CHAPTER V
Storage and Distribution of Medical Supplies
PACKING AND PACKAGING PROBLEMS
When the United States entered World War II and began to shipgreat quantities of medical supplies to overseas theaters, no preparations hadbeen made to meet the packing problems which soon developed. The sturdy woodenboxes which had been used in peacetime became scarce because of acute lumbershortages. Packing specifications continued to call for containers designed"in accordance with good commercial practices" or provided that thesupplies "shall be packed in a manner to withstand shipment andreshipment," but interpretation of these specifications soon became morelenient. In 1942, the customary shipping containers were flimsy, open-slattedcrates, thin plywood boxes for heavier items, and corrugated paper cartons andboxes for bottles, textiles, and miscellaneous items. No special efforts weremade to prevent corrosion, rust, insect damage, or other ill effects of exposureto dampness, heat, and rough treatment in handling.1
The circumstances under which the Medical Departmentdispatched its supplies to overseas stations had unfortunate effects upon theweak, ill-designed packing containers. Large quantities of supplies, hurriedlyassembled at overloaded ports, were stored in the holds of crowded vessels,often by inexperienced and poorly supervised stevedores. Lack of adequate harborfacilities and the exigencies of amphibious assaults frequently subjectedsupplies to sea water when they were unloaded on rafts or were thrown overboardand floated ashore. They might also be dropped on loading platforms, rolled,squeezed, and jostled before being jounced on trucks over shell-scarred roads.Even when delivered to the depots, there was no assurance that the supplieswould be protected from further inroads of the elements, for covered storagespace in the theaters of operations was far from sufficient.2
These storage and handling conditions which prevailed in theoverseas theaters had prompt and disastrous effects upon the shipping containerswhich the Medical Department used throughout 1942 and part of 1943. The medicalsupplies and equipment were subjected to every type of damage that can be causedby rough treatment and exposure to the elements.
1Record of the Processing and Packaging Conference-Exhibit, Toledo Medical Depot, 4-5 January 1945.
2Odenheimer, Robert K.: Report of Inspection and Investigation, Medical Department, Packing and Packaging, Southwest Pacific Area, March-April 1945.
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New Packaging Techniques
Reports from the South Pacific and from North Africa resultedin prompt action. U.S. Army Specification No. 100-14A, issued late in 1942,described requirements for all types of containers, both interior and exterior,including waterproof papers, and the meager knowledge then available regardingmethods of corrosion prevention. This specification corrected the most obviousand the most serious errors in export packing. During 1943, specifications wereissued which eliminated fiberboard cartons as export shipping containers,standardized box construction, reduced the weight of individual boxes, andprovided for the general use of waterproof case liners. These improved packingmethods were adopted by manufacturers slowly and with great difficulty. Bysummer 1943, however, most contracts for later delivery of supplies includedpacking specifications which reflected Medical Department experience during thepreceding 18 months. In 1944, additional and stricter specifications sought tocorrect packing deficiencies which still existed, particularly in the field ofcorrosion prevention. ASF (Army Service Forces) Manual 406, published inDecember 1943, was instrumental in the development and widespread use ofspecifications designed to protect all types of equipment subject to corrosion.A Packaging and Packing Section was established at the Army Medical PurchasingOffice. This section, in addition to drafting packing specifications, maintainedclose contact with the manufacturers and aided in the practical application ofthe specifications.3
From the end of 1942 until the close of the war, depotsassumed the main burden of the packaging problem, the repacking of supplies.Each depot relied initially upon experimentation and improvisation, butconsiderable progress was made in late 1943 when a Packing and Crating Unit wasestablished in the Office of the Assistant Chief, Supply Service.4The unit was charged with two jobs: the writing of packing specificationsand the institution of approved methods of repacking in the depots.
The manufacturers of medical supplies encountered manyproblems in adhering to packing specifications. In the summer of 1943, forexample, the lumber shortage became more acute, adversely affecting all packingand forcing resort to substitute materials. V-board, made of superstrength all-kraftfibers, was then adopted as a substitute for wooden boxes and as a successor tocorrugated fiberboard of the non-water-resistant type. This V-board made awaterproof box which was satisfactory when packed with light, closely fittingitems, such as blood plasma. It was widely used, however, to contain a number ofitems which could not be shipped safely in such a flimsy box. Consequently,there were numerous reports from overseas, describing unsatisfactory resultsobtained with V-board-crushed, torn, and perforated boxes, which caused
3Pile, Benjamin D.: Development of Packaging and Packing in the Medical Department During the Present Emergency, 16 Oct. 1945. [Official record.]
4Supply Service Memorandum No. 6, 8 Mar. 1943, subject: Packing and Crating Organization.
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the ruin of valuable supplies. Finally, in spring 1945,V-board was abandoned by the Medical Department, except for a restricted groupof items.5
Serious shortages were encountered in many other types ofpacking materials, including steel strapping, staples, strapping equipment,waterproof case liners, waterproof cement, cellophane bags, chipboard, and foilbarrier materials. Some shortages, caused by ineptly worded specifications,should have been corrected promptly, but most were caused by scarcities in basicmaterials and manpower. Often, the Medical Department hastened the completion ofa contract by using its influence to obtain higher preference ratings for therequired packing materials.
The two problems which appeared to be the most serious andimmediate were breakage in overseas shipments and damage by water. Supplyofficers in the depots applied themselves to the solution of these problems.Considerable progress was made in solving the breakage problem by theconstruction of sawed-board, nailed, metal-strapped boxes; the use of adequatebracing and blocks in packing equipment such as X-ray machines, sterilizers, andoperating lamps; placing a maximum load-limit on the contents of shippingcontainers; and the lavish use of ground cork, excelsior, and other cushioningmaterials.
Shortages of packing materials and the press of work wereattacked by preference ratings to the suppliers of packing materials, theemployment of additional civilian personnel, and the introduction of assemblyline procedures in the packing rooms.6
In devising methods of waterproof packing, the depots soonmade distinguished progress. Waterproof case liners, made of asphalt-baselaminated materials, were adopted for all boxes intended for export shipping.The case liner was first arranged in the box; then, the supplies were carefullypacked in the liner; and, finally, the liner was sealed, and the box was nailedand strapped. This produced a shipping container that admitted no water, evenwhen immersed. However, additional precautions were frequently taken.Cement-coated, rustproof nails were used in the construction of the boxes.Waterproof labels and markings were used on the exterior. In packing electricalequipment, a vaporproof barrier and a desiccant included within the package wereused to exclude moisture from delicate contact points (fig. 27.).7For expendable supplies, this method was satisfactory. Overseas installationsreceived the boxes and opened them as the supplies were needed. When thetactical situation required a move, only a small quantity of unpacked supplieshad to be dealt with. Nonexpendable supplies and equipment, on the other hand,had to be repacked, and few mobile units had either skilled labor or packingmaterials to provide waterproof containers. The Supply Service
5See footnote 3, p. 120.
6See footnote 1, p. 119.
7Memorandum, Capt. Paul Lipman, MAC, Asst. Purchasing and Contract Officer, to Lt. Col. E. A. Shea, MAC, Chief, Purchasing Division No. 4, AMPO, 31 May 1945, subject: Annual Report for Fiscal Year 1945.
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developed the "amphibious box" to meet thisparticular need. The box, when fully packed, could sustain a drop of 15 feetwithout loosening the watertight gaskets. This container proved to be invaluablein the functional packing of field installations for supplies and equipmentcould be quickly repacked when the unit moved. While the unit was in operation,the tops were removed and the boxes stacked on their sides, thus providing tiersof shelves for the storage and issue of supplies. The amphibious box was arelatively expensive item, costing the Medical Department $16 each, but itsusefulness was so great that more than 72,000 were purchased.8
Scarcity of material forced depots to procure high gradelumber for overpacking; for example, shipments processed by the depot at SanFrancisco, Calif., contained high grade redwood. Although this was inconsistentwith the prevailing policy, recipients of medical supplies in the Pacific werehighly pleased, as shipments were received intact and the lumber was used togood advantage in fabricating hospital furniture, floors, and similar items nototherwise available.
Preservation of Instruments
Soon after heavy overseas shipments began in 1942, it becameapparent that one of the most serious problems would be the protection ofsurgical instruments (fig. 28) from corrosion. Numerous reports from theaters ofoperations called attention to instruments which had corroded so badly that theywere useless. At first, transportation and storage conditions overseas wereblamed for this deterioration in the instruments, and efforts were redoubled topack them in moistureproof containers; but depot inspections revealed thatsurgical instruments in stock were imperfectly protected. Moisture in the airindustrial fumes, dirt, and even perspiration traces left by handlers causedcorrosion. It was discovered, also, that many box-lock instruments werecorroding in the locks, a condition caused by a scale formation.9
One solution of this corrosion problem involved a thoroughprocessing of the instruments in the following manner: The instruments wereplaced in a metal basket and lowered into a tank filled with stoddard solvent,which removed dirt, grease, and other organic residue. A second tank, filledwith the same solvent, provided a rinse. Next, the instruments were immersed ina third tank which was filled with specialized solvent, a fingerprintneutralizer. After draining, the instruments were placed in a drying oven heatedby infrared lamps. The dry instruments were removed from the oven, allowed tocool for 2 or 3 minutes, and dipped into a preserving tank containing an oil orgrease which was especially adapted to the items being processed. Finally, theywere sealed in laminated foil bags, and were then ready for storage. Zone ofInterior issue, or overseas shipment.10
8The Amphibious Box. Bull. U.S. Army M. Dept. 4: 424, October 1945.
9Shea, Elmer A.: Surgical Instruments. [Official record.]
10See footnote 9, above.
