CHAPTER VI
Medical Supplies Under Lend-Lease
While it was furnishing medical supplies to U.S. Army troopsin all parts of the world, the Medical Department had the additionalresponsibility of providing for the supply needs of numerous countries activelywarring against the Axis or in a state of friendly neutrality. The Lend-LeaseAct, approved on 11 March 1941, granted authority to sell, exchange, lease, orlend supplies and equipment to any government whose defense the President deemedvital to the defense of the United States. Under this authority, medicalsupplies valued in excess of $140 million were distributed among more than 30nations. Although these supplies represented only three-tenths of one percent ofthe value of all lend-lease shipments, they constituted more than 15 percent ofthe total value of Medical Department procurement during the same period.1
Accepting War Department responsibility for theadministration of the Lend-Lease Act, the Secretary of War authorized theestablishment of a Defense Aid Division in the Office of the Under Secretary ofWar to coordinate War Department activities, to route requests for lend-leaseaid to technical committees for screening and recommendations, and to authorizeprocurement and transfer of the supplies and equipment.2The technical committees were known as Defense Aid Requirements committees,whose principal function was the determination of material requirements by type,quantity, and destination. Such committees were established late in April orearly in May for Ordnance, Chemical Warfare, Signal, Engineers, andQuartermaster Corps. The first medical supplies distributed under lend-leasewere procured by the Treasury, and so a Medical Defense Aid Requirementscommittee was not set up until June. On the level above the War Department,responsibility for administering the act was assigned to the newly-createdDivision of Defense Aid Reports, Office for Emergency Management, which wassuperseded in October 1941 by OLLA (Office of Lend-Lease Administration).3
To carry out the determinations of the Defense Aid MedicalRequirements Sub-Committee, a Defense Aid subsection, staffed by one officer andfour civilian employees, was established in the Finance and Supply Division, SGO(the Surgeon General's Office) to procure and transfer all medical suppliesfurnished by the War Department under lend-lease.4
1(1) House Document No. 41, 80th Congress, 1st Session, Twenty-Third Report [of the President] to Congress on Lend-Lease Operations, January 1947. (2) See appendix B, p. 569.
2Letter, The Adjutant General to the Chiefs of Arms and Services and the Divisions of the War Department General Staff, 10 Apr. 1941, subject: Procedure Under the Lend-Lease Act.
3(1) Executive Order No. 8751, 2 May 1941. (2) Executive Order No. 8926, 28 Oct. 1941.
4This subsection seems to have been established in July or August 1941. Before that time, the very small lend-lease operations required about 20 percent of the time of one officer. Memorandum, Lt. Col. F. C. Tyng, MC, to Budget Officer for the War Department, 15 July 1941.
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ROLE OF THE MEDICAL DEPARTMENT IN LEND-LEASE
The first implementation of the Lend-Lease Act by the MedicalDepartment involved the supply of 2,000 standard litters, as directed in amemorandum from the Secretary of War to The Surgeon General on 9 April 1941.These litters were transferred from regular depot stocks to the United Kingdomfor probable retransfer to Yugoslavia, and the cost was to be charged againstthe initial lend-lease appropriation. No further demands were made on theMedical Department until July 1941, when Chinese requisitions were received formedical supplies worth $1.2 million during construction of the Burma-YunnanRailway (fig. 33). At about the same time, the United Kingdom presentedrequisitions for field equipment valued at $950,000. These two requirements putthe Surgeon General's Office in "the Lend-Lease business."5
Development of Procedures
During this early period, storage and issue activities formedical lend-lease were conducted in depot space provided at Shamokin, Pa.,Voorheesville, N.Y., and Marietta, Pa. Between July and December 1942, suchactivities were centered in the Marietta depot. In the latter month, theSharonville Engineer Depot, Ohio, provided space for lend-lease operations. Thisinstallation was succeeded, in August 1943, by the Louisville Medical Depot,Louisville, Ky., which continued until the end of the war as the only depotengaged in international aid activities. The many preliminary activities were,of course, conducted by OLLA, by the Defense Air Division of the Office of theUnder Secretary of War, and by the Defense Aid Sub-Section, SGO.6
One difficulty, however, was soon apparent. Since a specificallotment of funds was made to cover each requisition, it was necessary to makenumerous suballotments within the Surgeon General's Office and to extendsuballotments to each participating procurement and receiving depot so that allcosts occurring with each requisition could be charged against the specificallotment. In addition, materials available in regular depot stocks could not beused and subsequently replaced, for the allotments contained a clause declaringthat "None of the funds herein allocated may be used to reimburseappropriations of the War Department for the value of materials on hand and usedfor work herein authorized * * *." It was necessary, also, to maintain theidentity of each requisition throughout all stages of procurement, storage, andtransfer. On procurement operations alone, this entailed placing as manycontracts for the same item as there were requisitions calling for that item.Thus, quantities of an item could not be "lumped" for the efficiencyand economy of bulk purchasing. In storage operations, this requirement made itnecessary that depot employees segregate, on the basis of requisitions, allsupplies received for defense
5(1) Memorandum, The Secretary of War to The Surgeon General, 9 Apr. 1941, subject: Transfer of Defense Articles to the United Kingdom (Lend-Lease Act). (2) Unless otherwise noted, the material in the remainder of this chapter is based on the following April 1946 report: Wilson, R. E.: History of Medical Department Lend-Lease Activities. [Official record.]
