CHAPTER IV
Maintenance and Repair Parts
EVOLUTION OF MAINTENANCE REQUIREMENTS
Although medical equipment maintenance in the Army came intobeing with acquisition of the first technical instrument, it did not gain thestatus of an organized program until World War II when the influx of technicalequipment into the supply system became a flood. Each incoming wave of morevaried and complex equipment imposed problems and maintenance requirements whichsurpassed the existing or planned capability of the Medical Department.
Medical Maintenance in Hospitals
Medical installations and activities before World War II werevirtually autonomous from a medical equipment maintenance viewpoint. Somecentral direction and guidance were provided, mainly in the form of monitoringand approving expenditures for commercial contract maintenance, or procuring andinstalling new equipment. Station maintenance, however, was generally left tothe discretion of the post surgeon.
In the typical post or station hospital of 1939-40, medicalmaintenance was a function of medical supply, but there was no medicalmaintenance shop in the supply organization. On-post ordnance, engineer, andsignal shops were used to perform most common maintenance chores. Thisencompassed repairing or replacing valves, thermostats, and gaskets onsterilizers; repairing or overhauling small electric motors; overhauling motorarmatures; repairing heat lamps and other physiotherapy electromechanicalapparatus.
Repair of such highly technical items of equipment as X-ray,electrocardiograph, and other machines was accomplished either on manufacturer'sguarantee contract or by separate service call of the manufacturer'srepresentatives. Hospitals located in large metropolitan areas enjoyedparticular advantages in satisfying this aspect of the maintenance requirement.Because of the delicate nature of the machinery then in use, frequent repair andadjustment were necessary.
This organization was, for the most part, satisfactory fortypes of maintenance described. There was a decided gap, however, in the supportstructure involving the area falling between those simple maintenance operationsthat the user might perform for himself and those amenable to common shopwork.Included were such chores as replacing knobs and gages on sterilizers, replacingelements in heat lamps, replacing sockets and plugs on bedlamps, replacing knobson bedside tables, and a host of other tasks outside the area of user
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maintenance, but not sufficiently technical to arouse a readyresponse from the post shops or manufacturers' maintenance facilities. Themedical supply activities in prewar Army hospitals solved this problem invarious and sundry ways. At Fort Banks, Mass., for example, a handyman wasassigned to the medical supply activity. If nothing else, the handyman coulddetermine which items required the more skilled services of the post shops ormanufacturers' facilities. He could also do many jobs that required nothingmore than a screwdriver, a wrench, or a pair of pliers.
Thus, the medical maintenance problem was kept withinmanageable limits. User maintenance was not identified, defined, or promoted; itwas practiced only when the individual user was motivated to do so by hissuperiors. Preventive maintenance was not part of the structure. Even thehandyman, although perhaps serving the purpose of preventive maintenance to alimited extent, was not utilized with this object in mind.
As war approached, maintenance problems were swiftlyinflated. The draft took its toll of commercial medical equipment servicemenwhile existing medical installations were expanding and new ones were beingrapidly established across the country. Pending a centralized programcomplemented by a source of trained medical repairmen, each medical installationcontinued largely on its own to establish and expand shop capabilities, staffingand equipping from local resources. Because of the paucity of medical suppliesand equipment during 1942, many hospital commanders pointed with pride to theirmaintenance programs. These programs often included replating and resharpeningsurgical instruments, sharpening dental burs, and repairing and maintainingequipment. A substantial portion of the program was being effected within thehospital medical supply operation. The ability to accomplish it depended uponthe presence of skilled personnel. Otherwise, it was accomplished under localcontracts.
Development of the Maintenance Shop
The location of major medical equipment repair facilities inselected supply depots was a natural development that facilitated servingmaintenance needs of Army hospitals. Such a shop was located at the New YorkZone Intermediate Depot at the close of World War I. Concern was expressed overwho was to control the repair facility. In response to an inquiry on the matter,The Surgeon General, in a letter to The Quartermaster General on 11 July 1919,wrote, "It is believed to be better policy (than having another servicelike Quartermaster or Ordnance responsible) to have a central repairestablishment in the Medical Department to which surgical instruments anddelicate laboratory equipment can be sent for repairs."1
Amidst this uncertainty of control, the procedure wasestablished that all repair and return requests from military infirmaries andhospitals would be
1Letter. The Surgeon General to Chief, Storage and Issue Branch, Storage and Traffic Division [Office of The Quartermaster General] (attention: Col. R. B. McBride), 11 July 1919, subject: Repair and Salvage of Equipment.
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processed through the Surgeon General's Office and, in turn, through theQuartermaster General's Office before action by the repair facility of the NewYork Depot. About this time (the early 1920's), officers on field visitsreported observing "deplorable conditions" insofar as hospitalfurniture and equipment were concerned. These combined factors undoubtedlyinfluenced the decision to establish a maintenance shop at the St. Louis MedicalDepot, St. Louis, Mo., under control of The Surgeon General.
