Part II
MEDICAL SUPPLY IN THE WAR AGAINSTTHEEUROPEAN AXIS
CHAPTER VII
Outposts and Supply Routes
By the time the United States entered World War II, specifictheaters of operations, commands, and lines of communication already had beenestablished in the interest of national defense, and to implement the program ofaid to Britain (map 1). From the point of view of medical supply, these commandscame at an inopportune time because their activation, coinciding as it did withthe mushrooming of military installations in the United States, widened the gapbetween availability and requirements for both personnel and materiel.
NORTH ATLANTIC BASES
In September 1940, the United States obtained base sites atseveral British possessions in the Atlantic (map 2) and Caribbean areas.Although the Lend-Lease Act was not signed until 27 March 1941, U.S. troopsbegan occupying these bases in January of that year.1Medical service for the arriving troops was initially under thesupervision of the Corps of Engineers, who was also responsible for the healthof civilian construction workers. Preliminary surveys to determine medical needswere made under the direction of Col. (later Brig. Gen.) Leon A. Fox, MC.
Newfoundland Base Command
The station hospital, Newfoundland Base Command, was activatedon 15 January 1941, aboard U.S. Army Transport Edmund B. Alexander. Beforesailing from the Brooklyn Port of Embarkation, medical supplies were carefullyexamined, segregated from nonmedical supplies, and made readily accessible foruse upon arrival in Newfoundland.2 Shortlyafter arrival of the transport at the port of St. John's on 29 January 1941,it was discovered that no cassettes for chest X-rays were available. Thissituation was quickly remedied by the loan of two such cassettes from healthauthorities of St. John's.
When the USAT Edmund B. Alexander, which had beenserving as the station hospital, Newfoundland Base Command, was ordered back toits base in Brooklyn, N.Y., it became necessary to find temporary accommodationsun-
1(1) Conn, Stetson, and Fairchild, Byron: The Framework of Hemisphere Defense. United States Army in World War II. The Western Hemisphere. Washington: U.S. Government Printing Office, 1960, pp. 51-62. (2) Wiltse, Charles M.: The Medical Department: Medical Service in the Mediterranean and Minor Theaters. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1965, p. 9.
2This section, unless otherwise stated, is based on the following documents: (1) Annual Report, Station Hospital, Newfoundland Base Command, 1941. (2) Annual Report, Newfoundland Base Command, Part II: Fort Pepperrell, 1942. (3) Annual Reports, 308th Station Hospital, 1943 and 1944.
174-175
MAP 1.-Supply routes to Europe, Africa,and the Middle East.
176
MAP. 2.-Medical supply installations inNewfoundland, Greenland, and Iceland.
til a permanent hospital could be erected. Accordingly, alarge country estate, Northbank, was rented and remodeled to serve as atemporary hospital.
The assembly for a 50-bed hospital, which had arrived beforethe move to Northbank, remained stacked high on the pier at St. John's becauseof lack of storage space. Some remodeling of the estate was accomplished byconstruction of a temporary 25-bed ward, and by 5 June 1941, the stationhospital, Newfoundland Base Command, had completed its move into the Northbankestate. Supplies were stored in outhouses and other temporary storage spaces.The hospital moved in December to newly completed barracks at Fort Pepperrell,where it remained until its own building was ready in June 1943. It had beenredesignated the 308th Station Hospital in April of that year.
The medical supply unit of the 308th Station Hospital wasestablished as the medical supply depot for the entire Newfoundland BaseCommand, and eventually supplied four hospitals totaling 450 beds. This supplyoperation con-
177
FIGURE 36.-Panoramic view of FortPepperrell,Newfoundland, across Quidi Vidi Lake, April 1942.
tinued in a dual capacity until 12 August 1942, when it wasseparated from the hospital and designated the Medical Supply Office,Newfoundland Base Command. This office, which had the function of coordinatingthe medical supply activities for the entire base command as well as furnishingmedical supplies for the station hospital at Fort Pepperrell, was organized intoan administrative section, a receiving section, and an issue and shippingsection. The inadequate storage facilities at Northbank were replaced inDecember 1942 with better facilities located at Fort Pepperrell (fig. 36) in thebasement of the detachment barracks in the new hospital, and in a permanentwarehouse.
Although medical supplies were adequate for most of theNewfoundland Base Command, the system of automatic supply in some instancesproduced more or less than enough. For example, the surgeon of the stationhospital, Newfoundland Air Base (Gander Field), reported overstocking of drugitems. On the other hand, shortages soon developed in such vital supplies asutensil sterilizers, water sterilizers, distillation apparatus, and field X-rayequipment, none of which were on automatic supply.3
Because it was originally planned to use Eskimo dogs intactical training in Newfoundland, great quantities of veterinary supplies andequipment were received and suddenly became surplus when the project wasabandoned. The excess supplies were eventually returned to the Zone of Interiorwhen it was realized that they would not be used and were occupying neededstorage space.
Base medical supply levels were set at 75 days maximum, plusorder and shipping time of 75 days, and levels for each of the other three postswithin
3Annual Report, Station Hospital, Newfoundland Air Base, 1942.