6(1) Annual Report, Finance and Supply Services, OTSG, 1942. (2) See appendix B, p. 569.
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aid. Aspirin tablets procured to alleviate headaches in theUnited Kingdom could not mingle with aspirin tablets purchased to achieve thesame end in Russia, lest funds allocated to relieve the suffering of an Englishsoldier should be accidentally diverted to the soothing of migraine beyond theVolga.
Another cumbersome feature of early operating procedure wasthe type of records it was necessary to establish and maintain, based upon thosefrom defense aid depots, to comply with accounting requirements and to preparethe 14 reports prescribed by the Office for Emergency Management. These reportsdealt with distribution of appropriations, allotments, and expenditures;analysis of expenditures; schedule of obligations; statement of defense articlestransferred; property, rights, and privileges received from foreign governments;and related matters. The authority requiring these reports, apparently, had notcontemplated or recognized the tremendous variety of medical items sooner orlater to become involved in lend-lease operations.
Although current information was compiled on InternationalBusiness Machines, preparation of the required reports became complex andtime-consuming as the volume of individual requisitions grew, and quantities ofindividual items became so large that it was necessary to place severalcontracts to procure the full quantity. Moreover, since a given item appeared onmany requisitions undergoing action simultaneously, extensive analysis wasrequired to supply information on total quantities of that item or groups ofrelated items involved in lend-lease activities at a stated time. To speed thecompilation of these reports, a supplementary record was established, thematerial for which was accumulated by item rather than by requisition. By fall1942, when it became possible to discontinue this record, approximately 12full-size file drawers of 12- by 16-inch cards had been accumulated.
Only two countries, the United Kingdom and China, receivedaid in the form of medical supplies during 1941, and the dollar value of thosetransferred was small, amounting to only $276,000.7
The entry of the United States into the war had no immediateeffect upon lend-lease operations, except that shipments were suspended briefly.This suspension lasted only 2 days for nonstandard items and 4 days for standarditems. The first few months of 1942 produced no major changes in procedure; but,as the volume of transfers increased, the methods used to present and establishrequirements were elaborated.
Wartime Changes
Lend-lease beneficiary governments, at the beginning of eachyear, submitted to the Defense Aid Sub-Division, SGO, through the InternationalDivision, ASF (Army Service Forces), estimates of total requirements for theforthcoming calendar year; and, from time to time, they filed specificallynumbered "spot requisitions" for requirements which were unforeseenand therefore not included in the yearly programs. Both types of requirements
7See appendix B, p. 569.
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were first subjected to a process of "coordination," which involvedthe identification of each item by reference to the Medical Supply catalog,International Aid nonstandard catalog, and other lists of medical supplies andequipment. After this coordination, the yearly programs were forwarded to theRequirements Division, SGO, for incorporation into the Army Supply Program.Although specific War Production Board clearance on the yearly programs was notrequired, representatives of that agency were frequently consulted for advice asto availability.