The St. Louis shop was established in July 1922 on one floorof a building on the old Arsenal Reservation. Both wooden and metal equipmentwere repaired, and by the shop's fourth year of operation, the value ofprocessed equipment totaled about $14,000 yearly. Although significant at thetime, this approximated the value of one 200-ma. X-ray unit processed in theshop during World War II.
Personnel of the Civilian Conservation Corps and the PublicWorks Administration were added to the shop in 1938. By January 1942, thefacility had been moved to what was known as the Indian Warehouse in thebusiness district of St. Louis and had a staff of 26 persons.
Program and Organization
By the end of 1942, the need for an organized maintenanceprogram for the Medical Department was becoming increasingly evident. Creationof a program virtually overnight was not looked upon by anyone as an easy task.Nevertheless, in April 1943, following the lead of the ASF (Army ServiceForces), The Surgeon General promulgated a policy concerning maintenance ofmedical equipment overseas.2 Sixteenend items originally had been envisioned as constituting the range of equipmentrequiring such support, although the actual need turned out to be several timesthat number.
The maintenance plan followed a definite outline. Spare partswould be purchased in the United States and stored in the medical section of theColumbus Quartermaster Depot, Columbus, Ohio, where the initial issue foroverseas would originate. Manuals indicating the use of spare parts and themethods by which these parts should be replaced would be compiled and used in aprogram of training enlisted repairmen who would be assigned to tactical medicaldepots upon graduation. In overseas areas, tools and spare parts would befurnished to effect proper maintenance and repair of end items. These partswould be requisitioned as required from depot installations, and repairmen wouldbe ordered to technical installations in the combat zone. Certain items worthyof repair yet beyond the capability of local facilities would be returnedthrough reverse supply channels to medical depots for replace-
2(1) Memorandum, Lt. Col. C. G. Gruber, SnC, to Acting Director, Distribution and Requirements Division, 1 June 1944, subject: Annual Report for Fiscal Year 1944, Maintenance Branch. (2) Memorandum, Col. S. B. Hays, MC, Director, Distribution and Requirements Division, to Mr. [Edward] Reynolds, 26 Jan. 1944, subject: Distribution and Requirements Division, Supply Service, Fiscal Year 1944.
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ment or repairs as indicated, and unrepairable items of acritical nature would be returned to the Zone of Interior for reclamation.
By early 1943, the Commanding General, ASF, had established aMaintenance Branch, and maintenance first emerged as an organizational entitywithin the Surgeon General's Office.3 Anew organization chart titled the element "Maintenance (Repair)Branch" and placed it alongside the Storage, Requirements, Issue, and StockControl Branches, all within the Distribution and Requirements Division of theSupply Service. According to the chart, the new branch supervised "themaintenance and repair of medical equipment including the operation of repairshops under the jurisdiction of The Surgeon General" and prepared"spare parts and repair manuals." Maj. (later Lt. Col.) Louis F.Williams, PhC, was designated to serve as the first chief of the MaintenanceBranch. Also, early in the medical maintenance program, Lt. Col. CharlesBaumann, SnC, was assigned on temporary duty to the Maintenance Division, ASF,to effect liaison on the implementation of policies affecting medical equipmentmaintenance.
Following several minor organizational changes made to copewith the expanding medical maintenance activities, the Maintenance Branch wasshifted on 26 July 1944 to the newly organized Storage and Maintenance Division,Supply Service, of the Surgeon General's Office. The Maintenance Branch wasresponsible for maintenance and repair of Medical Department equipment,including supervision of the operation of repair shops under the jurisdiction ofThe Surgeon General; and for preparation of spare parts lists, technicalmanuals, supply bulletins, and other publications relative to maintenance.4
At its peak in mid-1945, the Maintenance Branch had 3officers and 8 civilians in the Surgeon General's Office, 14 officers and 16civilians in the St. Louis field office, and 1 officer and 1 civilian in the NewYork field office. In late 1945, the Washington, D. C., and St. Louis elementsof the Maintenance Branch were merged in St. Louis and allocated 7 officers and10 civilians, with supervision of these activities being retained by the Chiefof the Supply Service.
This organization continued until its functions either weregradually dissolved in postwar reorganization or were merged into other staffand operational elements, particularly into the Medical Technical MaintenanceDivision of the joint Army-Navy Medical Procurement Office.
TECHNICAL TRAINING
Success of the Medical Department maintenance program hinged onthe availability of adequately trained personnel. The most demanding duty thatfaced Capt. Thomas P. Dunn, MAC, when he assumed directorship of the
3Organization Chart, Office of The Surgeon General (Distribution and Requirements Division), 11 June 1943.
4Annual Report, Storage and Maintenance Division, OTSG, fiscal year 1945.