178
the command were 40 days maximum, plus the 75 days'shipping time. Most excesses which had accumulated in the command wereoccasioned by automatic supply of medical maintenance units, which system wasnot displaced by requisitioning until 1 December 1943. The ill effects ofautomatic supply were compounded by the fact that medical maintenance units weredesigned for combat operations and contained quantities of items that farexceeded the needs of the command. Excesses were periodically reported andconsolidated for return to the Zone of Interior.
Initially, all medical supplies were received and distributedby the base medical supply depot, but this was changed later when allrequisitions were filled to the extent of available stocks by the depot, andremaining items were extracted to the Boston Port of Embarkation for directshipment to requisitioning units. The command considered this the most practicalmethod of supply as it eliminated double handling and overstocking. Obversely,the War Department viewed the method as fostering overstockage, particularly atoutlying stations, and precluding central control. The command was directed torevise its goals. The new system, inaugurated on 1 January 1945, resulted inrequisitions to the port sufficing for stockage of the base depot and for issueto using units.
The command resisted the change to a centralizedrequisitioning system because it had been able to curtail its medical supplyactivity to a greater degree than the reduced command strength indicated,dropping from 13 civilian employees in January 1944 to 0 by December of thatyear when the base depot was inactivated. Moreover, the military personnelassigned to supply had been released, and a substantial portion of the medicalwarehouse space had been closed out. With the inauguration of centralrequisitioning, it was necessary to revise the curtailment of supply operationsdespite the progress that had been made in reduction of forces.
Bermuda Base Command
Contrasted to the bleakness and cold climate of the NewfoundlandBase Command, the Bermuda Base Command, located in a more temperate area, alsoserved as a link in overseas communication and as a defensive post for thehemisphere. Established in April 1941, the Bermuda Base Command experiencedproblems of supply because of its crowded facilities. Medical supplies werestored in two rooms on the ground floor of the 221st Station Hospital, whichoccupied the Castle Harbour Hotel.4
In May 1943, the hospital was transferred to a partiallycompleted building at Fort Bell (fig. 37), and supply facilities, similar tothose in the previous location, were established.
4This section is based on the Annual Reports of Bermuda Base Command for 1941, 1943, and 1945.
179
During 1944, 24 long tons of excess medical supplies werereturned to the States. Air-conditioning units were installed in operatingrooms, X-ray rooms, and in one recovery room.
The common complaint of the Bermuda Base Command concerningmedical supply was that intervals between freight transports prevented promptfilling of their requisitions made to the New York Port of Embarkation. However,as with the other bases and stations servicing the various air routes ofcommunication, emergency medical requirements, supplies, and patients were airdelivered to their destination rapidly.
Eastern and Central Canada
Bases located in eastern and central Canada were importantlinks in the North Atlantic Ferry Route. Traffic over this route reached a peakin 1944, when 8,641 aircraft were ferried to Europe.5 Medicalfacilities in eastern and central Canada ranged from dispensaries at tinyweather stations, such as
5Dziuban, Stanley W.: Military Relations Between the United States and Canada, 1939-1945. United States Army in World War II. Special Studies. Washington: U.S. Government Printing Office, 1959, p. 191.
180
Southampton Island, Padloping Island, and River Clyde, to station hospitalsat the key ferrying points of The Pas, Fort Churchill, Frobisher Bay, and GooseBay.
Because of the extreme isolation of most posts in easternCanada, supplies were shipped by water during the few summer weeks that theshipping lanes were open, or by air in an emergency. Ships sailing from theBoston Port of Embarkation to Goose Bay, Frobisher Bay, and other points carrieda 360-day level of expendable supplies as well as a 450-day level formaintenance items found in the 30-day unit for 10,000 men.6In central Canada, distribution of medical supplies to the isolatedweather stations during the summer months was necessary because of the extremelybad weather during the rest of the year. Items contained in these shipments werelimited to first aid and emergency treatment essentials and certain drugs neededto treat common ailments.7
The most serious supply problem encountered in eastern andcentral Canada was that of dealing with surpluses. By March 1944, the 4thStation Hospital at Churchill and the 131st Station Hospital at The Pas weretransferred from the theater and replaced by dispensaries. Thus, a surplus ofsupplies existed for some time.8
During 1945, the anticipated inactivation of the U.S. forcesin central Canada caused a flurry of inventorying and adjustment as well asreorganization. The supply policies, despite this hindrance, worked particularlywell on Southampton Island, where the post surgeon performed a successfulemergency appendectomy only 15 days before the arrival of the ship which was toevacuate supplies and equipment.9
Greenland Base Command
Following an agreement with the recognized Danish Minister inWashington, D.C., U.S. troops landed at the head of Tunugdliarfik Fjord insouthern Greenland on 6 July 1941. Included in the first contingent of troopswere 2 medical officers and 14 enlisted men of the Medical Department.10
The first medical facility, located at Bluie West No. 1, wasa first aid tent. In the interval between the arrival of this group and thecompletion of the original hospital building in October 1941, the 10-bed,field-type hospital moved from place to place. Upon completion of the building,facilities rose to 20 beds.