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In 1943, orders were issued to process all surgical, dental, andveterinary instruments, but precise specifications as to how this was to be donewere not laid down. The results were so generally unsatisfactory as todemonstrate the need for a technique that would be at once simple and effective.After considerable experimentation, an electrochemical process was devised andmade standard in time to be widely used during the latter part of 1944. Theinstruments were thoroughly cleaned, immersed in a light oil, wrapped tightly innearly pure aluminum foil, and finally were packaged in metal-lined, heat-sealedenvelopes. The process gave adequate protection against all the well-knowncauses of corrosion and the little-known cause of scale formation. Instrumentsthus processed and packaged were safe from corrosion for extended periods oftime and under all conditions. In addition, they were ready for use after theenvelope was opened, the foil wrapper removed, and the instruments sterilized.This ended the time-consuming removal of heavy greases, wax, and resin coatings,with which instruments formerly had been protected.11
It was intended that all processing of instruments would bedone at the medical depots at St. Louis, Mo., and Kansas City, Kans., but theshortage of personnel made it expedient to engage a private contractor in St.Louis. The purchasing office in New York prepared lists of instruments to beprocessed, grouping them according to patterns. Instructions were then issued tothe various Medical Department depots, requiring them to ship approximately100,000 per week to the St. Louis depot. This depot released the instruments tothe contractor on an established schedule; and after the instruments wereprocessed, they were placed in the St. Louis depot stock. This program began inthe fall of 1944. By 30 November 1944, approximately 1,250,000 instruments hadbeen processed, and during succeeding months, nearly 2 million more were giventhis protection against corrosion.12
Unfortunately, this new process was developed too late to beof great practical benefit in World War II. The heaviest shipments of surgicalinstruments to overseas installations were made during 1943 and 1944;consequently, only small quantities of instruments protected by the new processwere sent abroad before the end of the war.
Results of Research and Development
The Medical Department's experience with the protection ofsurgical instruments clearly demonstrated that the entire packing and packagingprogram in the depots should be subjected to central control. At the beginningof the war, the depot commanders were allowed to operate without interference inthe handling of outgoing shipments. This encouraged ingenuity and localinitiative, which produced many important advances in packing techniques.
11Hornbacher, Arthur: Surgical Instruments: Difficulties Due to Corrosion and Methods Taken to Combat Them. [Official record.]
12See footnote 11, above.
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Unfortunately, this system also had the disadvantages usually associated withlocal independence. Some depot commanders, possessing imagination and energy,applied themselves to the task of adapting their packing methods to wartimeconditions; but others were slow to change their methods even though the needfor haste was the theme of all reports received from overseas. Depot inspectionscould not correct these deficiencies; by the time the inspections were made,much of the damage had been done, and poorly packed supplies were deterioratingin every theater.
Packing methods which were developed in the depots, and theadvances which research produced, were standardized by the Medical Departmentfor use in all depots. Precise packing specifications were prepared, whichdescribed the materials and methods to use in packing the more important andeasily damaged medical items. Manuals were published and directives were issued.Training films were made and exhibited to the appropriate personnel of alldepots. At packing and packaging conferences (at Toledo, Ohio, St. Louis, andNew York, N. Y.), attended by supply officers from the various depots, newprocesses were explained and enthusiasm for better work was generated. In otherwords, strong and continuous efforts were made to develop and maintain an"export consciousness," to instill the belief that supplies must be sopacked that they would be usable to combat areas. The extent to which thisattitude was built up is indicated by the remark of a depot commander in 1945,who declared that he "would not quibble about spending $50 to insure thearrival of a single package of blood plasma to the battle front in goodcondition." To enforce the directives and to assess the value of thiswidespread training program, inspecting officers from ASF Headquarters and fromthe Supply Service of the Surgeon General's Office, made frequent visits tothe packing rooms of the depots. These manifold efforts bore a rich harvest. Byspring 1945, the Medical Department was reported to have climbed from the bottomrung of the ladder to a place near the top, in comparison with other technicalservices, in the protection and packing of supplies.13
This judgment, rendered by inspecting officials in the theZone of Interior, was confirmed by reports from overseas. Supply officers in theSouthwest Pacific declared that the supplies received during the period from 1July 1944 to 1 April 1945 showed a "100 per cent improvement" inpacking. The waterproof case liners and the nailed wooden boxes were hailed asthe most satisfactory packing materials used. The only persistent and importantcomplaints received from this area in 1945 were that fragile items should bemore carefully cushioned and that large pieces of equipment with projectingparts should be disassembled before shipment.14
By the spring of 1945, all the more serious packing andpackaging problems had been solved. The early and laborious efforts of thedepots, the research and experimentation in the laboratories, and thedevelopments in manufacturers' plants culminated in a series of jointArmy-Navy packing specifica-
13See footnotes 1 and 2, p. 119.
14See footnote 2, p. 119.
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tions, which replaced the ASF Manual 406 and a multitude oftentative specifications. The Joint Army-Navy Packaging Board, established in1945, coordinated the work of subsidiary groups and issued specifications to allbranches of the Armed Forces. The work of the Packaging and Packing Section,Army Medical Purchasing Office, resulted in the preparation of a "MasterPreservation Packaging and Packing Listing," which described in detail amethod of processing and packing for every item of the Medical Departmentcatalog.15 If an invasion of Japan had beennecessary, the medical supplies thrown upon the shores of that country wouldhave shown the great improvements in packing techniques which had been achievedsince the landings on Guadalcanal.
STORAGE OF MEDICAL SUPPLIES
The functions of storage and distribution are closely linkedin many ways. For a large part of the war, they were supervised by a singledivision of the Supply Service, and throughout the conflict both were carriedout by the Medical Department's farflung depot system. But, however linkedthey were, the functions of storage and distribution were essentially different.In the purposes they were intended to accomplish and in the problemsencountered, they found little in common.
Increased Depot Activities
At the outset of World War II, the Medical Department wasresponsible for procurement, storage, and issue of approximately 4,500 items. By1942, the number of items under medical cognizance had jumped to 6,000, andanother 1,000 items were added by 1943. During mid-1942, some 700 contractorswere serving the Medical Department, but within a year's time, this had jumpedto 2,500 contractors and the number of contracts had reached 25,000.16
Furthermore, until early 1944, contracts were F.O.B.destination, which meant that items received from contractors could not bepicked up on stock records and made available for issue until they were formallyaccepted. Some deliveries from procurement to depots were piecemeal, delayed,lost, or damaged in transit. Often, stocks arrived before receipt ofspecifications or copies of the contracts. These documents were necessary topermit identification, inspection, and acceptance. In the event of deficiencies,stocks upon arrival had to be segregated and withheld from issue pendingacceptance, or refusal and disposition instructions.
Aggregating more than 5.4 million square feet by July 1941,medical supply depot space continued to expand after entry of the United Statesinto the war. A new branch depot was established in Kansas City, with Lt. Col.Revel E. Hewitt, MC, as commanding officer; and medical sections were added ingeneral depots at Seattle, Wash., Atlanta, Ga., and Richmond, Va., so that in
15See footnote 3, p. 120.
16(1) Annual Report, Finance and Supply Services, OTSG, fiscal year 1942, and attachment "Office diary." (2) Annual Report, Supply Service, OTSG, fiscal year 1943.
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July 1942, the space available amounted to 7 million squarefeet. Additional space acquisitions increased storage facilities still furtherduring the next 6 months; in July 1943, the peak of 13 million square feet wasreached. From this time until the end of the war, the trend was reversed. Spacein depots and medical sections was sharply reduced, and a number ofinstallations were inactivated as the demand for storage area was diminished.Twenty depots and medical sections had been occupied in July 1943. This numberdropped to 17 in July 1944, and to 14 in July 1945. During the same period, thenumber of square feet occupied fell to 10,348,000 in 1944, and to 9,127,000 in1945.17
The number of military and civilian personnel employed in thedepots showed a steady climb to the middle of 1943 and a similar reduction afterthat year. A few months before Pearl Harbor, fewer than a score of trainedsupply officers were available for depot operations. This meager pool ofmilitary personnel was supplemented by granting commissions to individuals withappropriate civilian experience, calling to active duty a number who heldReserve commissions in the Medical Administrative Corps and the Sanitary Corps,and by training newly commissioned graduates of the Medical Administrative Corpsofficer candidate schools. These young officers, directly after receiving theircommissions, entered upon a period of supply training. The number of officers onduty in the depots increased from 171 in December 1941 to 465 in December 1942,and to 511 in June 1943.18
Despite difficult problems in recruitment, including arelatively low salary scale, the number of civilian employees increased at animpressive rate (fig. 29). When the United States entered the war, there wereapproximately 2,600 civilian employees in medical depots. This number wasincreased to 5,700 in July 1942, and to 14,100 in July 1943. As in storagespace, this was the peak period. Employment declined to approximately 9,400 inJuly 1944, and 6,800 in July 1945.19 It shouldnot be assumed, however, that this decrease in civilian personnel indicated adiminution of activity in the depots. Quite the contrary is true, for theworkload of the depots showed a distinct increase during the latter part of thewar. This striking conservation of manpower was made possible by the decrease instorage space, by the increased use of materials-handling equipment, by worksimplification, and by better training and control of employees.
Operation of the Depot System
Medical depots were able to survive the onslaught of work andconfusion that flashed into being during the first years of the emergency andwar. By June 1943, they were beginning to reap the gains of experience. Fromthen
17(1) See footnote 16, p. 127. (2) Annual Report, Storage and Maintenance Division, OTSG, fiscal year 1945.
18(1) See footnote 16(2), p. 127. (2) Report on Administrative Developments, Office of The Surgeon General, 1 Dec. 1942. [Official record.]