Spot requisitions were subjected to a detailed analysis uponreceipt to determine the cost, the delivery schedule, and the exact quantitiesof critical raw materials required. The Medical Sub-Committee of theInternational Supply Committee discussed the requisitions and made itsrecommendations to the parent committee. When a requisition was thus approved,the International Division, ASF, forwarded to the Medical Department theauthority to procure and transfer the medical supplies and equipment. Purchaseauthorizations were then prepared and sent to the appropriate procurementoffice, which made contracts for the required supplies. Deliveries from thecontractors were made to the defense aid depot and, there, were warehoused byrequisition numbers so that the identity of materials procured against eachrequisition could be maintained throughout the successive stages of procurement,storage, and issue. When all the material for a given requisition had beendelivered, or a sufficient portion thereof to warrant a shipment, the depotnotified the Surgeon General's Office, and, upon receipt of the shippinginstructions requested from the foreign government, the depot was directed toproceed with the shipment.8
During the spring of 1942, because of the increasing volumeand urgency of lend-lease requirements, efforts were begun to simplifyprocedures throughout the War Department. One notable result was a gradualliberalization of accounting requirements. The specific fund allocation, whichrequired the segregation of requisitions, was eliminated; in its place, MasterProcurement Authorities were substituted which were applicable to therequirements of all foreign governments approved at one time. Residues ofprevious fund allotments were converted into Undistributed Allocation Balanceand applied to new defense aid needs. Use of surplus Army stocks was permitted,and provision was made to reimburse War Department funds. In addition, theMedical Department was authorized to include lend-lease requirements in itsbudget estimates, thus permitting the economic and efficient lumping andscheduling of procurement.
As the year 1942 progressed, the Medical Department waspresented with spot requisitions involving large quantities of urgently neededsupplies, but it was receiving few long-range programs from foreign governmentson which to plan and procure against future needs. In the meantime, the BurmaRoad had fallen, and transport into the interior of China was at a virtualstandstill. As a result, supplies procured for the Chinese account were"backing up"
8In 1942, the International Supply Committee superseded the Defense Aid Requirements committees.
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in the defense aid depot to such an extent that warehousing by individualrequisitions became physically impossible. At this point, authority was obtainedto adopt more feasible methods of procedure.
In August 1942, the International Division, SGO, successor tothe Defense Aid Sub-Division, recommended to the International Division, ASF, anew procedure for lend-lease medical operations. The Medical Department desiredauthority to establish a large stockpile of miscellaneous medical supplies, uponwhich it could draw in filling the spot requisitions of foreign governments. Theproposal was approved in September 1942, and the procurement of approximately$60 million worth of medical supplies was promptly initiated. In compiling alist of materials for this stockpile, Medical Department officers were guided byrequisitions previously received from foreign governments and by qualifiedtechnical opinion as to what would be required in the future.9In addition to new procurement, all materials previously procured againstindividual requisitions, but not yet shipped, were consolidated and placed inthe unobligated stockpile, withdrawals from which were effected only byassignments receiving the approval of the Munitions Assignment Committee(Ground). This new procedure produced an important change in procurementprocedure. In the future, it became possible to accumulate requisitions and tonegotiate bulk contracts for the total quantities of all items needed. The newstockpile, moreover, introduced a large measure of flexibility into all MedicalDepartment supply operations, for numerous urgent and unforeseen needs of U.S.troops were met by drawing upon this accumulation of supplies.
MILITARY AND CIVILIAN LEND-LEASE REQUIREMENTS
As early as the fall of 1942, efforts were made to distinguishbetween civilian and military lend-lease requirements. From the inception of theprogram, all requests for medical supplies had been accepted for action by theWar Department and treated as military requirements, without regard to theeventual military or civilian use. This permitted the application of militarypriority ratings to the procurement of materials for civilian use abroad, whilecivilian needs in the United States received a much lower priority. Afterlengthy discussions between the War Department and OLLA, the latter issued anorder directing that, after 1 January 1943, the two types of requirements bedistinguished and treated separately. To implement this directive, theInternational Division, SGO, supplied figures on all unfilled requirements formedical supplies (except British requirements) and also reported stocks on handand quantities due in from outstanding contracts.
9One of the supply officers later declared that the list was based on "sheer guess as to what was likely to be called for in the future." Such uninhibited frankness in official reports is rare enough to merit serious and thoughtful consideration. In the present instance, however, it appears that an excess of candor has performed a disservice to truth. Possessing more than a year's experience in supplying the needs of foreign governments, defense aid officers could base their estimates on something far more substantial than guesses. See memorandum, Lt. Col. F. C. Little, MAC, Director, International Division, to Administrative Assistant to the Chief, Supply Service, 28 July 1945, subject: Request for Specific Instances of Surplus.