The second Greenland post, known as Bluie West No. 8, wasestablished at the head of S?ndre Str?m Fjord about 15 miles north of theArctic Circle
6Annual Report, U.S. Army Forces in Eastern Canada, 1943.
7Essential Technical Medical Data, Air Transport Command, North Atlantic Wing, for May 1944, dated 31 May 1944.
8Essential Technical Medical Data, U.S. Army Forces in Central Canada, for February 1944, dated 6 Mar. 1944.
9Essential Technical Medical Data, U.S. Army Forces in Central Canada, for August 1945, dated 18 Sept. 1945.
10This section is based on Annual Reports of the Greenland Base Command, 1941-44.
181
182
(maps 1 and 2). Dispensaries were set up under tentage and,by summer 1942, had grown into overcrowded, improvised hospitals. In September,the War Department authorized activation of four numbered station hospitals andconstruction was begun. Equipment arrived more quickly than the buildingmaterials. By the end of 1942, approximately 85 percent of the needed supplieswere on hand, but the buildings were not completed for another year.
Medical supplies for the Greenland Base Command came by wayof the Boston Port of Embarkation. The supply officer of the 188th StationHospital (fig. 38) acted informally as the base medical supply officer,supplying outlying posts, absorbing excess stocks, and redistributing stocks asneeded at other installations. Equipment and supplies were generally adequate.The automatic shipment of medical maintenance units actually resulted in asurplus of many items, but little or no corrective action was taken by medicalsupply officers, who lacked time to handle this particular problem. Thesesurpluses had accumulated from the original 6-month supply and resupply items,which had been shipped to each hospital. Not until after discontinuance ofautomatic shipment in December 1943 did Medical Administrative Corps officers,available only since May 1943, set up the stock records and systematicprocedures that enabled the command to institute a monthly requisitioning systemand to dispose of excesses.
Few medical supply difficulties were reported during the wardespite hardships of the climate and the long winter nights. There was someindication, in fact, that the Surgeon General's Office became overzealous incatering to the needs of this isolated command. It was reported in mid-1943 that50 to 75 packages per month were being received by airmail parcel post, whilefreight shipment would have sufficed for the majority.
As a result of excessive requisitioning, and a change in thetable of organization of the hospital, a total of 314,600 pounds of surplusmedical supplies was returned to the United States in 1944.
Iceland Base Command
In the middle of September 1941, the first contingent of Armytroops arrived in Iceland (figs. 39 and 40), reinforcing a Marine task forcethat had itself reinforced a British garrison in July. Medical supplies,initially, were handled by 2 officers and 25 enlisted men, who set up a depot intwo warehouses in Reykjav?k. Adequate space (8,000 square feet) was available,but the lack of elevators and the distance from the docks made normal depotoperations difficult. Although 6 officers and 75 enlisted men were authorizedfor supply duty, that number was never reached.
By the end of 1942, the supply system was being effectivelyoperated by 4 officers and 50 enlisted men.11
11This section is based on the Annual Reports of the Iceland Base Command for 1941, 1942, and 1944.
183
Besides the main supply depot in Reykjav?k (map 2), somesupplies were located in an original package storage depot at Yeomanry Camp andin a subdepot at Camp Ontario in the Alafoss subsector. The latter consisted ofthree 20- by 48-ft. huts, with a total floor space of 2,880 square feet; thepackage storage warehouse had a floor space of 4,000 square feet. The medicalsupply was separated into main depot and subdepots to facilitate dispersal ofsupplies more easily and conveniently.
All medical units maintained a minimum of 90 days' level ofsupplies, and certain isolated units maintained a level of 120 to 180 days. Fromthe beginning, replacement supplies were acquired by automatic supply of medicalmaintenance units supplemented by command requisitions. Controlled items weresupplied automatically against the command's monthly material reports to theZone of Interior. By early April 1943, the automatic supply medical maintenanceunits led to an unbalanced stock position. Supplies such
184
FIGURE 40.-An early, temporary, and ratherprimitive dispensary in Iceland.
as quinine and mosquito bars particularly were received inexcess, and were returned to the Boston Supply Depot.
The Iceland Base Command reached a peak strength of more than40,000 troops in May 1943, but the threat to the Western Hemisphere that had ledto the occupation had already passed. Troop strength was cut back by 25 percentin August and continued to decline thereafter, with corresponding decreases inthe number of hospital beds. The medical supply system was also reorganized,passing to a base depot section of the 20th Medical Depot Com-
185
pany in August 1943, and in December of the same year, the300th Medical Composite Platoon.
Medical supply levels did not fall as rapidly as troopstrength, in spite of the shipment of almost 2.5 million pounds of surplus itemsto the United Kingdom during 1943. Further reductions the following year werenecessary to achieve the 30 days' operating and 30 days' maintenance supplylevels. By the middle of 1944, depots and issue points remained only inReykjav?k and at Keflavik, adjacent to Meeks Field, principal Iceland base ofATC (Air Transport Command).