19(1) See footnotes 16(1), p. 127, and 17(2), above. (2) Memorandum, The Surgeon General for the Commanding General, ASF, 29 June 1945, subject: Report, Pursuant to Directive of 1 June 1945, Submitting Additional Material for Annual Report of ASF.
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FIGURE 29.-Window showing job openings at SanFrancisco Medical Depot, San Francisco, Calif.
on, even increased demands placed on depots seemed morereasonable in view of their extended capabilities, thus swelling theirproduction without an increase in manpower.
In December 1941, however, the depot system itself wasrudimentary, with specialization only just begun. The medical sections at NewYork, San Antonio, Tex., and San Francisco, Calif., distributed stocks to theirrespective distribution areas and to ports of embarkation, while the branchdepots at St. Louis and Savannah, Ga., performed similar functions. The medicalsections at Schenectady, N.Y., Columbus, Ohio, and New Cumberland, Pa., wereused for storage of the War Reserve. The branch depot at Toledo constructedhospital assemblies. This was the full extent of specialization, but wartimedemands soon proved too heavy for the existing framework.
One of the earliest difficulties arose from the scarcity ofcertain items. The old system under which stocks had been divided more or lessimpartially among the depots left no facility with sufficient scarce items tosatisfy its needs. The solution was the "key depot system" set up in1942. In each of three
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main geographical regions, one depot was designated toreceive and store stocks of these items.20
By summer 1943, the depot system was substantially in finalform. Storage facilities were divided then into five categories, each with itsspecialized function-distribution depots, assembly depots, port filler depots,reserve depots, and holding and reconsignment points. In each category, thedepot type determined to considerable degree the variety and quantity of medicalsupplies sent to it.
Depot administrative organization, originally conditioned bylocal needs and the wishes of individual commanders, was brought into conformitywith a general pattern in 1943, the pattern being laid down by the StorageDivision, ASF. The basic divisions were Administration, Transportation, StockControl, Personnel, and Storage.21 Thestorage divisions were usually composed of Inventory, Storekeeping, and Laborand Equipment Pool Branches, and required the largest number of military andcivilian supervisors because of the variety of functions for which they wereresponsible. Receiving and inspection were the first duties of the StorageDivision. Inspection extended to quantity, condition, and packaging, but not toactual testing for conformity to specifications of drugs, chemicals, andbiologicals. This latter function was performed by the Army Medical PurchasingOffice and the U.S. Food and Drug Administration.
Movement of supplies within the individual depots was oftenseverely handicapped by poor elevators. The construction of single floorwarehouses by the Army helped solve this problem.
Before the war, medical supplies were stored, to a greatextent, in "item sequence"-that is, all quantities of each item werestored in one place and, so far as practicable, all item numbers were storedadjacently and in sequence. The huge procurement program of 1942-43 forcedexpansion in depots, and item sequence storage could be maintained only bybuilding bigger warehouses and rewarehousing. Because of this complication, mostdepots which were activated in 1941 and 1942 never employed the item sequencemethod, and those which antedated the war were compelled to abandon this method.Under the new system, the location of each medical item was determined by theamount of storage space it required, appropriate storage conditions (such asload limits on floors), and the speed with which the item was used orrequisitioned. The experience of the Toledo Medical Depot suggested thatfast-moving items, such as beds and mattresses, should be stored on the firstfloor. Slower-moving items and bulky hospital equipment and supplies should beplaced on the top floors, while surgical dressings, instruments, laboratoryequipment, dental equipment, and X-ray equipment should be stored near thepacking room.22
20(1) See footnotes 16(1), p. 127; and 18(2), p. 128. (2) Hangen, Herman C.: Key Depot System, in Program of Port and Assembly Depot Conference, SGO, 22 Jan. 1943.
21History and Procedure Manual, Toledo Medical Depot, 1941-1945. [Official record.] Some of the larger depots (for example, the St. Louis Medical Depot) established additional divisions.
22See footnote 21, above.
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When the item sequence method of storage was abandoned, orwhen a new depot was established which did not employ it, a card locator systemwas absolutely essential. At first, in most depots, the cards for all items wereassembled at one place, so that through an examination of the cards in onecentralized unit, the selectors could determine the location of the stock onevery floor of all warehouses. In the early summer of 1944, a decentralizedstock locator system was established in all depots, remaining in effect untilthe end of the war. This system established a small locator unit on eachwarehouse floor. A locator card for each item stored on that floor showed: (1)the location, (2) number of original packages, (3) number of units in eachoriginal package, and (4) the condition of the packing. This new methodincreased the efficiency of the stock selectors and, at the same time, providedsufficient information for depot stock records.23
Need for Periodic Inventories
In October 1942, the Surgeon General's Office directed themedical depots to make a physical inventory of all stock in storage and toreconcile the balances on the stock records with the actual physical count. Inaddition, this directive required that each accountable item be inventoried atleast every 6 months. Thus originated the "cycle inventory," whichcontinued throughout the war and which acted as a continuous corrective ofthe stock records. A Cycle Inventory Branch was established in each depot, andan inventory schedule was developed which made possible the count of each itemevery 6 months. Additional inventories were made upon special requests. Theseregular and special inventories provided valuable information for both thestorage and stock control officers.
At the same time, a simplified inventory adjustment proceduregiving greater latitude to post, camp, and station commanders was substitutedfor the rigid property accountability of the peacetime army.24
Another matter, more directly connected with storagefunctions of depots, was the layout of storage areas in the warehouses. Allfloors were divided into sections and designated by letter of the alphabet. Manyfactors, such as local conditions, floor space, and volume of supplies,determined the size of the sections. These sections, in turn divided into baysby supporting columns, were numbered consecutively. The number of aisles variedand the height to which supplies were stacked depended upon the load limit ofthe floor, the location of the sprinkler system, and the type of suppliesstored.
Use of Materials-Handling Equipment
When the heavy procurement program of 1942 and 1943 began tofill the depots with unprecedented quantities of supplies and equipment, theincreased
23(1) History of the St. Louis Medical Depot, 7 Dec. 1943-7 Dec. 1944. [Official record.] (2) See footnote 21, p. 130.
24(1) See footnote 23, above. (2) War Department Circular No. 101, 12 Apr. 1943, Section IV: Simplified Inventory Adjustment Procedure (AR 35-6640).
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workload rendered materials-handling equipment necessary, andthe abundance of funds made its acquisition possible. Forklift trucks, tractors,and trailers became standard equipment in the depots for moving and storingnearly all supplies. The widespread use of this equipment was rendered morepracticable by the adoption of a simple but ingenious aid-the wooden pallet.Supplies were unloaded on pallets at the receiving platforms and were then movedby trailers or forklift trucks to the inspection area. Still remaining on thepallets, the supplies were tallied-in, inspected, and conveyed to the storagearea, where they were stacked by forklift trucks. Under the new system, the forkof the forklift trucks was inserted into the pallet, and a large number oforiginal boxes were thus moved and stacked by a single operation. Stacks in thewarehouses could be erected to greater heights, with a consequent saving ofspace, because the pallets provided both secure platforms upon which to storethe supplies and open spaces for free circulation of air. After supplies wereunloaded from freight cars and placed on pallets, they received no more manualhandling until they were withdrawn for shipment (fig. 30).25
Work Measurement System
During the last 18 months of the war, another factor madeimportant contributions to the efficient operation of the Medical Departmentdepot. Early in 1944, a "work measurement system" was installed, whichinvolved a close study of each piece of work performed in a depot. Records weremaintained on the methods employed in performing each task and on the amount oftime and personnel required. By comparing records of the various depots,supervising officers of the Surgeon General's Office could discover weak spotsin the operation of a depot and could point out, with great particularity, thespecific tasks which were being inefficiently performed. Better methods whichhad been devised and adopted by other depots could be introduced wherever theywere needed, with a consequent saving in time, personnel, and materials. Atregular intervals, the records of the work measurement system were brought tothe attention of all depots, so that each could determine its efficiency incomparison with the others. This produced a spirit of competition and rivalryamong the depots which still further increased their efficiency.26
DISTRIBUTION OF MEDICAL SUPPLIES TO ZONE OF INTERIORINSTALLATIONS
The nature of the war which the United States entered in 1941made it clear that in the Zone of Interior there would be two major requirementsfor large quantities of medical supplies. One concerned the training of morethan
25The extent to which materials-handling equipment was used is indicated by the fact that at the St. Louis Medical Depot, the number of forklift trucks increased from 7 in 1942 to 29 in 1943 and to 40 in 1944. Pallets, which were not used in 1942, increased to 23,390 in 1943 and to 51,250 in 1944. See History of the St. Louis Medical Depot, 1941-1944. [Official record.] See also footnote 21, p. 130.
26See footnote 17(2), p. 128.
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FIGURE 30.-Use of pallets in warehouses.
10 million men and women of the Army. The great variety ofmedical care and the large number of troops involved made inevitable the needfor immense quantities of supplies. The second requirement was the provision ofsupplies for the named general hospitals, which provided definitive treatmentfor all American soldiers and especially for those evacuated from theaters ofoperations. These general hospitals were the fifth and final echelon of medicalsupport; and, as such, they required the most elaborate equipment and a steadystream of supplies.
On each major Army installation, a medical supply officer wasresponsible for receipt, storage, and issue of all medical supplies. Thisofficer sent periodic requisitions to his distribution depot, stored thesupplies as they arrived, and filled the requisitions of the station hospitals,dispensaries, and other medical units on the post. Before January 1942, allrequisitions from posts, camps, and hospitals were first edited by the corpsarea surgeons, who compared the requisitions with appropriate allowance tablesand stock levels. If supplies in excess of the allowances were requisitioned orif nonstandard medical equipment was required, the corps area surgeon obtainedthe approval of The Sur-
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geon General before forwarding the requisition to thedistribution depot. The final step in this supply chain was the medical depotwhich handled the inspection, storage, and distribution by requisition ofmedical supplies to the training camps and general hospitals.