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In the meantime, the foreign governments filed all newrequirements for calendar year 1943 with OLLA, through the InternationalDivision, ASF, and all requirements thus filed were separated into civilian andmilitary categories. OLLA considered as 100 percent military all unfilled 1942requirements and the 1943 requirements for Russia, China, Latin Americannations, and the British forces in the field. Other British programs, assubmitted by various parts of the Empire, were divided on a percentage basis.All other requirements were classified as 100 percent civilian. Stocks on handand quantities due in from procurement were to be applied first against militaryrequirements, with the residues to be used to satisfy civilian requirements.This comprehensive statement of requirements and assets, known as the "OLLAControl Books," was finally presented to the International Division, SGO,in March 1943. A detailed review of these books revealed some 1943 programs hadnot been carefully screened and that quantities obviously designed for civilianuse were included as military requirements. In addition, procurementauthorizations, so frequently departed from programed requirements, wereforwarded at such sporadic intervals and were amended so often that, by summer1943, not more than 25 percent of that year's requirements for medicalsupplies had been placed under contract. Had it not been for the stockpileauthorized during the previous year, only a thin trickle of lend-lease medicalsupplies could have been shipped during 1943.
This unsatisfactory state of affairs provoked reneweddiscussions between the War Department and OLLA, and culminated in a newagreement, defining in detail the functions and responsibilities of the variouslend-lease agencies.10 In effect, OLLA waseliminated from the processing of military requirements. Its responsibility wasconfined to presenting civilian requirements and ordering shipment of thesupplies as they became available. The International Division, SGO, was toprocure military requirements and maintain any records needed to exercise thiscontrol. This change produced a distinct improvement, but important difficultiesstill remained. OLLA continued to issue procurement authorizations sporadicallyand, in some instances, for only a small part of the total civilian requirementsfor which approved programs had been received. The Inventory Control Branch hadto deduct lend-lease civilian requirements which came up in a "buyposition" under the automatic stock control procedures in effect. Thiscumbersome extra step was eliminated in November 1943, when the Surgeon General'sOffice received from the International Division, ASF, a "blanket"procurement authorization applicable to all programed civilian requirements notpreviously authorized for procurement.11
In the meantime, the OLLA Control Books had become obsolete,and a strong need was felt for a reliable and current record of total lend-leasere-
10Procedure for Handling Lend-Lease Medical Supplies, 11 Aug. 1943. [Official record.]
11Memorandum, Col. George Olmsted, GSC, Chief, Requirements and Assignment Branch, International Division, to Office of The Surgeon General (attention: Lt. Col. [Charles] Garside), OTSG, 23 Nov. 1943, subject: Lend-Lease Civilian Requirements for 1943 and 1944.
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quirements. Accordingly, all known requirements, includingspot requisitions and yearly programs, were submitted to the Machine RecordsBranch, SGO, for tabulation. The result was a consolidated listing by item,divided into 1943 and 1944 requirements, subdivided into military and civilianaccounts, and coded to indicate the unfilled requirements for each item by eachforeign government. This listing was then subjected to a comprehensive anddetailed review by OLLA, by the International Division, ASF, and by the BritishMinistry of Supply Mission to eliminate any unjustified requirements. By fall1943, the electric accounting machine listing had been thoroughly screened; and,with subsequent additions, it provided a reliable guide to lend-leaserequirements during the remainder of the war.
REORGANIZATION AND REALINEMENT OF RESPONSIBILITIES
During 1943, a general reorganization of the Supply Service, SGO,eliminated duplication of functions pertaining to lend-lease and realined theInternational Division in its relationship with other divisions and branches.
Procedure relating to lend-lease procurement was developed inMay 1943. Foreign government spot requisitions were received, analyzed, andprocessed by the Coordination and Analysis Branch, with assistance of theDistribution and Procurement Divisions. Availability of critical raw materialand the effect on the Army Supply Program were determined by the ProductionScheduling Branch of the Materiel Office, ASF. After coordination with theDistribution Division regarding the availability of surplus stock, purchaserequisitions were prepared by the Procurement Division, and issue requisitionswere prepared by the Distribution Division.