CARIBBEAN DEFENSE COMMAND
In early December 1941, a total of 66,000 U.S. troops weredeployed in the Caribbean area to protect the vital lines of communication froma German submarine threat, and to repel any possible Japanese attempt to attackthe Panama Canal. Expansion was rapid during 1942, when the Panama CanalDepartment alone had more than 68,000 troops. The Puerto Rican and Panama CanalDepartments were the major elements for supply until May 1943, when the AntillesDepartment was formed. The latter's aggregate strength at that time wasapproximately 55,000, but strength in the Panama Canal Department was thendeclining.12
Organization for Medical Supply
The medical supply functions of the Caribbean DefenseCommand (map 3) were carried out primarily at departmental level until May 1943.One reason for this was the need for relatively independent sources of medicalsupply for each, in view of the possible isolation that might attend sea surfaceand submarine warfare against shipping. Another factor was implicit in theexpansion of the Caribbean Defense Command, which assumed an active role neitherdepartment had been equipped in the prewar years to carry out.
It is noteworthy that the problems of medical supply werecomparatively greater in the Antilles Department than in the Panama CanalDepartment. Among others, two primary factors conditioned the difference: first,the Panama Canal Department was much better established in 1939, and second, theextreme dispersion within the Antilles Department was a definite handicap.
Panama Canal Department
In late 1940, the medical supply depot for the Panama CanalDepartment consisted of 19,000 square feet of storage space at Fort William D.Davis. This space had been adequate for prewar years, but the possibility of thedisruption of transportation by air attacks on the Canal Zone necessitatedlarger facilities. Freight movement within the Panama Canal Zone was besthandled
12A History of Medical Department Activities in the Caribbean Defense Command in World War II, vol. I. [Official record.]
186-187
MAP 3.-Medical supply depots in the CaribbeanDefense Command, 1941-45.
188
by a single-track railroad or by ship via the canal. Bothroutes were considered attractive targets. Because of this potential danger, itwas decided to disperse stocks for safety and to provide sources of medicalsupply on both the Pacific and Atlantic sides of the Canal Zone.13
Early in 1942, although there was an acute shortage of nearlyall classes of medical supplies, the establishment of the automatic issue ofsupplies worked out especially well. A few items were found to be in excess, andsome were issued in amounts slightly below requirements, but adjustments weremade with the medical supply officer at the New Orleans Port of Embarkation.14
On 1 April 1943, a new medical supply warehouse, measuring40,000 square feet, was completed at Corozal. Thus, two medical supply sections-theAtlantic and Pacific-were functioning simultaneously until 1944, when stockcontrol was transferred from the Atlantic Branch Medical Depot, and the CorozalGeneral Depot became the dominant installation. The Fort Davis Depot simplybecame a medical warehouse section of the Corozal General Depot.
The outstanding accomplishment of medical supply activitiesfor 1944 was the establishment of rigid stock control procedure, effective on 1July 1944; all station medical supply functions were placed on a formalaccountability basis. After a complete inventory was taken, new stock recordcards were initiated, and a requisitioning objective of 165 days was establishedfor the entire department, with a 46-day level set up for the stations. Allexcesses were returned to the medical sections of the general depots, and allitems not required for depot stocks were returned to the Zone of Interior. Atotal of 124,480 cubic feet of excess material was returned during the period 1January-11 December 1944. The established stock levels worked ideally anddistribution was without interruption.
Well-trained X-ray and dental repair technicians in thedepartment rendered invaluable assistance in the repair of appliances andequipment even though spare parts were not always available.
The most serious problem in Panama was the deterioration ofequipment. The struggle against termites, rust, chemical decomposition, andcorrosion was continuous because of the high humidity of the area. X-ray filmswere received improperly packed and, as a result, cloudiness developed on thefilm. This condition was corrected by the development and use of a"tropical pack film." Metal instruments had to be specially processed,and certain biologicals had to be refrigerated under controlled conditions.Items that were particularly susceptible to the effects of humidity were storedin a "dryroom" constructed for the purpose at the Corozal depot.
Preplanning in the closing days of World War II produced twooutstanding accomplishments: 24-hour-a-day emergency supply service toredeployment
13A History of Medical Department Activities in the Caribbean Defense Command in World War II, vol. III. [Official record.]
14This section is based on the following documents: (1) Annual Reports of Panama Canal Department for 1942, 1944, and 1945. (2) Annual Report, 262d General Hospital, Fort Clayton, Canal Zone, 1944.
189
troops passing through the canal, en route to Pacifictheaters; and complete and prompt delivery of all such emergency requisitions tothe ship by medical section transportation and personnel through use of advancedrequisitions on the States.
The closing of the Atlantic Branch Medical Depot at FortWilliam D. Davis on 5 September 1945 caused the transfer of the supplies andequipment to the Corozal General Depot. This move released 40,800 square feet ofwarehouse space located in two buildings. Equipment and certain personnel werereleased as well. During 1945, 13,286 cubic feet of excess supplies werereturned to the Zone of Interior, and 1,819 cubic feet were disposed of throughlend-lease.
Puerto Rico
The medical section of the Puerto Rican General Depot wasactivated on 1 September 1940 and functioned through the Medical Supply Office,port of San Juan, P.R., until 2 October 1940, when it was moved to Fort Buchananand assigned 50,000 square feet of storage space. From a staff of 1 officer, 5enlisted men, and 6 civilians in 1940, the organization expanded by 1943 toinclude 3 officers and 13 enlisted men.15
Trinidad Base Command
The Medical Supply Section of the Trinidad Base Command wasfirst established in May 1941. As the sector grew and other bases wereestablished, this became a large facility.