Use of Medical Unit Assemblies
Large quantities of medical supplies were issued in the form ofunit assemblies. All the supplies and equipment needed to establish a medicalunit (whether a 50-bed station hospital or a 1,000-bed general hospital) wereassembled, packed together, and clearly labeled. When supplies for a particularmedical unit were requisitioned, the depot simply added the deteriorating itemsand shipped a unit which had been previously assembled and packed. Althoughthere were unanticipated difficulties, the advantages of the unit assembly as avehicle for issuing supplies were so pronounced that it continued to be usedthroughout World War II. The assemblies were especially valuable in theactivation of station hospitals in Zone of Interior posts. As new training campssprang up all over the country, station hospitals opened rapidly. Many hospitalswere commanded and manned by Reserve officers and Army of the United Statesofficers who were unacquainted with tables of equipment and could not anticipatetheir supply needs. Time was saved and efficiency was advanced by the systemwhich made it possible for them to requisition a station hospital, a regimentaldispensary, or any other appropriate unit. When the depot system expanded withmobilization, the St. Louis Medical Depot, commanded by Col. Royal K. Stacey,MC, was responsible for construction of assemblies; and until 1943, this depotdevoted a large part of its space and personnel to the assembly program.Assembly depots were also located at Toledo (hospitals); Atlanta (hospitals);Kansas City (kits and chests); and Columbus (civilian aid program).27
In the construction of a hospital assembly, much"paperwork" was required. The basic equipment list, of the items andthe quantities of each to be included in the assembly, was reproduced on punchedcards in the electrical accounting machine section, and then run through themachine to determine if sufficient stock was on hand to construct the assembly.In 1941-42, while the procurement program was getting underway, stock wasextremely short. Consequently, the first "run" of the cards usuallyaccounted for only 60 to 70 percent of the items needed. When speed wasessential, the assemblies were shipped incomplete, and the receiving agencieswere authorized to requisition the missing items at a later time. During thisearly period, the shortage of "housekeeping" items created anespecially difficult problem in Zone of Interior medical installations.28
27(1) History of the St. Louis Medical Depot, 7 Dec. 1941-7 Dec. 1942. (2) See footnote 16(2), p. 127.
28Memorandum, Lt. Col. R. L. Black, MSC, to The Historical Division, SGO, 16 Nov. 1944, subject: Supply Depot Historical Highlights.
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Many medical items were in chronically short supply untilsummer 1943, necessitating back orders and extracts to other depots. The delaysthus occasioned in constructing the assemblies still further aggravated thescarcities; supplies available when the first accounting machine run was madewere obligated and, consequently, could not be used for any other purpose. Theresult was that, for periods as long as 6 months, scarce supplies lay unused inthe depots, because they were being held to build assemblies. Requisitions toother services were necessary, and these requisitions also frequently resultedin an almost interminable process of back orders and extracts. For example, theMedical Department was dependent upon other technical services for procurementof web equipment, electric motors, mattresses, and other nonmedical supplies.Sometimes, the supplies were not placed in procurement until shortages wererevealed by the effort to build a unit assembly. Even after the supplies wereprocured and shipped by the other services, there still remained the problem ofcombining them with the medical items in the assemblies. If the assembly was tobe shipped complete, this process was accomplished at the medical depot; butfrequently, to save time and to prevent crosshauling, the"marrying-up" process was performed at the Zone of Interiorinstallation which received the assembly or at the port of embarkation to whichit was shipped.29 Assemblies wereheld for weeks and sometimes months, awaiting the arrival of missing items, andmany units were shipped incomplete. The mere process of packing and storinghospital assemblies, pending requisitions for them, also resulted inimmobilizing large quantities of critically needed medical supplies.
Another problem arose when basic equipment lists were changedor when packing instructions were altered after an assembly was packed, labeled,and stored. Such changes made it necessary that depot personnel remove theassembly for storage, make the indicated alterations, and repack it-work whichinvolved large quantities of packing supplies and many hours of labor. Somedepots tried to solve this problem by building only a limited number ofassemblies, which were held for emergency requisitions, and by maintaining asufficient quantity of stock to build any additional assemblies that might berequired. When medical supplies became comparatively plentiful, this solutionwas quite practicable, for a large assembly could be constructed within 2 weeks.30
While the assembly concept had definite advantages, executionof the concept caused many serious problems for the Medical Supply Serviceduring World War II. Tremendous major assembly requirements were relativelypredictable, unlike those for minor assemblies. The lateral transfer of kits andchests among units was necessary because of volume, movement, and changes inpriority of tactical units; this made it impossible to determine total assets asthey pertained to material in the hands of troops. Major assemblies when issuedwere more stable and controllable, but had an irrepressible tendency to
29See footnote 27(1), p.134.
30See footnote 21, p. 130.
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FIGURE 31.-Hospital assembly, ready foroverseas shipment.
fly apart in transit because of their size. For example,complete table-of-organization equipment for a 1,000-bed general hospitalcomprised one assembly of more than 3,000 items. It weighed over 600,000 poundsand required approximately 20 freight cars for shipment. When one of theseassemblies was shipped to a Zone of Interior hospital, it was relativelyunimportant if the 20 freight cars arrived at different days provided the lastone arrived on time. For an assembly destined for use in a general hospitaloverseas, the situation was entirely different. If the whole assembly did notarrive as a unit, the port was faced with the almost impossible job ofreassembling it (fig. 31).
Regular and Emergency Requisitions
The building and shipment of hospital assemblies was only onemethod by which medical supplies were distributed to Zone of Interiorinstallations. The other, and more important, method of accomplishing the taskwas the filling of regular and emergency requisitions initiated by the medicalsupply officers.
After Pearl Harbor, speed became more essential. In February1942, the medical supply officers began to send their requisitions directly tothe distribution depot, which was empowered to approve all requisitions exceptfor controlled items and quantities in excess of authorized allowances. Anyrequisition on which the depot lacked authority to approve and fill wasforwarded to the Supply Service for a final decision.
These forwarded requisitions called for quantities in excessof allowance, for nonstandard supplies, or for unauthorized equipment. As thewar progressed, the number of requisitions forwarded for the approval of theSurgeon
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General's Office steadily mounted; before the conflictended, disposition of these requisitions became the most time-consuming duty ofthe Issue Division, Supply Service. This work grew in volume, despite the manyefforts to decentralize, so far as possible, all phases of the distributionprocess. It was quite necessary, however, for the Surgeon General's Office toexert firm supervision over the issue of controlled items and quantities ofsupplies in excess of authorized allowances, for only in this manner couldprocurement and distribution be coordinated.
The depots' work in the distribution of medical suppliesmay be divided into three parts: receiving and editing the requisition;accomplishing the preliminary paperwork; and selecting, packing, and shippingthe supplies. The editing process determined that the items were properlyidentified, were authorized for the station which had requisitioned them, andwere not requested in quantities exceeding allowances. International BusinessMachines were used to ascertain if the items were in stock, to obligate thestock, and to print shipping tickets. The tickets were transmitted to the issueroom, the stock was withdrawn by the selectors, and the items were packed andmade ready for shipment. After "tally-outs" and inspection, the paperswere transmitted to the transportation department and the supplies were shipped.31
The unpreparedness of industry, the production timelag, thescarcity of certain raw materials, and the administrative friction of a greatbuying machine all contributed to delays in placing orders and to delays in themanufacture of medical supplies and their shipment to depots. The simple resultwas the inability of the depots to fill many of the requisitions they received.When stock was not available, but was due in from procurement, the requisitionwas placed on "back order," a procedure which obligated thesoon-to-be-received supplies to the filling of these requisitions. The number ofitems on back order, therefore, is some indication of the extent of shortages.In May 1942, on back order at the St. Louis depot were approximately 3,700medical items, the most important of which were sterilizers, rubber goods,generators, anesthesia apparatus, litters, and X-ray machines. This large numberof back orders was gradually reduced, but it is significant that, as late as May1945, a total of 1,250 items were on back order at this depot.32
In the emergency and early war period, a depot unable to filla requisition for urgently needed supplies extracted the requisition to theSurgeon General's Office. After consulting the consolidated stock report,supply officers in Washington, D. C., sent the requisition to the depot whichhad a supply of the required items. The system broke down when shortages of manyitems became nationwide. The consolidated stock report, moreover, was not anaccurate record of stock location during most of 1942 and the early months of1943. So many requisitions were received and filled after the depots'"cutoff date" and before the stock report could be compiled that thereport was out of date,
31See footnote 27(1), p. 134.
32(1) History of the St. Louis Medical Depot, 7 Dec. 1942-7 Dec. 1943. (2) See footnote 27(1), p. 134. (3) History of the St. Louis Medical Depot, 7 Dec. 1944-8 May 1945.
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for many items, on the day it was printed. The practice ofextracting requisitions from one depot to Washington and thence to another depotnevertheless continued unchanged throughout 1942, with most unhappy results forthe posts needing the supplies. Extracts of requisitions moved futilely from onedepot to another, via Washington, to a third, fourth, or even a fifth depot.