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Maintenance Shop, St. Louis Medical Depot, in 1943, wasprobably that of training a staff. Equipment technology had outdistanced thetraining and experience of shop personnel. Thinking first centered around usingthe facilities of medical equipment manufacturers to satisfy trainingrequirements. This may have started out as a valid consideration, but it wassoon doomed as impracticable. Early in 1942, quotas were obtained to place 20enlisted men with Ritter Dental Manufacturing Co., Inc., Rochester, N. Y., for 2weeks, but this was too limited for Medical Department needs. Factories had notthe capacity, the organization, or the understanding of the Army's greatvariety of requirements to meet the task. Equipment density of any onemanufacturer's products, at any one location in the Army, was so small thatthe military could ill afford to have a so-called "factory trainedman" for each make of equipment in any given hospital, or supporting depotshop. Moreover, to attempt to train military personnel in selected factories ina roundrobin-type affair would have been costly, inconsistent, ineffective, andparticularly time-consuming when time, most of all, was of the essence.
During the war, hospitals were equipped more extensively, andmedical equipment became more complex and often of poorer quality. This poorerquality was attributed to scarcity of critical raw materials and to waivers onspecifications to expedite delivery of items during the early days. Thesefactors imposed increased maintenance demands at a time when commercialmaintenance service was dwindling because of the selective service impact.
Personnel Requirements
Medical equipment manufacturers were extremely cooperativeand willing to assist The Surgeon General in any way possible to establish aneffective maintenance training facility. In addition to establishing courses indental equipment maintenance, which were attended by military personnel in late1941 and early 1942, various manufacturers furnished suggestions and adviceregarding technical aspects of their particular line of equipment. Moreover,they gratuitously assigned qualified personnel from their sales and serviceorganizations to act as civilian instructors.
The real seed was planted on 10 January 1942, when TheSurgeon General authorized a 3-month maintenance training course and requestedThe Adjutant General to publish quotas for a school to be conducted at the St.Louis Medical Depot.5 A quota wasestablished of 14 students each for classes starting on 16 February, 18 May, and17 August. Quotas were oversubscribed, and the class began with 24 students fromthe Corps Areas, the Army Air Forces, and War Department overhead personnel.
Opening the first class did not by any means signal fullestablishment of the school. Manufacturers' representatives, acting asinstructors, taught sub-
5(1) Memorandum, Lt. Col. F. C. Tyng, MC, to Commanding Officer, St. Louis Medical Depot, 10 Jan. 1942, subject: Training of Enlisted Maintenance Men. (2) Annual Report, Medical Supply Services School, St. Louis Medical Depot, fiscal year 1943.
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jects pertaining to items manufactured by their firms.Textbooks were lacking and available instructional aids, in many instances, werethe personal property of factory representatives. Nevertheless, during theseearly days of maintenance training, visiting Medical Department officers and theDeputy Director of Training, ASF, impressed with the program and itsessentiality, made favorable reports upon their return to Washington. In August1942, the school was established on a permanent basis. Mr. John J. Russell, whoas a civilian instructor from one of the manufacturers had participated in theX-ray phase of training, was commissioned Captain, MAC, and assigned to directthe training operation.
Maintenance and Repair Course
Factory-furnished instructors with generally good practicalbackgrounds had filled an immediate need, but a permanent staff ofofficer-instructors, some with engineering training, was required. All neededthe "field viewpoint" as well as training in "how to teach"for few had had previous field or training experience. The problem was solved bycommissioning five factory-loaned teachers, who, together with noncommissionedofficers and enlisted men retained from the graduating classes, formed thenucleus of the school staff, which was eventually rounded out to an academicallybalanced faculty in 1943 (fig. 23).
Since no existing textbook covered the range of equipment inthe training curriculum, the staff had to compile texts. To compress time to aminimum, various manufacturers were asked to furnish data on their respectiveitems. The response was generally magnificent, and the information was compiledand printed locally in a three-volume series.
High school graduation was the primary announcedprerequisite, and completion of training or substantial experience in X-raytechnicianship became a sought for, but infrequently obtained, prerequisite.Information on the quotas for the course was made available to service commandsand medical replacement training centers. Limited-service personnel wereincluded in training quotas to replace general-service personnel on duty infixed installations. Except those attending from medical replacement trainingcenters on an unassigned basis, graduates were usually returned to theirstations upon completion of the course. All other graduates were assigned topriority vacancies.
Upon graduation, each man was to receive a complete tool kit(fig. 24), which had been carefully designed for use in the field. Until thesewere ready, an ordnance ignition mechanics' kit was used as an interim item.Even after the prescribed kit became available, the supply was limited, andprocurement difficulties on components necessitated sending the item to thegraduate's duty station after he completed the course. Some kits never caughtup with the men. Ultimately, to effect distribution where the planned system hadfailed and to compensate for it in transit losses, requisitions, based on thenumber of course graduates who had arrived without kits, were honored.
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FIGURE 23.-Familiarization of students with30-ma. Army field X-ray unit.