Electric accounting machines installed in the medicallend-lease depot eliminated the necessity for sending copies of receivingreports from the lend-lease depot to the International Division for maintainingstock records.
As the procurement districts assumed responsibility forcompiling statistics for the monthly progress reports, the InternationalDivision was able to eliminate processing of procurement authorizations to theMachine Records Section as well as copies of contracts.
Responsibility for preparation of fiscal reports (DDA Forms)was transferred to the Fiscal Division, and preparation of notices ofavailability pertaining to shipping instructions and maintaining liaison withforeign government shipping agencies were decentralized to the lend-lease depot.12
By fall 1943, the Supply Service had formulated and adopted anew system of inventory control which was extended to apply to all lend-leaserequirements. Under this routine, total lend-lease requirements for a 6-monthperiod were reflected in the monthly Delivery Needs report. Where indicated, the
12Supply Service Memorandum No. 30, 18 May 1943, subject: Procedure Relating to Lend-Lease Procurement.
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Inventory Control Branch initiated interdepot transfers intosegregated military and civilian stock accounts in the lend-lease medical depot.Also, new procurement was initiated in the event of an overall stock shortageagainst total requirements.
Efficient operation of this system apparently wasincompatible with OLLA's practice of issuing procurement authorizationssporadically and in some instances, for only partial quantities of totalprogramed requirements. For a time, therefore, the Inventory Control Branch hadto make special provision for the deduction of any lend-lease civilianrequirements which came up in a "buy" position under the otherwiseautomatic procedures in effect. Since lend-lease civilian requirements involvedthe entire range of items procured by the Medical Department, this cumbersomeextra step imposed a real burden on the International Division and on theprocurement offices because special procurement authorization had to beinitiated for the nonstandard civilian requirements.
The situation was corrected in part in December 1943, with a"blanket" procurement authorization applicable to all programedcivilian requirements not previously authorized for procurement. This blanketauthorization was issued by the International Division, ASF,13 uponauthorization in turn from FEA (Foreign Economic Administration), whichsuperseded OLLA in September 1943.
Two problems in civilian lend-lease procurement stillremained to be corrected. The first of these involved the fact that numerouscivilian requirements for items previously allocated under the bid system, anditems in short supply, had been authorized for procurement under the blanketauthorization which, as it developed, had never been cleared through the WarProduction Board. Thus, the Army Medical Purchasing Office often was unable toplace contracts for full quantities of certain items programed by FEA and, moreseriously, in some instances was criticized and held accountable by the WarProduction Board for exceeding War Department allocations. No satisfactorysolution to this problem was ever reached through discussion or agreement withFEA.
The second problem remaining to be corrected involvedaccountability for materials procured and delivered against requirementspresented, but subsequently canceled, by FEA. This occurred frequently andintroduced surpluses. Therefore, the "Procedure for Handling Lend-LeaseMedical Supplies," dated 11 August 1943, was amended on 29 March 1944.Following this amendment, an allotment of FEA funds to the War Department for$68.5 million was effected to cover the entire civilian lend-lease program.Funds were made available to The Surgeon General for reimbursement on shipmentsmade for the FEA account. Such other expenses or losses as might be incurred inthe handling of procurement, storage, and issue on their behalf, includingovershipments, were adjusted periodically against the allotment.
13See footnote 11, p. 161.
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These many changes and developments gradually formed anoperating procedure, within the framework of which the obligations of medicallend-lease could be discharged. By spring 1944, this procedure had been sodeveloped that only minor changes were made during the remainder of the war.
The first important duty of the Analysis Branch of theInternational Division, SGO, was the identification of items requested, theinsertion of proper nomenclature and stock number, and the recommendation ofsubstitutes. After this preliminary "screening," the lists werereturned to the foreign governments, which then submitted them to theInternational Division, ASF, as formal programs. Draft requisitions werereturned directly to the International Division, ASF, for submission as formalrequisitions.
Formal programs and requisitions were screened against"excesses chargeable to Lend-Lease governments" and, if appropriateexcesses were not found, were submitted to the Inventory Control Branch, SGO, todetermine which items would require new procurement. Items requiring procurementwere submitted to the Production Division, ASF, to ascertain the availability ofthe quantities requested and to provide for allocation if necessary. After totalcosts were computed and the quantities of controlled materials estimated, theprograms and requisitions were returned to the International Division, ASF, withrecommendations as to the procurability and suitability of the items requested.When approved by the International Division, ASF, the quantities were added tothe Army Supply Program and thus were authorized for purchase.