By December 1942, a medical section was established in theTrinidad General Depot, from which medical supplies for the whole sector werehandled. Housed in new warehouses in the Fort Read area, the depot reached itspeak of requisitioning in mid-1943, and by fall of that year, excess stocks werebeing returned to the United States.16
Reorganization of the Medical Supply System
After the Antilles Department17 was created in 1943,the medical supply system underwent a complete reorganization, brought about bythe changing tactical situation and the improvement of shipping schedules. Therewere several major changes in supply organization and procedure. Requisitionsfor medical installations in Jamaica and Cuba were submitted directly to the NewOrleans Port of Embarkation. All classes of medical supplies were ordered on amonthly basis instead of periodically as needed. The supply organization wasdivided into the Trinidad Sector and Base Command, and the Puerto Rican Sector.
15See footnote 13, p. 188.
16Annual Report, Medical Department Activities, Trinidad Sector and Base Command, 1943.
17This section is based on Annual Reports of the Antilles Department for 1943, 1944, and 1945.
190
The stock record system for all stations in the AntillesDepartment was changed in 1943 by the incorporation of a department surgeon'soffice memorandum with the stock control manual. New practices for maintaining astock level were also introduced.
Disposal of excess stock was handled well by circulating alist of items throughout the department. Extracted items were shipped withoutreimbursement. A total of 232 tons of excess items was shipped out in November1943, and 86 more tons were reported ready for shipment in December. In January1944, new stock levels were established for the Trinidad Sector and Base Commandand for the Puerto Rican Sector, and arrangements were made to transfer surplusmaterial to the Navy or to the Public Health Service.
The Optical Repair Team Type No. 1, formerly located atWaller Field, Trinidad, was moved to the Antilles General Depot in May 1944.This unit began handling requests for lenses which had previously been referredto the Zone of Interior. In addition, the facilities and services of theoptical repair team were made available to the U.S. Navy and Coast Guard. In1944, more than 1,700 requests were handled by the team.
The main responsibility for supplying the island outposts ofthe Antilles Department rested with the Trinidad General Depot, which wasredesignated Sub-Depot, Antilles General Depot, in April 1944. This depotsupplied the St. Lucia Base Command, British Guiana Base Command, French Guiana,the Trinidad Base Command, and Surinam (including Zanderij Field). The use ofthis subdepot greatly reduced time in filling requisitions.
As of 31 December 1944, 2,164 tons of excess medical supplieswere returned to the Zone of Interior.
Repair facilities for Medical Department equipment in theAntilles Department were not satisfactory before 1945. The medical section ofAntilles General Depot No. 1, Puerto Rico, had been using civilian personnel,but low civilian ratings hampered the hiring of adequate personnel. Thesituation was similar in the area served by the medical section of AntillesGeneral Depot No. 2, Trinidad. Repair could be accomplished only on minor items;often, complete replacement was necessary on units and assemblies which becameunserviceable and could not be repaired locally.
An effort was made in late 1944 to establish a medical repairsection which would accomplish third and fourth echelon maintenance. Enlistedmen were sent to the St. Louis Medical Maintenance School, St. Louis, Mo., fortraining. As a result, the repair situation improved in 1945 when four enlistedmen returned from the course and began putting their newly acquired knowledge towork.
The inception of the Green Project necessitated thefollowing: air redeployment of combat troops from the European and Mediterraneantheaters to the United States for transshipment to the Pacific during May 1945,and the attendant necessity for immediate additional supplies and equipment forTrinidad and British Guiana to meet the influx of new personnel of ATC and theAntilles Department. To cooperate with other services in conserving airlift
191
space for supplies required from the Zone of Interior,medical stocks in Puerto Rico were used to meet shipping requirements for theinitial phase, this to the point of depleting many items of depot stock.
Subsequently, requisitions were transmitted to the NewOrleans Port of Embarkation for later phases of supply for the Green Project,and supplies were sent to the medical sections of Puerto Rico and Trinidad. As aresult of advance shipping from the port, and because newly arrived personneltransported with them additional expendable supplies, an overstockage resultedin both depots. To readjust this situation, a requisitioning procedure wasestablished between both depots, obviating the necessity for requisitioning onthe New Orleans Port of Embarkation and reducing overages to a balanced level.
SOUTH ATLANTIC THEATER
Early in June 1942, a Special Headquarters Staff of the SouthAtlantic Wing, ATC, was established at Georgetown, British Guiana. This unit wasthe forerunner of U.S. Army Forces, South Atlantic, which was activated on 24November 1942 (map 1).