With continued technological developments, including morecomplicated circuitry and an increasing range of equipment in the supply system,the desirability of lengthening the course soon came under study. For the timebeing, however, The Surgeon General chose to stress quantity rather than qualityto meet, to some degree, the growing need for maintenance in the field. Herecommended, accordingly, that the school be enlarged to permit the training of300 enlisted students at one time.6 ASF approval was granted on 4 May1943, but less than a month later, following an inspection by the Director ofTraining in the Surgeon General's Office, the need for lengthening the coursewas reconsidered. A short time later, the course was reprogramed on a 16-weekschedule, which included a staggered class input at 9-week intervals.7
6(1) AG Memorandum No. W615-37-43, 6 Apr. 1943, subject: Training of Enlisted Technicians at St. Louis Medical Depot. (2) Memorandum, Col. F. B. Wakeman, MC, to Director of Training, ASF, 23 Apr. 1943, subject: Expansion of School Facilities.
7Memorandum, Col. F. B. Wakeman, MC, Director, Training Division, for The Surgeon General, 28 June 1943, subject: Training Inspection of the Medical Supply Services School (Class IV), Medical Supply Depot, St. Louis, Missouri, and 2d indorsement thereto.
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FIGURE 24.-Medical Department maintenance andrepair tool kit.
About the same time, all courses at the St. Louis Medical Depotwere grouped under one head, and the Maintenance and Repair Course becameidentified as part of the Medical Supply Services School. Better organizationand administration resulted from this consolidation. Meanwhile, the originalteaching equipment, some of which had been obtained on a special fund allocationand some from the field and classified as unfit for further use, wassupplemented from depot stock to meet the expanded student loads.
An unanticipated requirement soon canceled the gain incurriculum time. In July 1943, ASF Headquarters directed that standards ofmilitary training and physical conditioning be sustained at all schools. Theseventh class, starting on 10 August 1943, accordingly gave up much of itslengthened time to courses in basic military training and physicalreconditioning.8
Officer Training
Faced with a conspicuous absence of technical know-how at theofficer level, The Surgeon General in August 1943 directed that a class of 10Medical
8Memorandum, Maj. N. R. Walker, AGD, Assistant Executive Officer, Military Training Division, ASF, to Chiefs of Services, 6 July 1943, subject: Concurrent Basic Military Training and Physical Conditioning in Army Service Forces Schools.
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Administrative Corps second lieutenants be selected to attendthe Maintenance and Repair Course. Officers, upon graduation, were assigned toMOS (military occupational specialty) 4890, Medical Equipment MaintenanceOfficer, and, for the most part, filled assignments in the Surgeon General'sOffice, staffed depot shops and liaison billets, and eventually were deployedoverseas with field medical depots. Some few went directly to medical sectionsof theater headquarters or to other special-type assignments.
In the meantime, before the 10 officers graduated from thecourse, an additional 5 officers with some previous training as equipmentservicemen in civilian life were assigned as medical equipment maintenanceofficers to the medical depots at Chicago, Ill., and St. Louis, and to themedical sections of the ASF depots at San Antonio, Tex., Savannah, Ga., andSeattle, Wash. Until officers could be made available through graduation fromthe course, these five officers constituted the complement of medical equipmentmaintenance officers in the field. Their duties included liaison with posts,camps, and stations; inspection trips; and coordination with the medical supplyofficers at hospitals.
With few exceptions, one common phenomenon characterizedmedical equipment maintenance officers. Because of the extreme shortage ofenlisted maintenance personnel and of the prevailing concept of using officersas troubleshooting equipment servicemen on a regional basis, they were generallyseen in fatigue uniforms inspecting, installing, repairing, or dismantlingitems. Commanding officers and other executives usually considered themtechnicians rather than supervisory directors, as compared with other officersassigned to more "dignified," although none to more important, duties.
By the end of 1943, 360 students had been enrolled formaintenance training: 210 had been graduated, 42 had failed academically, and108 were still in training. By the end of the following year, 830 enlisted menand 56 officers had been graduated.9 Equippedwith the necessary know-how and tools, an excellent esprit de corps wasevidenced among maintenance school graduates. Letters and other reports fromalumni stationed in practically every area of the world usually carried sometechnical message relating to the maintenance situation. This information wascarefully analyzed by the staff, and class schedules were revised to stress themost commonly noted phenomena. Such correspondence was encouraged by the coursedirector, who advised graduating students of the continuing availability of thefaculty to assist by correspondence when unusually perplexing service problemswere encountered or when the graduate experienced any apprehension about a taskat hand.
9(1) History of the St. Louis Medical Depot, 7 Dec. 1942-7 Dec. 1943. (2) A Summary of the Training of Army Service Forces Medical Department Personnel, 1 July 1939-31 December 1944. [Official record.] (3) History of Maintenance of Medical Department Equipment, 14 Feb. 1946 [official record], gives 835 enlisted through 5 January 1945, and 98 officers through 29 December 1945.