The final important duty of the Analysis Branch was themaintenance of the International Requirements Record. Compiled monthly by theMachine Records Branch, this record provided current information on grossrequirements approved within the calendar year, by item and country, togetherwith cumulative assignments made against these requirements. In addition, itshowed a net balance due and the stocks on hand in the lend-lease military andlend-lease civilian accounts. It furnished currently adjusted lend-leaserequirements to the Stock Control Division for inclusion in the ConsolidatedStock Report and the Army Supply Program; and it afforded a simplified means forrecording requested reductions in requirements.
The first duty of the Assignments Branch was registry ofrequisitions and programs to identify them in the process of assignment andshipment. An SGO shipping order number was given to each new requisition orprogram, and the number thus given became the permanent file reference for therequirement.
This branch also determined and presented bids for availablestock before the medical subcommittee of the Munitions Assignment Committee(Ground). A monthly military International Requirements Record was compiled,which showed the bids of each beneficiary government. At the subcommitteemeeting, these bids were routinely approved when stock was available to satisfyall claimants; but, when the supplies were inadequate to meet all unfilledrequire-
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ments, the subcommittee allocated the available stock on thebasis of urgency of need. A copy of the International Requirements Record wastransmitted to the Munitions Assignment Committee (Ground), which authorized thetransfer of the supplies to the foreign governments.
The Assignments Branch then prepared the necessary shippingorders, posted them to sequence records for permanent cross-reference, andtransmitted them to the appropriate depots for action. At every stage of theshipping process, the Assignments Branch received information on the shipmentsand maintained comprehensive records on them. It was possible, therefore, torespond to inquiries from beneficiary governments without frequent reference todepots and ports.
The foregoing procedure was confined to military lend-leaseshipments. The Medical Department had ceased to have any responsibility forcivilian lend-lease, except to act as a purchasing agent for FEA. Early in 1944,it became apparent that even this limited responsibility was interfering withduties which were more closely related to the winning of the war. The ForeignEconomic Administration had presented to the Medical Department a programinvolving the purchase of $66 million worth of medical supplies, which werepouring into the depots from contractors' plants with little likelihood thatthe bulk of it would move out before the end of the war. There was, moreover,reason to believe that relief requirements would grow with the passage of time,that they would continue beyond the war period and would burden the MilitaryEstablishment while it was undergoing demobilization. The War Departmentproposed, therefore, that all responsibility for the procurement, storage, andissue of medical supplies programed by FEA be transferred from The SurgeonGeneral to appropriate civilian agencies not later than 31 December 1944. Thegeneral terms of this proposal were promptly accepted by FEA, with reservationsas to the time limit, and representatives were named by the agencies involved toformulate plans for the transfer.14 Protracteddelays by FEA then ensued, which were finally ended in the fall of 1944. At thattime, the War Department forced the issue by announcing that additional civilianrequirements necessitating new procurement would not be accepted, and proposingto release one of its medical depots to FEA.
Negotiations were begun promptly, and basic agreements weresoon reached. Commencing on 15 October 1944, the shipment of all medicalsupplies programed by FEA for civilian rehabilitation would be called forwardthrough the Procurement Division, U.S. Treasury Department. Shipments to actualparticipants in the civilian lend-lease program would be handled, as in thepast, on FEA shipping orders. New civilian requirements of any type would bereferred to the Treasury Department for procurement although the War Departmentwould screen the requirements and would accept any portion
14(1) Letter, Maj. Gen. Lucius D. Clay, GSC, Director of Materiel, ASF, to the Hon. Leo [T.] Crowley, Foreign Economic Administration, 11 Mar. 1944. (2) Letter, Mr. Leo T. Crowley, Administrator, Foreign Economic Administration, to Maj. Gen. Lucius D. Clay, 23 Mar. 1944.
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that could be filled from excess stocks. The MedicalDepartment would release a suitable depot, complete with equipment and civilianoperating personnel, to the Treasury Department as operating agent for FEA.