The principal mission of U.S. Army Forces, South Atlantic,was to establish, operate, maintain, and support all ATC activities, tocooperate with the Brazilian Armed Forces in the defense of north and northeastBrazil, and to defend Ascension Island where U.S. Force Composite 8012 had beendeployed in March 1942.18
Between July and December 1942, medical supplies wereobtained by requisitions submitted directly to the Surgeon, ATC, in Washington,D.C., filled by the Medical Supply Section at Wright Field, Dayton, Ohio, andairshipped to the station where the requisition originated. Authority had beengranted to obtain supplementary supplies by requisition from the Trinidad Sectorand Base Command; however, supplies available at Trinidad were limited anddelays of 4 to 5 months occurred when requisitions had to be extracted by theTrinidad Supply Section to the New Orleans Port of Embarkation.19
Until supply personnel were assigned to the theater in lateDecember 1942, Lt. Col. George E. Leone, MC, Theater Surgeon (fig. 41),personally prepared requisitions, and in anticipation of an expanding command,medical maintenance units were ordered. To supplement the requisitions comingthrough regular channels, permission was granted to purchase medical supplieslocally. Although no major items of technical equipment were available in Recife,a fair quantity of drugs, chemicals, small sterilizers, and minor equipment waspurchased there.
Preliminary plans were made to establish a medical supplysection within the Recife General Depot, with the proposed hospitals at Nataland Bel?m serving as subdistribution points for supplies which would berequisitioned from the New Orleans Port of Embarkation.
18Annual Report, Medical Department Activities, U.S. Army Forces in the South Atlantic, 1942.
19This section is based on Medical History, World War II, U.S. Army Forces, South Atlantic. [Official record.]
192
FIGURE 41.-Lt. Col. George E. Leone, MC,Surgeon, South Atlantic theater.
By 1 February 1943, medical depot personnel had arrived andhad set up a small general depot at Bel?m, staffed by one officer and oneenlisted man. The medical section of the general depot at Recife, was manned bytwo officers and two enlisted men.
The Bel?m depot was originally intended to function also asthe supply point for medical activities at Amap? and S?o Lu?z. However,because the actual volume of traffic with these base dispensaries was so small,it was clearly more efficient to supply them from the 193d Station Hospital atBel?m. In November 1943, the medical section of the Bel?m depot wasinactivated.
In contrast, the medical section of the Recife General Depotwas assigned 200 square feet in warehouse No. 14, in the Recife dock area. Withexpanding activities and increasing responsibilities, the allotted space provedinadequate. The medical section moved first to an adjoining warehouse and, byearly 1944, to a garage in downtown Recife. By late 1944, more space again wasneeded, and the section was expanded an additional 7,500 square feet, includinga built-in bank vault for alcohol and narcotics. This enabled the entire medicalsupply section to be under one roof.
The mission of the medical section of the Recife GeneralDepot, after November 1943 when the Bel?m depot closed, was to furnish medicalsupplies and equipment to all U.S. Army installations in Brazil. This includedstation
193
hospitals at Recife, Natal, Bel?m, and Ascension Island(assumed in February 1944), and base dispensaries at Amap?, S?o Lu?z,Fortaleza, Fernando de Noronha, Bahia, and Rio de Janeiro. The Recife depot wasalso responsible for supplying U.S. Army transports which docked at ports of thecommand, and for supplying U.S. military commissions in Paraguay and Uruguay. Aclose liaison was maintained between the depot medical supply officer, Maj. JohnJ. Ryder, MAC, and the officer in charge of the U.S. naval medical storehouse inRecife.
The Recife depot furnished the Brazilian Army with a limitedamount of material under lend-lease according to the availability of requesteditems in excess stocks.
Development of penicillin resulted in a flood of requestsfrom various sources. A policy was adopted to furnish penicillin only tomilitary patients except in extreme emergency with the approval by theCommanding General or Chief of Staff necessary. When more penicillin becameavailable to the civilian population in 1945, the Surgeon's Office publishedinformation regarding the purchase of penicillin from commercial sources.
Early in the war, there was no command system ofaccountability for supplies and equipment; however, depot supply officers keptaccurate property records, and stock record accounts were kept in all stations.Formal accountability was established in October 1943. Because of the accuracyof the medical supply officers, or base surgeons who served as supply officersin some instances, the problem of initiating stock record accounts according toinstructions was minimal.
Although a formal directive establishing inventory stockcontrol procedures for all supply services was not published by theaterheadquarters until late 1944, these procedures had been followed before thatdate. The medical supply section at Recife maintained a 45-day minimum level ofsupplies, plus a 30-day operating level. Some difficulties were encountered inestablishing a proper requisitioning objective for the depot, but by raising theobjective slightly, adequate stocks were maintained despite shipping delays.
Before February 1944, routine supplies were requisitionedfrom the Trinidad Sector and Base Command, and nonroutine items were obtainedfrom the New Orleans Port of Embarkation. As of 1 February 1944, Trinidad waseliminated as an intermediate supply point. Vaccines, biologicals, and emergencysupplies were shipped by airfreight from Miami, while other supplies andequipment were shipped by water from New Orleans. Air shipments were receivedwithin 2 to 4 weeks after requisitioning while shipments by water were receivedwithin 110 days. In an emergency, supplies could be received in as few as 5 to 8days.
Until mid-1944, procurement of sufficient supplies andequipment to meet the needs of a rapidly expanding command was a major problem.Until initial stocks were supplemented by medical maintenance units, reliancewas placed on the local market. Biweekly rounds of the local drug companies andsurgical and dental supply houses were made by a medical officer of the Recifedepot.