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SUPPORT OF USING ORGANIZATIONS
The sudden growth in station maintenance requirements whilecommercial support was dwindling is explained in part by the 65 percent increasein number of station and general hospitals from July 1940 to July 1941. Moreconcretely still, in the 15 months between September 1940 and December 1941, thenumber of normal beds in Zone of Interior general hospitals increased from 4,925to 15,533, and in station hospitals from 7,391 to 58,736.10Concurrently, medical technical items began to spread around the world. It is oflittle wonder that existing facilities, civilian or military, could not copewith the staggering requirements for technical medical equipment installationand maintenance.
The maintenance training program was oriented to theperformance of maintenance and repair in hospitals, of both the fixed and themobile types. Despite any backlog of items at depot shops, or the urgency ofissue requirements, maintenance at the using level was of paramount andtranscending importance. It was there that patients' lives could be directlyjeopardized by inadequate maintenance.
Combined technical services maintenance shops beingestablished at most stations were of little benefit to hospital commanders foranything other than maintenance of nonmedical hospital equipment. Except for theX-ray technicians' course where relatively good operator maintenance wasemphasized, equipment servicing techniques were generally absent from coursesfor enlisted technician operators.
During the war, medical maintenance support of the operatingunits was derived from three sources: that inherent in the unit, in the shop,and from commercial resources. With commercial capability diminishing in theface of bounding requirements, The Surgeon General had no alternative but tobecome self-sustaining in the field of medical maintenance. Units were directedto make repairs within the scope of their assigned capability and localresources and to effect other repairs by shipping items to designated depotshops. In an emergency, the depot was notified, and either a replacement itemwas furnished immediately or depot maintenance personnel were dispatched to theunit for on-the-spot repair. The latter alternative was used more extensively astrained shop personnel became more plentiful. Scheduled periodic visits to unitsalso proved beneficial by providing preventive maintenance as well as timelyrepairs, but most of these refinements became full-fledged only toward the closeof the war.
Because of their complexity, items such as X-ray tubes, X-raytube inserts, stopwatches, microscope objectives and oculars, certain electricalinstruments and meters were keyed to the St. Louis Medical Depot for replacementand repair. These instructions were applicable to overseas commands only for
10Smith, Clarence McKittrick: The Medical Department. Hospitalization and Evacuation, Zone of Interior. U.S. Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956, p. 24.
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X-ray tubes. Where required repairs were beyond the capabilities oreconomical use of depot facilities, the items were shipped to the manufacturerfor repair.
As maintenance requirements mounted, this total system ofhandling repairs and returns evolved. To illustrate, until exacting instructionswere well disseminated, confusion and delay attended the repair and returnmethod because shipping units would often fail to identify the item as"repair and return" or to indicate its defect. As a result, the itemwould be processed erroneously as an excess return and then placed in depotstock. Also, improper packaging resulted in breakage in transit, with resultantproblems regarding responsibility occurring.
MAINTENANCE SHOP OPERATIONS
Some confusion existed as to the maintenance responsibilityfor items, such as electric fans and typewriters, which were not exclusivelystocked by the Medical Department. On 12 May 1943, ASF assigned the maintenanceof certain Medical Department items to Ordnance, Quartermaster, Engineer, andSignal Corps under provisions of a previously published ASF memorandum.11However, on 28 July 1943, following protests from the Surgeon General'sOffice, Army Service Forces withdrew the designations indicating that "nospecific Medical Department equipment will be assigned to other technicalservices for maintenance" but that "the Medical Department, asrequired, could obtain services needed and available from the shops of therespective technical services" in accordance with the latest edition of thebasic maintenance manual. Final disposition and replacement, in any event, wouldbe through depot channels.
War Department Supply Bulletin 38-1-8, dated 13 May 1944,"Repair of Critical and Nonessential Items," became the"Bible" for fifth echelon repair shops in directing, from an inventorycontrol standpoint, what to repair and what not to repair. Additionally, machinelistings were compiled monthly by the Inventory Control Branch and furnished tofifth echelon repair shops.12 Items indicatedas being in short supply were given priority in shop processing as were itemsreceived from stations for "repair and return." Also, as the medicalstock position improved and the backlog of maintenance requirements pyramided,the Supply Service directed that cost of repairs for the listed items would notexceed 50 percent of the value of the item after it was repaired.
11(1) ASF Memorandum S850-23-43, 5 Apr. 1943, subject: Maintenance of Army Equipment. (2) War Department Technical Manual TM38-250, August 1943, Basic Maintenance Manual.
12Maintenance categories were defined as follows: First echelon, that degree of maintenance prescribed and performed by the user or operator of the equipment; second echelon, that degree of maintenance performed by specially trained personnel in the using organization beyond the capabilities and facilities of the first echelon; third echelon, that degree of maintenance prescribed and performed by specially trained personnel in direct support of using organizations; fourth echelon, that degree of maintenance performed by units organized as semifixed or permanent shops to serve lower echelons; fifth echelon, that degree of maintenance authorized for rebuilding major items, assemblies, parts, accessories, tools, and test equipment, usually located at a depot.