Before the procurement program could be expected to make upall deficiencies, partial remedies were developed. The most outstanding andsuccessful of these remedies was the establishment of the key depot system latein 1942. The distribution depots were "keyed" to receive, store, andissue certain classes of items in short supply. When a depot received arequisition for key items which were not assigned to it, an extract wasforwarded to the key depot which stocked the items. Important advantagesresulted from this system. During the first 6 months of 1943, the time requiredto process requisitions through depots was reduced by 50 percent. Many man-hourswere saved by the elimination of fruitless extracts, and the small stocks ofscarce items were less dispersed and their issue more strictly controlled.33
Central Stock Control
The establishment of a more efficient central stock controlsystem produced distinct improvements in the distribution of medical supplies.The installation of electric accounting machines in the depots and in theSurgeon General's Office in 1941 was followed by the establishment of a newsystem of stock records, which by 1943 was in successful operation. Under thissystem, each depot submitted periodic reports to the central stock controlpoint, located at first in Washington and later in New York. The principalinformation carried on these cards, for each item of medical supply, was thequantity on hand, quantity on back order, quantity due in from procurement andtransfers, and the quantity issued. The central stock control point sorted thepunched cards and printed periodic stock reports, which showed the informationof each depot and a total for all depots.
The preparation of a consolidated report a few days after thecutoff date made possible an efficient system of centralized stock control.Using the consolidated stock report, the Surgeon General's Office controlledprocurement and distribution which was impossible in peacetime. It becamepracticable to compute short-term procurement requirements and to directshipments from manufacturers to the proper depots. More important fordistribution, the central stock control point was able to transfer stock betweendepots and to send requisitions or extracts to the depots which had the neededstock.34
The technique of ordering medical supplies was also changedin the interest of conservation. Throughout 1942, medical supply officers oftraining camps and general hospitals submitted to their distribution depotsthree types of requisitions: Semiannual, quarterly (for deteriorating items),and emergency
33See footnote 16(2), p. 127.
34Material submitted informally by Col. S. B. Hays, MC, Supply Service, 13 May 1946.
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requisitions. Shortly after the attack on Pearl Harbor,special requisitions were added, differing from the emergency type in that theywere produced by the activation and expansion of training camps, and thus wereintended to fill urgent needs which could be anticipated. In January 1943, athoroughgoing change was made. From that date, all requisitions were submittedmonthly and were divided into three new categories according to the type ofsupplies required: standard expendable supplies, standard nonexpendablesupplies, and nonstandard supplies. In addition, a staggered schedule wasarranged by each distribution depot, so that the flow of requisitions from theposts would be evenly spaced over all the days of the month. This was apronounced improvement over the system which it succeeded. Serious shortages ofmedical supplies had been aggravated by allowing the posts to hold a quantitysufficient for 6 months. The institution of monthly requisitions was an attemptto get the greatest use possible from the insufficient supplies then available.35
Although this change in requisitioning procedure producedgood results, it was soon obvious that more heroic measures were necessary. Asthe number of training camps and general hospitals increased during 1942-43, thequantity of medical supplies held in storage at these posts proportionatelyincreased. And as shortages became more acute, medical supply officers weretempted to hoard against possible future needs. Even under normal circumstances,a large quantity of medical supplies were, from necessity, unavailable forimmediate use. The distribution "pipeline" remained full, and aconsiderable quantity was in storage. This meant, specifically, that largeamounts of medical supplies were always in transit and that another quantityremained in storage at the factory, medical depot, and the warehouses of thepost. It became essential, therefore, to reduce these idle supplies to thesmallest amount commensurate with efficient operations. Immediate shipment bythe manufacturer, elimination of delays in transit, and speedy filling ofrequisitions submitted to depots offered a partial solution to the problem.
These factors made a tight stock control system absolutelyessential to accomplish a fair and economical distribution of medical supplies.For many years, the control of stocks at posts and general hospitals had beeninadequately administered. Hospitals were allowed to carry a year's stock ofnon-deteriorating items and a 6-month supply of deteriorating items. Inaddition, no accurate due-in records were kept. As hospitals grew in number andsize and as requisitions were submitted with increasing frequency, it becameimpossible for supply officers to maintain an accurate knowledge of what was onorder. In the fall of 1942, therefore, the Surgeon General's Office devised anew stock record card for posts and general hospitals which showed a stock levelfor each item, receipts, issues, transfers, stock on hand, and stock due in. Thestock level, as originally established, was sufficient to care for a post'sneeds for 60 days, calculated from actual issues made during the previous 90-dayperiod. In the spring of 1944, when the demand for supplies in theaters
35See footnotes 18(2), p. 128; and 27(1), p. 134.
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of operations had mounted to unanticipated heights, the levelof stock authorized for posts was reduced to a 45-day period. The stock levelfor nonexpendable Medical Department items was reduced to the actual amount ofthe items on memorandum receipt at the posts, plus the necessary quantity onhand for the replacement of damaged or wornout equipment. At the same time, theMedical Department depots were authorized to maintain a stock level of only 90days of anticipated issues. In September 1944, the stock level of depots wasreduced to 60 days. This resulted in such a serious increase in out-of-stockitems that, in February 1945, medical depots were authorized to return to the90-day level for expendable items.36
Hoarding in Zone of Interior Installations
Post medical supply officers were expected to abide byauthorized stock levels, to requisition no more than they needed, and to returnto the distribution depot any excesses that developed. Each month, theysubmitted, to the distribution depot, reports which were supposed to reveal anyexcess supplies on hand. However, the experience of 1942 indicated ratherclearly that stock levels must be policed by the distribution depot.Accordingly, in 1943, liaison sections were established in medical depots andstaffed with personnel trained in stock control procedures. These liaisonofficers made quarterly visits to posts and general hospitals, examined thestocks on hand, and declared excess all supplies above the authorized levels.These excess supplies were returned to the distribution depot. At many trainingcamps, the liaison officers discovered tremendous excesses in many items.
By summer 1944, liaison officers had reduced the more easilydiscovered excesses to such a point that their operations became routine innature. Time was available, also, for the officers to discuss and offersuggestions on major supply problems which troubled post medical supplyofficers. During this period, moreover, substandard and obsolete surgicalinstruments were removed from the posts, and the inspection of these instrumentsbecame a duty of the liaison officers.37
These efforts to police stock levels were not altogethersuccessful. Medical supply officers of training camps and general hospitalsnaturally considered that their primary job was to maintain sufficient suppliesfor their installations. If the medical supply officer hoarded his excesses, hisimmediate superiors were not inclined to censure him. But, if he promptlyreturned all excess stocks and then, at a later period, was unable to supply theneeds of his units, his reputation as a prudent and foresighted supply officerwould suffer. In fact, a division of power and responsibility, and a divergenceof interests between the service commands and the Medical Department depotsystem
36(1) See footnotes 16(2), p. 127; 27(1), p. 134; and 34, p. 138. (2) Annual Report, Station Section, Issue Branch, Distribution and Requirements Division, Supply Service, OTSG, fiscal year 1944. (3) Notes on Supply Service Staff Meeting, 14 Dec. 1944. (4) Annual Report, Stock Control Division, Supply Service, fiscal year 1945.
37See footnote 23(1), p. 131.
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made it difficult to police the stock levels. These twoauthorities, it is true, were subject to the same overall command in the ASFHeadquarters; but the actual work of stock control was not done at this highlevel. It was done in the field, where divided responsibilities and clashinginterests were most evident.38
From the viewpoint of post medical supply officers, somecircumstances justified exceeding authorized stock levels. These levels, it willbe recalled, were based upon previous consumption. Yet, when there had been nostocks of certain scarce items for many months, there was no issue experienceupon which a stock level could be based. In many other instances, previousissues had been small because the stock was chronically low. The real need foran item, therefore, was not always indicated by the authorized stock level.Delays in the filling of requisitions created shortages at the posts and(because these shortages reduced issues) led to lower authorized levels in thefuture. In addition, some medical supply officers wished to retain excesssupplies for they had good reason to believe that the patient census of theirhospitals would soon increase. The service command surgeons were unwilling todeclare any supplies as surplus for they feared a large influx of patients wouldresult from the bitter fighting then in progress in Germany. These fears werewell founded. In the late winter of 1944 and the early spring of 1945, Zone ofInterior hospitals became crowded with overseas casualties.39
It became clear, during the last year of the war, that largequantities of excess supplies had been issued to, and were being held by,hospital pharmacies, operating rooms, and dental clinics. No surpluses appearedon the books of the medical supply officers or in the warehouses; for allpractical purposes, the excesses were hidden away in the using installations. InJanuary and February 1945, approximately 1,250,000 artificial teeth wererecovered from dental clinics-a windfall which, together with quantitiesalready on hand, was estimated to be sufficient for all needs during 1945 and1946 and made possible the cancellation of several procurement contracts. In asurvey of general hospitals by the chief of the Issue Division, Supply Service,excessively large quantities of quinine and dental burs were discovered andreturned to distribution depots. In the summer of 1945, when medicalinstallations began to close all over the country, even larger excesses wereunearthed. In one general hospital an entire year's supply of Pentothal sodium(thiopental sodium) was located in the surgical service. Quite obviously,therefore, this type of hoarding not only created scarcities in less fortunatehospitals, but also led the Medical Department to purchase great quantities ofunneeded supplies. Procure-
38During October and November 1944, when heavy fighting in Europe caused shortages in the Zone of Interior, service command surgeons were taking action contradictory to Medical Department policies by holding on to medical supplies above authorized stock levels. At least a part of this was caused by failure of the Surgeon General's Office properly to inform the service command surgeons, some of whom were not familiar with Medical Department policies. See Notes on Supply Service Staff Meeting, 5 Dec. 1944.
39(1) Annual Report, Station Hospital, Laredo Army Air Field, Laredo, Tex., 1944. (2) Notes on Supply Service Staff Meeting, 28 Nov. 1944. (3) Notes on Supply Service Staff Meeting, 23 Feb. 1945.