194
Despite a language barrier and a lack of extensive knowledgeof drugs, a considerable quantity of X-ray, dental, and laboratory equipment waspurchased in Rio de Janeiro and, in March 1943, a general purchasing agency wasestablished there.
Inexpensive spectacles of good quality were readily availablein Recife and, as requirements increased, procurement time lapsed. Therefore,arrangements were made to obtain spectacles from a large optical company in Riode Janeiro. However, because of delay in delivery and poor workmanship,arrangements were made for forwarding spectacle orders to a branch of theAmerican Optical Co. through the medical supply officer at Camp Blanding, Fla.
The problems that occurred in the South Atlantic theater weretypical of the type of climate and situation which prevailed. The heat andhumidity of Brazil made equipment maintenance difficult. Instruments rusted, andX-ray film often deteriorated beyond use. Cargo received rough handling, andbreakage was exceptionally high until packaging methods improved. Despite thesedifficulties, the medical supply situation improved rapidly because of theefforts of medical supply officers who learned to anticipate problems and toovercome them.
AFRICA-MIDDLE EAST THEATER
The long thread of air communications from Florida to Indiahad its genesis in the route established by the Pan American Airways. Near theend of June 1941, Pan American Airways, in complying with a requestfrom the U.S. Government, had accepted the responsibility of ferryinglend-lease planes to British forces in the Mediterranean and points further east.
In September 1941, President Franklin D. Roosevelt addresseda memorandum to Secretary of War Henry L. Stimson, indicating that arrangementswere to be made at the earliest practicable time to establish and operate depotsin the Middle East. These depots were for the maintenance and supply of Americanaircraft and ordnance material furnished to the British in that area. Sucharrangements were made, and these establishments became the embryo of USAFIME(U.S. Army Forces in the Middle East). The Persian Gulf Command was born of theU.S. Military Iranian Mission, activated late in 1941 to provide aid to Russiaand Great Britain.20
U.S. Army Forces in the Middle East
On 16 October 1941, Maj. (later Col.) Crawford F. Sams, MC(fig. 42), joined the newly created U.S. Military North African Mission asSurgeon. On 29 October, Major Sams presented plans which he had been developingbefore his departure from Washington; after his arrival in the theater on 22Novem-
20A Narrative History of Medical Activities in the PersianGulf Command. [Official record.] For a more detailed account of the formation ofthe Persian Gulf Command, see Wiltse, Charles M.: The Medical Department: Medical Service in the Mediterraneanand Minor Theaters. United States Army in World War II. The Technical Services.Washington: U.S. Government Printing Office, 1965, pp. 56-60.
195
FIGURE 42.-Brig. Gen. Crawford F.Sams.
ber 1941, he modified these plans substantially, based onfirsthand information.
As additional medical personnel arrived, dispensaries anda 250-bed station hospital were established. Concurrently, arrangements weremade to hospitalize civilians employed by American contractors, as well as U.S.military personnel, in British military hospitals until U.S. facilities werecompleted.
Absence of an organized medical service in the Africanportion of the aircraft ferrying route presented a serious problem in Malaya andAustralia. A medical plan to establish regular medical service along theferrying routes was prepared by the mission surgeon after consultation with theChief Medical Officer, Pan American Airways. By 19 June 1942, militarization ofthe North African Mission was accomplished and American military activities inthat region were consolidated into a theater of operations, the U.S. Army Forcesin the Middle East.21
This command was considered an active theater of operations,as well as a Service and Supply Command (map 1), reaching its peak strength ofmore than 66,000 troops in July 1943. The departure of the Ninth Air Force inAugust 1943 left the residual mission of supply and service. Further declineoccurred in December 1943, when the Persian Gulf Command became autono-
21General Orders No. 1, U.S. Army Forces in the Middle East, 17 June1942.
196
mous, having been on a separate requisitioning basis for sometime because of its independent mission of supplying Russia.
Medical supply-The medical supply requirements andactivities were determined by such factors as hospital bed strength, patientload, and various ancillary medical facilities. On these were based the numberof medical unit assemblies required, the resupply and general logistical aspectsof a distant command overlapping portions of two continents. Supplies andequipment for dispensaries established in early 1942 were drawn from a 50-bedhospital assembly which had been made available to the command. Maximum hospitalbed strength coincided with the peak troop strength in July 1943, with 6,250fixed beds scattered from Liberia to Tehran.22
On 17 June 1942, civilian personnel arrived in the command tooperate the Douglas Aircraft Corp. hospital in Gura, Eritrea. The bulk ofmedical items to equip this 250-bed hospital, which was to accommodate allAmerican citizens in the area, was furnished by the Medical Department. Shortlythereafter, many hospitals, dispensaries, and other medical units began to moveinto the command from the United States. Because of the delay in shipping and ofshortages of medical material in general, however, several items were eitherborrowed or obtained from the British on reverse lend-lease to expedite theopening of these U.S. medical care installations. Some local procurement waseffected to advantage, also.