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The first formal maintenance report submitted by the St. Louisshop on 1 February 1943 indicated that equipment valued at $34,465 had beenrepaired and returned to the supply system in 1 month. This was about 30 timesthe production rate of the prewar shop. Techniques of repair which steadilyimproved processing time and standards were instituted. Production reached apoint at which equipment worth almost $5 million was being repaired and returnedto the medical supply system in a single year.
Meanwhile, because of crowded conditions and the need toplace the shop in proximity to the maintenance and repair school, the decisionwas made in July 1943 to relocate the shop from the Indian Warehouse to BuildingNo. 18 on the St. Louis Arsenal Reservation. By September, the move wascompleted. The activity operated first as the Maintenance Division repair shopand later (February 1945) as the fifth echelon repair shop, St. Louis MedicalDepot (fig. 25).
As a flourishing repair activity, the shop employed 124civilians and was administratively organized into branches and sections todelineate functional responsibilities and to facilitate equipment processing andinternal coordina-
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tion. Rapidly filling its 125,000 square feet of floor space,the shop expanded beyond the physical limitations of its facilities within 2years. In the fall of 1945, it was relocated in modern, spacious quarters on thefifth floor of the same building (fig. 26) in which two men with a handful oftools had begun to repair medical equipment in 1922.
In January 1945, a fifth echelon repair shop was opened atthe Denver Medical Depot, Denver, Colo., but it was short lived. In its onlyfull year of operation, 1945, the Denver shop, in addition to a vigorous stationliaison program, repaired items with a dollar value of $1,664,816, thusrelieving the St. Louis shop of a tremendous load. During the planning stages ofthe Denver shop, serious consideration was given to opening shops at other Zoneof Interior depot locations, although it was generally accepted that the St.Louis facility could handle any foreseeable additional load.13
In any event, the time was right for a reappraisal, if onewere to be made at all, in terms of a small-scale shop that had been organizedat the Bingham-
13(1) Annual Report, Denver Medical Depot, 1945. (2) Memorandum, Lt. Col. R. L. Black, MSC, Director, Storage and Maintenance Division, OTSG, to Col. [Edward] Reynolds, 19 Aug. 1944, subject: Medical Department Repair Shop-St. Louis Medical Depot.
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ton Medical Depot, Binghamton, N.Y., in January 1944. Theproblem was whether a facility, essentially the duplicate of the St. Louis shop,should blossom from the small Binghamton establishment. After further study andcoordination, it was decided that the Binghamton shop should remain relativelysmall, and a similarly small shop should be established at the San FranciscoMedical Depot, San Francisco, Calif. These two shops were phased in slowly; notuntil fall 1946, when some equipment was transferred from the shop then beingdissolved at Denver, did they finally become fully operative. Another smallshop, equipped to repair only field items and assemblage components, wasestablished in June 1945 at the Louisville Medical Depot, Louisville, Ky. FromAugust until the end of the year, this shop repaired more than 10,000 itemsvalued at almost $100,000.14
CATALOGS AND TECHNICAL MANUALS
From the very beginning of the emergency period before World WarII, spare parts-or rather, the lack of them-had plagued the maintenanceprogram. Spare parts were regarded by some as strictly a supply problem, byothers as a maintenance responsibility, with no one taking a strong positioneither way. In time, a semblance of a spare parts catalog emerged, and the spareparts themselves became relatively abundant, but not until relatively late inthe war.
By the end of 1942, the need for spare parts was becomingmore evident to The Surgeon General. In January 1943, preliminary estimatesindicated that more than 200 types of medical end items were in use in theatersof operations which should have spare parts support. By March 1943, mostessentials of a spare parts program were under consideration in the SurgeonGeneral's Office.
On 5 May 1943, an Army spare parts policy was announced byThe Adjutant General.15 The policyprovided that end items intended for use overseas would include specified"high mortality" parts packaged with each item, together with theconcurrent procurement of 1 year's supply of spare parts, plus an additionalprocurement where availability would not otherwise be assured of parts for theexpected life of the equipment. At least 6 months' supply of spare parts wasto be shipped with the equipment. The remainder was to be requisitioned on thebasis of usage rather than that of anticipated failures. Packaging was to bestressed to insure safe arrival at destination and to prevent deterioration fromclimatic conditions.
These were logical and well-conceived policy objectives, butthey never fully materialized. Again, although this decision probably did moreto foster spare parts support than any other single factor, it was too late incoming for optimum benefit in the war. Too much equipment was already in thesystem and too much slack had to be taken up from the 3 years of equipmentinflux
14See footnote 9(3), p. 109.
15AG Memorandum No. W700-23-43, 5 May 1943, subject: Procurement and Oversea Distribution of Spare Parts for Medical Equipment.