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ment was based upon issues, and purchasing officers were unable todistinguish between issues for hoarding and issues for use.40
To wipe out the scarcities caused by hoarding, inspectingofficers visited dental clinics, station hospitals, and general hospitals; butthis was a remedy which took effect only after the disease had caused muchdamage. A revision of the Stock Control Manual for Stations sought to preventthe evil by extending stock control to hospital pharmacies, dental clinics, andother using agencies.41 This, also, came too late for, by the timethese new orders were issued (May 1945), Germany had collapsed and the entireworld conflict was drawing to a close. Quite probably, many scarcities ofmedical supplies, which were so serious in 1942-43, were caused not by overallshortages, but by maldistribution of the quantities procured. And the largeexcesses recovered in 1944-45 clearly indicate that hoarding was partlyresponsible for this maldistribution.
From 1943 until the end of the war, an unremitting effort wasmade to operate medical depots more efficiently. Training programs foremployees, work measurement studies, improved methods of packing and labeling,and use of materials-handling equipment were only the most outstanding methodsemployed in the pursuit of efficiency. The results were closely connected withthe speedier distribution of medical supplies to training camps and generalhospitals. During 1942-43, many requisitions remained in the depots for 4 to 6weeks before they were filled; by the early summer of 1944, the usual periodrequired was 10 to 14 days. The increasing abundance of medical supplies duringthe third year of the war was very influential, but administrative improvementswithin the depots had a considerable share, in producing this result.42
Central Service System
In the station and general hospitals, a noteworthy economy inthe use of equipment was obtained through the establishment and operation of thecentral service system. During 1943, a number of hospitals inaugurated thissystem which centralized the storage, care, and issue of supplies and equipmentused in certain diagnostic and therapeutic procedures. These items werehighly specialized and could be used for any patient, but only as the occasiondemanded. Their constant presence in each ward was unnecessary and entailedthe expenditure of unreasonably large quantities of scarce medical equipment.The establishment of a central agency permitted a greater utilization ofavailable equipment and also assured better care and longer life to criticalmaterials. This innovation produced such good results during the latter partof 1943 that, early in the following year, a directive was issued, requiring allstation hospitals of 750 beds or larger and all named general hospitals to
40(1) Notes on Supply Service Staff Meeting, 6 Mar. 1945.(2) Address, Brig. Gen. Edward Reynolds to Medical Department officers assembledat Walter Reed General Hospital, 19 Sept. 1945, subject: Medical Supply Problemsof World War II. [Official record.]
41War Department Technical Manual (TM) 38-220, StockControl Manual for Stations, May 1945.
42See footnote 36(2), p. 140.
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establish the central service system.43 Obviously,the widespread adoption of this procedure relieved the shortages in essentialequipment and aided the Supply Service in solving its procurement anddistribution problems.
War Department Shipping Documents
Possibly the most extensive standardization in the supplysystem during the war was the War Department Shipping Document. First introducedon a trial basis in the summer of 1943, it became a permanent fixture in January1944.44 From the master copy, four variations were reproduced: order copy,property copy, overseas copy, and price copy.
The order copy was used by the consignor as a shipping orderto the Storage Division which prepared the freight for shipment; as a packinglist; as a basis for preparing bills of lading; as a basis for completing theproperty, overseas, and price copies of the shipping document; as a notice ofavailability to ports, when required; and, as a back order or extract form.Property copies were used by the consignor for domestic shipments to stations,depots, ports, holding and reconsignment points, and similar recipients; and, bythe consignee, to tally-in shipments and as a basis for the stock recordaccount. The overseas copies were used for shipments passing through water andaerial ports of embarkation and debarkation, holding and reconsignment points,and air in-transit depots. Price copies were used in instances wherereimbursement or pricing in terms of unit cost was involved, such as lend-leaseshipments.
The Army Service Forces extended the principles of the WarDepartment shipping document to procurement activities with the publication inMay 1944 of a vendor's shipping document-a combination form thatstandardized and simplified procedures for accepting, shipping, receiving, andinvoicing shipments from vendors. This document expedited supply action andsatisfied back orders before filling current requisitions with newly arrivedstock. Its uniformity also was an outstanding factor in its use. However, itsintrinsic value was never fully realized because the size of the unit assembledrequired a giant-sized shipping document to move it. The volume and length ofthe shipping document invited errors and misinterpretation, and much training ofdepot personnel in its use was necessary.45
DISTRIBUTION OF MEDICAL SUPPLIES TO THEATERS OF OPERATIONS
Responsibility for Distribution of Supplies
The responsibility of the Medical Department for distributionof its supplies to overseas commands was limited. The ports of embarkationthrough which the supplies moved and the vessels and aircraft which conveyedthem
43War Department Memorandum No. W40-44, 12 Apr. 1944,subject: Central Service System in Army Hospitals.
44Army Service Forces Manual M401, War Department ShippingDocument, 25 Jan. 1944.
45Army Service Forces Manual M410, Vendor's Shipping Document, 5 May 1944.
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abroad were not under the Medical Department'sjurisdiction. Once overseas, the supplies were transported, stored, and issuedunder the supervision of the theater commanders, who were completely independentof the technical services. Yet, in the first stages of overseas distribution,the Medical Department had important responsibilities, the discharge of whichplaced the supplies on board the ships and consigned them to usinginstallations.
The depot system was employed for both Zone of Interior andoverseas distribution. Port filler depots were the most important installationsfor the supply of overseas commands. Located at strategic spots some distancefrom the seaboard, these depots had, as one of their most important missions,the responsibility of receiving medical supplies of all classes, storing thesesupplies in warehouses, and shipping them to ports of embarkation. At Toledo andAtlanta, assembly depots packed the hospital assemblies, and shipped them to theports when needed. In addition, many depots of the Medical Department were keyedto receive and store certain scarce items; and to those depots, ports ofembarkation sent extracts of requisitions. Finally, holding and reconsignmentpoints, operated by the Transportation Corps, were used to hold completedhospital assemblies so that requisitions from ports could be speedily filled.Since these holding and reconsignment points were located close to the ports,the assemblies could be moved quickly to meet ship sailings on short notice.46
Ports of Embarkation
At the apex of this system stood the ports of embarkation,located at Boston, Mass., New York (fig. 32), Hampton Roads, Va.,Charleston, S. C., New Orleans, La., Los Angeles, Calif., San Francisco, andSeattle. Through these ports, troop units and replacements moved to overseasstations, carrying with them their initial allowances of supplies and equipment;and, through them, vast quantities of maintenance supplies were funneled to allfighting fronts. Administered at first by the Quartermaster Corps and during thegreater part of the war by the Transportation Corps, the ports of embarkationwere nonetheless important parts of the Medical Department's supply system.
Each port had a Medical Supply Division which was headed by aport medical supply officer. This officer was on the staff of the portcommander, functioning directly under him, and was the technical agent of TheSurgeon General in supply matters. The port medical supply officer's dutiesand responsibilities are difficult to describe for he was both a staff officerand an operating officer. His duties included advising the port commander onmatters pertaining to medical supply, maintaining shipment status reports,following up all requisitions scheduled for overseas shipment, checking onserviceability of equipment of all units moving through the port, and purchasingmedical supplies needed in emergency to supply outgoing forces. The port medicalsupply officer also maintained port stocks of deteriorating items by placingdelivery
46See footnote 16(2), p. 127.
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orders against open contracts, furnished medical equipmentand supplies to Army transports and hospital ships, furnished emergency suppliesto port terminals and staging areas, and exercised staff supervision overstock control in the separate commands of the port.47
Under the plan inaugurated in March 1942, each port ofembarkation supplied an assigned overseas area. For example, the New York port,with Lt. Col. Theodore M. Carow, MC, as medical supply officer, was responsiblefor supply in the European theater, the Mediterranean theater, and the Azores;the Boston port, of which Maj. William A. Bell, MAC, was medical supply officer,served U.S. garrisons in Greenland and Newfoundland; and the Seattle port, whosemedical supply officer was Maj. Joseph B. Kingsley, SnC, furnished supplies toAlaska and the Aleutian Islands. Close liaison was maintained between the portand its overseas area by survey trips, cable, and ordinary correspondence.
As overseas commands and combat areas developed and portactivities surged beyond capacity, supplies were moved from ports as rapidly aspossible. Additionally, because primary ports were not physically capable of
47(1) Memorandum, Brig. Gen. C. P. Gross, Chief ofTransportation Service, to Commanding General, New York Port of Embarkation, 2May 1942, subject: Port Medical Supply Officers. (2) Training Kit of the PortMedical Supply Division, New York Port of Embarkation, 22 July 1944.
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transshipping all supplies required by the larger and moreactive theaters, and for economy reasons, primary ports could direct that somecargo be loaded at other ports known as outports. Primary ports, however,retained the responsibility for control and timely delivery of material to theirdesignated consignees. In practice, a part of the port medical supply officer'smission was absorbed by the Oversea Supply Division of his port, which wasstaffed with representatives of all technical services and served as a clearinghouse and control center for overseas supply actions.
The port medical supply officer carried stocks of biologicals,antimalarial drugs, and other items needed to fill last minute shortages ofoutgoing troops, and emergency requisitions from overseas. To meet suchrequirements, it was often necessary to resort to local off-the-shelfprocurement. Port stockage was contrary to basic ASF policy and was a subject ofcontroversy between ASF and The Surgeon General's staff, but was condonedbecause of the urgency of the need. Early in 1945, the medical local procurementfunction was absorbed by a newly established Port Control Procurement Division.
