japanese population and our own troops were afflicted in the samemanner, and losses of vital items at such a time and in such circumstances arealmost impossible to prevent.

After the Philippines, the medical supply story in thePacific was one of difficulties and delays, but of ultimate building up ofnecessary stocks to sustain the offensive that began in August 1942 withGuadalcanal and slowly gathered momentum until the abrupt ending of the war bythe use of the newly devised atomic bombs.

⁴²For a more detailed account of the medical side of theevacuation of the Philippines, see Daboll, Warren W.: The Medical Department:Medical Service in the Asiatic Theater. United States Army in World War II. TheTechnical Services. [In preparation.]

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