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which had passed with inadequate spare parts support.Nevertheless, to make these policies effective for the time remaining, themachinery had to be put together and set into motion.
To assist in developing this portion of the growingmaintenance program, Capt. (later Maj.) Eric A. Storz, MAC, was ordered toWashington on temporary duty from the Kansas City Medical Depot, Kansas City,Kans., on 17 June 1943. Numerous conferences were held, trips were made to theArmy Medical Purchasing Office in New York, N. Y., for coordination, and, as aresult, the Supply Service of the Surgeon General's Office issued MemorandumNo. 8 on 25 May 1943. This directive focused attention of the spare partsaspects of the plan and delineated internal functional responsibilities.
By autumn 1943, planning for the maintenance program was wellunderway. Much had been accomplished in coordination with the Army ServiceForces and the Government Printing Office as well as with other staff elementsof the Surgeon General's Office, all of which inevitably became involved inthe printing of any maintenance and spare parts publications. It soon becameapparent that the equipment analysis essential to determining spare partsrequirements could not be effected without direct access to the particularequipment involved. Thus, in September 1943, Captain Storz was ordered to St.Louis to set up the spare parts and manual program directly under The SurgeonGeneral as well as to monitor the establishment and designation of the fifthechelon repair shops under the St. Louis Medical Depot.
Locating the maintenance publications and spare parts groupat the depots adjacent to the shop and school proved to be an ideal arrangement.The school used shop facilities for some practical training, and instructors ofthe school were available to facilitate training of the initial shop personnel.
Assigned as a Maintenance Branch responsibility first andfundamentally was the task of reviewing Medical Department end items toidentify, describe, and list the spare parts which should be cataloged insupport of each item requiring maintenance in the field. Included in the programwere development and revision of spare parts lists, determination of initialrequirements, and establishment of distribution schedules. Primary emphasis wasnaturally placed on end items subject to overseas shipment.
By the time the spare parts program really got underway, anASF catalog had been established.16 Relatingthis new publication to the medical spare parts program, it was decided that theMED (Medical Supply) 7 section (organizational and higher echelon spare parts)would be issued as a series of pamphlets listing spare parts, replacement parts,special tools, and accessories, requiring frequent replacement. Further, it wasdesired that no publication would be made under the MED 8 section (higherechelon spare parts) since MED 7 would contain information adequate for theMedical Department. MED 9 section (list of all parts) would consist of a seriesof pamphlets listing all component parts of the end items. This conceptcontemplated that all spare
16ASF Circular No. 121, 17 Nov. 1943, subject: Establishment of Army Service Forces Catalogs.
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parts listed in MED 7 would be stocked. Seldom used and notnormally stocked spare parts, plus those included in MED 7, would be containedin MED 9.
Work previously done in preparation for spare partscataloging was thus integrated into the MED 7 program. By November 1944, some1,600 separate parts had been identified, and it was expected that the figurewould reach nearly 4,000 when the MED 7 program was completed.
By V-J Day when publication of such documents ceased, 54 MED7 pamphlets covering 64 end items had been prepared, of which 41 had beenpublished and distributed. Some seven additional pamphlets were in variousstages of development. No MED 9's had been published although some had beendeveloped. To make optimum use of the work that had been done on these suspendedpamphlets, The Surgeon General permitted the data to be mimeographed and issuedon an informal basis as the "Spare Parts and Tool Listing."
Near the end of the war, the President's Committee onCommodity Cataloging17 reported its findings. One major proposal was thatcommodity classification criteria and a uniform numbering system be adopted withcentral monitorship. Meanwhile, a joint medical spare parts catalog with aunique joint parts numbering system was already under active consideration bythe Surgeons General of the Army and the Navy. Actually, this effort wasactively implemented before final determination of action on the proposals ofthe President's committee. Thus, the World War II MED 7 spare partsprogram and the joint Army-Navy effort immediately following became springboardsfrom which to derive a new and better postwar medical spare parts catalogingsystem under the auspices of the Army-Navy Medical Procurement Office.
As a corollary to the spare parts effort, certain othermaintenance publications were required to promulgate technical instructions andother maintenance data to the field. A project was established to publishtechnical manuals covering operational aspects and maintenance requirements atthe several echelons for selected technical medical items. By V-J Day, 39 suchmanuals had been published, and several others were in process of development.Other type publications used for dissemination of maintenance data includedmodification work orders, lubrication orders, supply bulletins, technicalbulletins, Surgeon General's Office code letters, and port medical supplyinformation letters. The last two items were Surgeon General administrativedirectives, which would be quickly published and which were convenient todistribute.
To overcome the negative pressure existing in the spare partssupply pipeline, automatic supply was carried out according to allowance listsprepared by the Maintenance Branch. As fast as procurement could be effected anddelivery realized, action was initiated to distribute the initial allowance ofspare parts to the several active theaters of operations. Approximately 60
17Established on 18 January 1945 by letter fromPresident Franklin D. Roosevelt to Hon. Harold D. Smith, Director, Bureau of theBudget, requesting development of a U.S. standard commodity catalog.