Medical Maintenance Units
Shortly after the United States entered the War, the acuteneed for a uniform method of automatic supply of medical items to overseascommands became apparent. Directives of the War Department originating with theAssistant Chief of Staff, G-4, called for immediate action. As a result ofconcerted effort by Mr. Mead M. Messick, civilian consultant to the chief of theStorage and Distribution Division of the Surgeon General's Office, a medicalmaintenance unit was developed, which provided great quantities of medicalsupplies for U.S. soldiers in all parts of the world. Each unit consisted of 700to 900 medical items and was designed to supply 10,000 men for 30 days. Theentire unit weighed 15 tons, occupied 1,500 cubic feet of space, and was valuedat approximately $10,000.48 To each major troop unit stationed overseas,a number of medical maintenance units was shipped which was sufficient toprovide the prescribed level of supply. This level varied from time to timeduring the war, but it never fell below 60 days as a minimum nor rose above 180days as a maximum. As additional troop units moved overseas, they were providedwith the requisite number of maintenance units; and, after the arrival of thetroops, other units were shipped to maintain the level of supply.
Instructions governing the medical units made the portmedical supply officers responsible for insuring timely delivery. Thisincluded recommending to the Surgeon General's Office the number of such unitsto be placed to the port's credit in the designated filler depot. Originally,the port filler depots established credits upon which the ports of embarkationdrew whenever it became necessary to ship maintenance units overseas; but,beginning in 1943, they were shipped from port stocks. During a large part ofthe war, however,
48Letter, Lt. Col. S. B. Hays, MC, to Medical SupplyOfficer, New York Port of Embarkation, 19 Mar. 1942, subject: Medical MaintenanceUnit.
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the port medical supply officers were responsible forrequisitioning or shipping sufficient medical maintenance units to maintain thesupply in the overseas theaters at the prescribed level.
Supply officers in the Zone of Interior looked upon themedical maintenance unit as a temporary expedient, designed to provide medicalsupplies to overseas bases only until the bases accumulated the issue experienceto guide them in requisitioning the items needed. Before going on arequisitioning basis, each base was authorized to inform its port ofdeficiencies in the automatic supply system. It could, for example, request thatcertain items be deleted from subsequent shipments, that other items beadded, or that the prescribed quantities be reduced or increased. Thisflexibility, it was thought, would enable the port to adapt the maintenanceunits to the needs of the various troop units and would provide informationleading to revision of the standard medical maintenance unit. Numerous valuablesuggestions were indeed received, but some overseas supply officers were contentto take these units just as they were sent. They were inclined, moreover, toremain on this automatic basis of supply for protracted periods. The resultingimbalance was a natural one and could have been predicted by any supply officerfamiliar with the variety of conditions under which American soldiers lived andfought. For example, the quantities of quinine in the maintenance unit resultedin large surpluses in Alaska and in acute shortages in the South Pacific. Theconsumption of many other items varied from place to place, with the result thatenormous excesses were built up in some parts of the world while soldiers inother areas did not receive their minimum needs.
To overcome this problem, a Balanced Medical Depot Stocklisting was developed early in 1943. The new listing was formulated bysupplementing most items on the 1,000-bed general hospital list with anestimated 90 days' supply of all items not found in the 1,000-bed assembly,but included in other selected Medical Department standard unit assembly lists,plus 30 medical maintenance units. Certain items were added or deleted byprofessional personnel to conform to possible needs and to complement thepeculiarities of the geographic area.49
Final Reserve Units
American experience in the Bataan campaign seems to indicatethat troops should be provided with a quantity of medical supplies to be usedonly when they were besieged. To satisfy this presumed need, a Final Reserve Unitwas devised, which consisted of 200 highly necessary medical items in quantitiessufficient for 10,000 men for 30 days. This unit was approximately one-thirdthe size of the medical maintenance unit and had a monetary value of $5,000.Each overseas base was required to have on hand a 90-day supply of final reserveunits-three units for each 10,000 men-to be provided by the
49(1) See footnotes 16(2), p. 127; and 48, p. 146. (2)Freedman, Abraham: Overseas Supply, 22 Nov. 1944. [Official record.]
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port medical supply officer when the troops embarked.Deteriorating items were to be rotated, and each box in the unit was marked: FinalReserve-Medical Supplies-Not for Routine Use. When and if thesesupplies were consumed, the overseas base was expected to notify its port, sothat additional units could be shipped.50
Several factors tarnished the repute of this final reserve.Instructions governing its use were issued under a classification of Secret sothat, in many instances, the personnel actually receiving and handling thesupplies were never told how they were to be handled. This resulted inconsiderable confusion and disturbed the morale of the forces concerned.Keeping these supplies separate from other stocks, even though the items werethe same as those on hand, created a variety of problems in areas where mobilitywas of the essence and adequate storage facilities were scarce ornonexistent.
Transportation Problems
Requisitions were prepared by medical supply officers of thetheater surgeon's staff and were transmitted by radio, cable, or airmail tothe appropriate port of embarkation. Here, they were received by the OverseaSupply Division, and then submitted to the port medical supply officer forediting. All controlled items, all items in excess of allowances, and allnonstandard items were referred to the Distribution Division, ASF, for approval,the latter agency basing its decision upon information received from the SurgeonGeneral's Office. Early requisitions called for amounts far in excess of thoseauthorized by consumption tables because of the use of a projected troopstrength of which the ports were unaware. Later, theater troop strengths wereannounced in tables published by the Oversea Supply Divisions of the ports,and thus requisitions came to be submitted and edited on the same basis. Afterediting, the requisitions were returned to the Oversea Supply Division, whereextracts were prepared and sent to the appropriate port filler depot. The portmedical supply officer maintained close liaison with the port filler depot, toassure that the supplies were available within the convoy period for which theywere planned.
To get the supplies to the theater in the required time, aCargo Priority System was inaugurated in 1944. Upon request of the theater, theOversea Supply Division was authorized to apply priority 1 to any item on arequisition, priority 2 on any special requisition, or priority 3 to all otherrequisitions. The port medical supply officer was responsible for expeditingpriority 1 items into the port for loading as soon as possible. Priority 2items were given attention to insure shipment within the scheduled convoyperiod. Priority 3 items were not expedited, but were followed up routinely tosee that shipments were made. When the depot made a shipment to the port,advance copies of the War Department Shipping Document were sent for the use ofthe Port Transportation Division and the port medical supply officer. Uponreceipt
50See footnote 49, p. 147.
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of shipments at the port, tally-in copies of the shippingdocument were furnished to the port medical supply officer. And, when thesupplies were loaded aboard the ship, he received "floated" copies ofthe hatch tally. Thus, the port medical supply officer received and maintainedrecords on the progress made with each requisition, and was able to check on,and expedite the filling of, requisitions.51
Considerable delay and difficulty were caused by the failureof overseas commands to prepare and submit requisitions as authorized. Sometimesrequisitions for badly needed supplies were sent directly to the Surgeon General'sOffice. Instead of hastening the arrival of the supplies, this proceduredelayed them; such requisitions were routinely referred to the ports ofembarkation, to which they should have been addressed in the first instance.Frequently, the requisitions did not give sufficient information. Theseomissions occasioned serious delays in filling the requisitions for editingauthorities were compelled to query the theater and obtain the missing data.52
Equipping Tactical Units
In addition to providing for automatic supply and the filling of itemized requisitions, the Medical Department supply system had important responsibilities in equipping all tactical units of the Army with organizational equipment before overseas movement. In 1942, a Field Equipment Subdivision was established in the Finance and Supply Division of the Surgeon General's Office to discharge this duty. Tactical units customarily received their organizational equipment through the port medical supply officer, who drew upon his distribution depot. During most of the war, however, and because of shortages, this equipment could be supplied only through the aid of the Surgeon General's Office. Reports of shortages were transmitted to the Field Equipment Subdivision, which consulted stock reports from depots and ordered shipment of the needed equipment. So far as possible, during 1942-43, the tactical units were completely equipped at their home stations, and any remaining shortages were supplied by shipment to the port of embarkation from which the unit was scheduled to depart. Occasionally, units left for overseas stations before their equipment could be furnished; in such instances, the equipment was shipped to the port and followed the units overseas. These belated shipments became so numerous, and in so many instances never reached the troop unit to which they were directed, that in the spring of 1945 a new procedure was adopted. Thereafter, when the equipment could not reach the home station by the required date, the unit was so informed and the requisi-
51For full discussion of procedures employed in filling requisitions at the New York port, see footnote 49(2), p. 147.
52(1) The original source for this paragraph was "Charleston Port of Embarkation, Overseas Medical Supply," an official record used by Capt. Richard E. Yates, MAC, in preparing the first draft of this chapter. The document has since disappeared, but the practice of sending requisitions directly to the Surgeon General's Office is verified by (2) Circular Letter No. 36 [(Supply No. 6), OTSG, 5 Feb. 1943, subject: Overseas Supply], which officially terminates it.
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tions were canceled. The missing items were supplied fromport stocks or, if not available at the port, were issued at the overseasdestination.53
Priority System for Medical Supplies
In the meantime, the available organizational equipment wastoo limited in quantity to supply all units moving overseas in 1944. To equipthe units scheduled to participate in the European campaign, the Red Listprocedure was initiated in June of that year. It was stipulated that all unitson the list must be fully equipped before overseas movement and that the troopsand their equipment were to be combat loaded. This plan required specialprocedures by the Supply Service, the medical depots, and the units themselves.The units on the list were notified early of the pending movement so that localsupply officers could make a final effort to complete their equipment. Shortageswere promptly reported to the Surgeon General's Office, which issued toppriority requisitions to the depots. When time was not available for this directshipment, the equipment was sent to the holding and reconsignment point atElmira, N.Y., where shortages for each unit were segregated and assembled. Then,equipment was shipped to the proper port of embarkation and thus was availablewhen the troops arrived.