PROBLEMS OF LEND-LEASE ADMINISTRATION
After extensive negotiations, the Toledo Medical Depot, Toledo,Ohio, was declared surplus and was transferred to the Treasury Department,effective on 1 May 1945.15 During the interimfrom November 1944 to May 1945, the Medical Department continued to operate thedepot, but Treasury Department representatives were assigned to participate inits administration, pending the actual transfer of accountability and title. Anextensive assembly program for civilian rehabilitation was continued at Toledountil the end of December 1944. Since the depot was to be transferred to theTreasury Department in May 1945, it became necessary to clear Medical Departmentstocks from the warehouse areas and to replace them with FEA stocks then in theLouisville Medical Depot. This transfer was first estimated to involve themovement of 1,200 to 1,500 carloads, but a "paper transfer" of stocksgreatly reduced the size of the contemplated movement. FEA supplies atLouisville were credited to the Army or military lend-lease accounts whileMedical Department supplies at Toledo were transferred to Treasury Departmentaccountability. After these paper transfers were made, the movement of only 800carloads of supplies completed the transfer and relieved the Medical Departmentof all responsibility for civilian lend-lease just a few days before the end ofhostilities in Europe.16
The administration of lend-lease was a "war baby"without antecedents and, so far as anyone could tell, without hope of posterity.It was born and grew to maturity within the short space of 4 years. For theexpansion of the Army and the waging of a war beyond the seas, precedent andexperience offered some guide. But lend-lease was without precedent. It wasconstructed by inexperienced hands to meet pressing and changing needs. Theresult was an almost continuous establishment, revision, rescission, andreestablishment of offices and policies, in and out of the War Department, whichappeared frivolously inconsistent to those at the lower operating levels.
Excessive Foreign Requirements
There is reason to believe that some countries looked uponmedical lend-lease as a grab-bag filled with gifts for the needy. In the earlydays before any distinction between military and civilian requirements wasrecognized, all lend-lease materials were procured under a military priority.This created in beneficiary governments a strong temptation to fill civilianneeds which were un-
15Army Service Forces Circular No. 164, section VI, Installation, 8 May 1945.
16It should be noted, however, that a large quantity of supplies was held at Louisville to maintain an uninterrupted flow of civilian lend-lease shipments. FEA had given assurances that these supplies would be "called forward" before 31 December 1944, but as late as September 1945, approximately 500 tons still remained in the FEA stock account at Louisville.
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connected with military operations. Even after the division ofmilitary and civilian requirements, occasional abuses occurred which left theimpression that the United States was looked upon as a lush source of materialwealth. For example, the U.S.S.R. continued throughout the war to enjoy a 100percent military classification on all her requirements, receiving tremendousquantities of many items which were designed primarily for civilian use (fig.34). Objections by the International Division were promptly overridden by higherauthority. During 1943, Australia was allowed to classify her artificial teethrequirements as 100 percent military. She asked for, and received, a quantity inexcess of total U.S. Army issues for that year. When it is considered that thetotal population of Australia was somewhat smaller than the U.S. Army, it isprobable that the 1943 shipments amply supplied the Australian forces withartificial teeth. However, that country promptly submitted another requisitionfor the following year's needs, which were estimated at 75 percent of thequantity received in 1943. The second requisition was disapproved on therecommendation of the International Division, SGO.17The British had a 100 percent military classification for all requirementsof X-ray equipment until late in 1944 on the strength of the argument that theirdistribution system did not permit segregation for military and civilian use.Since much of this equipment was of an elaborate type not essential for militaryuse, the International Division interposed vigorous objections and was finallyable, in July 1944, to distinguish civilian from military requirements. At thistime, the American X-ray industry had on its books domestic civilian orders 16months
17Memorandum, Lt. Col. Charles Garside, Director, International Division, OTSG, to Director, International Division, ASF (attention: Col. George Olmsted, GSC), 8 Dec. 1943, subject: "Adjustments" in UK Programs.
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old and commercial export orders antedating Pearl Harbor, whileBritish civilians were enjoying an AA-1 military priority for their X-ray needs.