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percent of the total purchase quantities were distributedaccording to this scheme.
Early in the spare parts planning period, it appeared thatsome distinct advantages would accrue if certain spare parts were grouped andidentified collectively for procurement, storage, and issue. As an example, asmall assemblage of spare parts for gasoline stoves and burners was cataloged asa "kit." Such kits, normally issued with the end item for which theywere designed, constituted the initial issue of high mortality spares. Kits werealso available for replacement issue to the field.
Use of the kit concept for appropriate spare parts groupingshad the advantage of identifying several related spare parts under a singlestock number, thus facilitating recognition and handling at all levels. Whilekits had considerable merit, this usage admittedly resulted in some degree ofwaste. Often the assortment of parts in the kit did not represent a balancedsupply, and one or two parts would become depleted leaving others unused. Whenindividual parts were not readily available for issue, as was often the case,new kits were requisitioned merely to obtain the one or two needed components.This imbalance, continually corrected with experience, did not invalidate thewisdom of the kit concept for the supply of selected spare parts.
As experience with the spare parts program grew, packaging ofparts became increasingly important, and attention was focused on this problemby the Army Medical Purchasing Office. Not only was packaging the criticalconsideration relating to protection of spare parts during storage and shipment,but it served as the primary means of identification. Faulty packaging,including illegible or poor markings by the manufacturer, was experienced. Itwas not until early 1945 that the Army Medical Purchasing Office could reportthat processing, packing, and marking problems had been worked out with thevarious contractors, and that spare parts were being delivered according tospecifications.
MAINTENANCE ACHIEVEMENT
Proponents, planners, and others responsible for themaintenance program did not have to wait long for comments from the field.Informal reports, received by almost all conceivable means-personal contacts,telephone, personal letters, word of mouth, and informal visits-indicated moreclearly than formal reports could do that the program was effective and hadgained enthusiastic acceptance at all levels of Medical Department activity. Theonly noteworthy complaints concerned shortages of trained maintenance personnel,lack of spare parts and spare parts information, and the need for more technicalpublications.
The training course output never seemed to meet the demandsof the field for technical personnel, and inevitably some course graduates weremisassigned. Zone of Interior hospital staffs were, at first, hesitant aboututilizing Army-trained enlisted men to service and repair expensive andelaborate
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diagnostic and therapeutic equipment. At the outset, thefatigue uniform worn by the military repairman did not instill the same degreeof confidence as did the coveralls or shop coat of a commercial representativewith the name of a prominent equipment manufacturer emblazoned across the back.Similar complaints, however, were not voiced by professional and othersupervisory personnel of medical units deployed in combat support operations.For them, the Army-trained maintenance personnel were vital to the success oftheir missions. As they became accepted, demands for course graduates steadilyincreased, thus compounding the shortage which was never entirely eliminatedthroughout the wartime period.
Spare parts and spare parts listings (MED 7's) were ingreat demand. Although some maldistribution of spare parts did occur, andoverzealous or inexperienced planners often requisitioned more than they needed,there was a genuine shortage throughout the war at the consuming level. This wascaused primarily by inadequate usage factors, by incomplete knowledge of enditem density to be supported, and by the long supply pipelines which wereentirely dry at the beginning. It is not surprising, therefore, that personnelin the field complained of having to use rope to replace worn out invalid chairtires, steel wool to replace brass screens in gasoline burner vaporizers,frayed web belts to fabricate kerosene refrigerator wicks, or of having to grinddelicate needle valves from welding rod stock.
The most frequent complaint about the MED 7 parts lists wasthat they did not cover enough end items in their range. Technical manuals andother maintenance publications were generally well received, but had started toolate and were too slow in coming. Probably the most frequently heard complaintabout technical manuals was that those which did become available for the mostpart, were received only when the recipient unit unpacked an end item and foundtherein the manual, which usually began with instructions on how to unpack theitem.
Demobilization served to underline the need for a balancedand effective permanent maintenance program in the Medical Department. Beforethe end of September 1945, shop production had been cut to a 40-hour week, andpersonnel reductions were being experienced. Technically qualified maintenanceofficers and enlisted men were released from the service, and the militaryhospitals and depots were quickly depleted of skilled personnel. All this cameduring the pressure of demobilization when demands were being placed on themaintenance shops for personnel to visit and assist in closing stations. Also,demands on depots for emergency repairs were increasing at permanent stationsbecause of the exodus of maintenance personnel from the service.
A postwar evaluation of the wartime maintenance and repair oftechnical medical equipment by the Medical Department showed the program as awhole to have been so successful that its peacetime continuance was recommendedby The Surgeon General.18
18Letter, Col. Robert J. Carpenter, MC, Executive Officer,OTSG, to Director of Supply, Headquarters, ASF, 7 Jan. 1946, subject: MedicalDepartment Peace Time Maintenance Program.