In the execution of Red List procedures, several problemsdeveloped. Frequent transfers of units within the Zone of Interior resultedin much cross-hauling, lost shipments, and duplicate shipments. Themisinterpretation of directives regarding equipment which should be sent to thehome station and that which should go to Elmira resulted in duplicate shipmentsand excesses at Elmira. At length, the holding and reconsignment point became soswamped with freight that it was impossible, within the time available, to sortand mark the equipment. This produced numerous shortages, especially in hospitalassemblies, that had to be filled from port stocks.
Despite these difficulties, the achievements produced by theRed List procedure were impressive. The list included 100 separate movementorders, directing the overseas movement of approximately 725,000 men and theirequipment. In discharging its supply responsibility, the Medical Departmentprovided the appropriate organizational equipment for 20 infantry divisions; 8armored divisions; 1 airborne division; 42 general hospitals; 14 fieldhospitals; 22 evacuation hospitals (400-bed); 1 evacuation hospital (750-bed);17 hospital trains; and 2 medical laboratories.54
Preshipment of Supplies
In 1943, large quantities of medical items were shipped tothe British Isles in anticipation of heavy troop movements to follow. Thispreshipment plan
53(1) See footnote 16(1), p. 127. (2) Memorandum, Maj. R.L. Parker, MAC, to The Historical Division (attention: Capt. R. E. Yates), 6Mar. 1946, subject: Supplementary Material on History of Supply Service NotPreviously Covered.
54(1) See footnote 53(2), above. (2) Annual Report, EquipmentBranch, Issue Division, Supply Service, OTSG, fiscal year 1945.
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was based on the knowledge that the excess shipping spacethen available would be transformed into a deficit when the movement of troopsreached its peak. The decision was made, therefore, to take advantage of theavailable shipping space and to build up a stock of medical equipment andsupplies which would partially support the large scale campaigns in prospect.
The first shipments under this plan, made in April 1943,contained specific organizational equipment for the troops plus 45 days ofmaintenance supplies. Units included in the preshipment plan returned theirorganizational equipment to local supply officers. All outstanding requisitionswere canceled, and any subsequent ones were returned without action. The troopscarried a minimum of essential equipment, referred to as TAT (To AccompanyTroops), including individual medical kits and Medical Department chests Nos. 1and 2. The kits proved to be readily available and very practical in providingmedical care en route, but the chests, packed in the hold of the ship, were notaccessible to the using organization during the entire trip.
Before the troops left their home stations, the SupplyService studied the appropriate tables of organization and equipment andcalculated the quantities which would be required for the units. Shipping ordersfor these quantities were then sent to the appropriate depots. All shipments ofthis equipment moved through the New York and Boston ports: 75 percent throughNew York and 25 percent through Boston. The packing cases were marked"ADV" to identify them as advance supplies and additional markings("SOXO" and "GLUE") represented the destination ports in theUnited Kingdom. Having arrived in the British Isles, the supplies were conveyedto a designated key depot and then were transported to a depot near the troopunit's permanent camp. Poor transportation facilities and pilfering caused thelast movement to be accompanied by considerable losses, and in March 1944,Medical Department units were authorized to move into the key depot and pick uptheir equipment with their own transportation.
The advantages of preshipment were numerous and important. Itallowed the shipment of supplies in bulk and eliminated the losses and damageexperienced when organizational equipment accompanied troops. It permitted thedistribution of critical items within the theater according to the tacticalpriority of units. And it made possible the modification of equipment in bulk.
There were, however, two distinct disadvantages to the plan.Throughout the period, troop lifts were subject to frequent amendments, makingit difficult for the Medical Department to plan its shipments. In addition,numerous changes in tables of organization and equipment lists were made afterthe publication of a troop lift and before the movement of troops. This causedunits to requisition new items before the items were available in the theater,and necessitated the cancellation of requisitions and the augmentation ofpreviously calculated requirements and shipments. This latter disadvantage veryprobably is inseparably connected with all supply operations in a lengthy war,
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and can be eliminated only by foregoing the advantages whichaccrue from the improvement of equipment lists.55
Shipment of Penicillin and Blood
Throughout the war, special procedures were adopted in theshipment of medical supplies whenever the tactical situation or the nature ofparticular supplies required a departure from routine operations. The bulk ofthe supplies, of course, moved through ports of embarkation and was conveyedoverseas by surface ships; but, from 1943 until the end of the war, twoimportant medical items-penicillin and whole blood-used facilities ofthe Air Transport Command for speedy distribution to theaters of operations. Airshipment was rendered necessary by the perishability of the items and by thepressing needs of overseas installations.
Routine air priorities were established, the commerciallaboratories which produced penicillin rushed the drug to aerial ports ofembarkation, and planes of the Air Transport Command carried increasingquantities of the item to American troops on all continents. Penicillin ceasedto be an allocated item in 1945, and the quantities shipped depended upon theexpressed needs of overseas commands. In addition, surface vessels began tocarry a portion of this cargo late in the war. Despite these changes, however,the distribution of penicillin was never characterized by the routine procedureswhich were used in shipping more stable and more plentiful medical supplies.56
Experience gained in the air shipment of penicillin proved tobe valuable in the distribution of whole blood, an even more perishable item.Fortunately, the need for whole blood, first demonstrated by the North Africancampaign, had been anticipated by the Supply Service and most essential items ofequipment had already been developed, such as anticoagulant solutions, donorsets, and recipient sets. The farflung service of the Red Cross, established toprocure donations for blood plasma, was available to furnish the type"O" whole blood which was needed at the battlefronts. Using thefacilities of the Air Transport Command, whole-blood shipments to Europe werestarted on 21 August 1944, within a few days after the request for them wasreceived by The Surgeon General.
In the beginning, the shipments were not refrigerated for it was assumed that the relatively high altitudes maintained by the planes would keep the blood sufficiently cool. The bottles were chilled before and after the blood was drawn; and, when ready for shipment, they were packed in cardboard boxes wrapped in heavy paper. It was discovered, however, that refrigeration of the blood en route was desirable. In the spring of 1945, the Technical Division of the Surgeon General's Office developed a special shipping container, which consisted of an insulated refrigerator holding a can of wet ice. The refrigerator weighed 35 pounds empty and 104 pounds when fully packed; it held 24 bot-
55See footnote 53(2), p. 150.
56See footnotes 36(2), p. 140; and 40(2), p. 142.
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tles of 600 cc. capacity, a can with 19 pounds of ice, and 24recipient sets. Temperature of the whole blood was maintained at less than 5?C. during 24 hours of summer weather. The plan for shipping blood to thePacific theaters was similar to the procedures established for Europe, exceptthat it was Navy-operated.57
Editing Requisitions
As the war progressed, the problems of overseas distributionwere rendered more acute by the excessively large requisitions transmitted tothe ports of embarkation. Supply officers in the theaters were authorized tomaintain levels of supply sufficient for a designated number of days. Thequantity of each item stocked depended upon the days of supply authorized, thenumber of troops in the theater, and the maintenance or replenishment rates. Itwas expected that the maintenance factor would be largely based upon issueexperience, but the uncertainties of war rendered it necessary that allowance bemade for unexpected and unprecedented needs which only the future could fullydisclose.
The elasticity of this maintenance factor producedrequisitions for excessively large quantities of medical supplies; and theserequisitions, in turn, created serious problems in the ports of embarkation andin the Surgeon General's Office. Requisitions for unusually large quantitieswere edited by these agencies, but there was a disposition to be lenient in theediting and thus allow the theaters to have what they wanted, so far as theavailability of the supplies and equipment permitted.58 As an inevitable result,inequities and maldistribution resulted.
By December 1944, Supply Service officers concluded that thepolicy of lenient editing must be abandoned. So many large requisitions had beenreceived recently from the Pacific that strict editing would be necessary ifother theaters were to have their minimum needs supplied.59 A large part of thisdifficulty apparently was caused by poor stock control procedures in thetheaters, the natural tendency to hoard, and by failure to base requisitionsupon issue experience. Continued use of medical maintenance units alsoperpetuated the basic error of automatic supply which produced some shortagesand great surpluses.
Extremely large requisitions from the European theater placeda burden upon ports of embarkation and medical depots. A 90-day stock level fordepots, based upon previous issues, was adopted on 1 July 1944. During the 3months which followed, the Medical Department learned that this stock level wasunequal to the huge quantities of medical supplies used in mechanized warfare.After beachheads were established on the Normandy coast and requisitions werereceived for direct shipment to the Continent, it became apparent
57Medical Department, United States Army. Blood PrograminWorld War II. Washington: U.S. Government Printing Office, 1964, pp. 206-215.
58Notes on Supply Service Staff Meeting, 13 Oct. 1944.
59Notes on Supply Service Staff Meeting, 22 Dec. 1944.
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that a quantity of many items sufficient to last 90 daysbefore the invasion was insufficient to meet a single overseas requisition.Stocks at Binghamton, the port filler depot which served New York, were soonexhausted; and extracts were rushed to the eastern and central depots in afrantic effort to fill the requisitions. Despite new procurement and heavyinterdepot transfers, the port filler depot continued to be burdened beyond itscapacity until V-E Day, in May 1945, brought relief.60
The foregoing experience clearly indicated the necessity foraccurate, up-to-date maintenance rates. In April 1945, a special board wasestablished by the Stock Control Division, Supply Service, to review maintenanceissue experience for the period 1 January 1944 to 31 March 1945, and to computemaintenance rates on the basis of that experience. Near the end of the war,therefore, the Medical Department developed and put into use maintenance rateswhich reflected its experience in preparing for combat, stockpiling in theaters,and actual expenditures of supplies and equipment under combat conditions.61
60See footnote 36(4), p. 140.
61See footnote 36(4), p.140.