In seeking to obtain lend-lease medical supplies in excess ofmilitary requirements, the Republic of Ecuador proved that small nations cannourish large hopes. That country presented a 1943 military program requiringmedical supplies and equipment for 50 infantry and 20 cavalry divisions. Thisambitious program was disapproved, and plans were made to provide a quantity ofmedical supplies more directly related to the size of Ecuador's Army-fivedivisions.18
Differences in Terminology
Another major problem in early lend-lease operations resultedfrom wide variations in medical practices, customs, and terminology throughoutthe world. The identification of some items required by the beneficiarygovernments was extremely difficult because of language barriers, inadequatespecifications, and inability of representatives of foreign governments todiscuss and agree upon technical interpretations of stated requirements. Thiswas especially troublesome in screening Russian requirements; the Soviet Missionusually insisted upon materials being furnished exactly as requested althoughthe technical description of the desired item was meaningless to Americanofficers and the Russian officials were unable to furnish clarification (fig.35). When additional information was received which suggested the advisabilityof substitutes, the Soviet Mission was reluctant to approve the changes. Duringthe last 18 months of lend-lease operations, several competent Russian physicianswere assigned to the Soviet Mission. This change produced a distinct improvementalthough relations were far from perfect at the war's end.
After the items were identified, other difficulties whichwere related to the variety of medical practices, developed. There wererequirements for large quantities of medicines and equipment which weredifficult to procure, either because such supplies were obsolete in the UnitedStates or because they had never been produced and used in great volume. Verylittle calomel was used by American troops, but tremendous quantities wereprocured and shipped to foreign governments. Although widely used in the UnitedStates, insulin was employed in far greater quantities abroad. In X-rayequipment, the same problem was encountered. On one occasion, the RussianGovernment requested 3,000 X-ray tubes of a type which had not been manufacturedin the United States for 25 years. Since it was obviously impractical to tool upa factory to
18Memorandum, Lt. Col. Charles Garside, Director, International Division, OTSG, to Director, International Division ASF, ASP (attention: Col. George Olmsted, GSC), 30 Sept. 1943, subject: Ecuador 1943 Military Program. In discussing the abuses of medical lend-lease, the author has been aware that the maintenance of civilian health and well-being is related to military operations and that it is sometimes difficult to distinguish between military and civilian use. But even after the fullest allowances are made, it is apparent that large quantities of lend-lease medical supplies were diverted to uses which were only faintly connected with military operations.
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produce these obsolete tubes, a new type was shipped which, itwas thought, could be used in the Russian machines.19
In the Medical Department supply catalog, approximately 7,000standard items were listed, but even this collection of medical supplies andequipment was inadequate to cover the needs of lend-lease governments. It becamenecessary to compile an "International Aid Non-standard Catalog,"consisting of items employed for medical purposes but not standard with, and notused by, the Medical Department.
The whole problem was pointedly summarized by Lt. Col.Francis C. Tyng, MC, in October 1942. "After all," he wrote to Brig.Gen. Paul R. Hawley, "the United States is the last remaining bastion ofmedical supply and it must supply all the Allies in the world, but it cannotcontinue to fill the unconscionable demands of the Allies and at the same timeleave anything for
19Address, Brig. Gen. Edward Reynolds to Medical Department officers assembled at Walter Reed General Hospital, 19 Sept. 1945, subject: Medical Supply Problems of World War II. [Official record.]
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our own armed forces, to say nothing of our civilians. Youcan easily see that we are heading into a catastrophic situation."20
OTHER RELIEF ACTIVITIES
In addition to the administration of lend-lease medical supplyactivities, the International Aid Division also handled medical supplyactivities for the Russian War Relief Society and for the American Red Cross. InAugust 1944, the latter function was transferred to the Liaison Branch,Purchases Division.
Activities on behalf of Russian War Relief and the AmericanRed Cross involved accounting of special funds provided for the purpose, withthe consequent necessity of maintaining the identity of separate requisitionsthroughout the stages of procurement, storage, and issue. Medical supplies inthe common lend-lease stockpile were not authorized to fill these two agencies'requirements. Use of Army stocks excess to current requirements, however, wasprovided; specifically, requisitions in these categories were forwarded throughthe Liaison Branch to the Stock Control Division for stock transfers orprocurement as necessary. Reimbursement from funds allocated to the WarDepartment (for Red Cross shipments) or from funds on special deposit with theWar Department Finance Officer (for Russian War Relief shipments) was obtainedby the Fiscal Division, SGO, on the basis of actual shipping documents.
20Letter, Lt. Col. F. C. Tyng, MC, to Brig. Gen. Paul R. Hawley, 18 Oct. 1942.