Upon arrival of the Advance Depot Platoon, 4th Medical DepotCompany, on 1 November 1942, two advance depots were established at Darb El Hagg,Egypt, and Tel Litwinsky, Palestine, with the base depot being at Decamere,Eritrea. Due to the change in the military situation in North Africa at thattime, depots in Palestine and Eritrea were consolidated with the advance depotat Darb El Hagg by February 1943. In March, this unit became the MedicalSection, Heliopolis Quartermaster Depot, Camp Russell B. Huckstep, Egypt. Thismedical section included an optical shop for fabrication and repair ofspectacles and a medical maintenance and repair shop. Maintenance shopfacilities were adequate for the needs of the command as was the optical shop,which had a manufacturing capacity of 1,000 pairs of spectacles per month.During the most active portion of the buildup period, the Ninth Air ServiceCommand operated a medical section in the Advance General Depot at Benghasi,closely supporting combat missions of the Ninth Air Force.
Until October 1943, all items of resupply were shipped automatically in the form of medical maintenance units, and requisitions were submitted to the Charleston Port of Embarkation for supplemental items and emergency requirements. From the beginning of the theater, medical maintenance units representing an estimated 6-month supply for the existing and contemplated force were set up for shipment as a means of establishing the base depot stocks. These medical maintenance units were far from complete, and back-
22This section is based on Essential Technical Medical Data From Overseas Forces, U.S. Army Forces in the Middle East, for January 1944, dated 1 Feb. 1944.
197
ordered items followed the original shipments for severalmonths. Available 6-month supplies were initially distributed as follows: Mobiledispensaries received 10 days' supply; Air Force service squadrons, 30 days'supply; and hospitals, 90 days' supply.
U.S. Army Forces in the Middle East, while favoring the useof medical maintenance units during the buildup period, made these severalrecommendations to the Surgeon General's Office in view of the overages andshortages ascribed to their use: (1) the simultaneous arrival of the firsttroops with their initial maintenance, subsequent troop shipments to be precededby their initial maintenance; (2) the nonestablishment of back orders for itemsshort in the medical maintenance units shipped overseas; and (3) shipment ofmedical maintenance units at regular intervals, with the theater supply officerconstantly checking and advising the port medical supply officer of allinadequacies and overages.
Simultaneous shipments were tried in every instance. Initialmaintenance preceding the arrival of troops was accomplished occasionally whentroop movements could be anticipated with any degree of certainty and suppliescould be made available in advance of a movement.
By early 1943, back orders were discontinued on initialmaintenance shipped with the units. Monthly shipments of medical maintenanceunits were considered as basic stocks for the theater and an interimsubstitute for theater requisitioning. These items, although many wereconstantly shifting from availability to nonavailability and back again,constituted a cross section of the essential items of supply.
Thus, failure to backorder items for the maintenance unitscould deprive the theater of many essential items for protracted periods withoutdetection or correction. This was particularly true in the Middle East where thefirst 6 months' supply of units was shipped as rapidly as shipping spacepermitted. The theater policy was recognized as having some merit, especiallywhen accumulated back orders arrived 6 months after the original shipment andaccompanied the succeeding periods' shipments of maintenance units whichincluded authorized quantities of the items by reason of their suddenavailability. This virtually transposed the status of some items from a shortageto an excess position.
There was never discord within the medical supply system onthis matter. The paucity of shipping space during the early days and therelatively low priority of nonemergency medical supplies permitted accumulationof medical maintenance units on U.S. docks for prolonged periods, provokinghardships despite the protests of the Surgeon General's Office.
Levels of supply-Because of distances involved betweensupply points and the limited means of transporting bulk stocks, it was highlydesirable that stations carry at least 90 days' stock. This was attempted atthe outset, but theater stocks would not permit such an extravagantdistribution, and stations necessarily reverted to a 30-day level, with monthlyrequisitions. As command stocks became more abundant in mid-1943, all stationswere authorized to in-
198
crease levels to 120 days (not to exceed 6 months), and torequisition quarterly. Dispensing with the medical maintenance unit as theprimary means of supply, quarterly command requisitions were instituted on theport, based on 210 days of supply including 110 days' shipping time.Commencing with the March 1944 requisition, the War Department directed thatcommand levels would be reduced to 45 days' minimum plus 30 days' operating,or a total of 75 days' maximum level plus shipping time. Stations againreverted to a 30-day level and monthly requisitions. This War Department actionprovided the Zone of Interior with a better means of meeting accelerateddemands in the scattered combat areas.
With unit personnel frequently arriving months ahead of theirunit assembly, and with unit assemblies invariably split in transit, allassemblies were shipped to the depot for reprocessing before issue to units. Atthe outset, unit assemblies had to be improvised by using the limited U.S.stocks available, augmented with British equipment and the limited, but moreexpensive, locally procured items. The command found that this processing ofunit assemblies through the depot had a dual benefit. Initial requirements weremet with limited stocks, and a reserve stock was accumulated for reprocessingand reconstructing assemblies, which would conform to actual needs with a savingin material. Despite these benefits, shortages persisted and unit improvisationwas necessary.
Persian Gulf Command
Having originated with the Military Iranian Mission inOctober 1941, and become the Persian Gulf Service Command in August 1942, thePersian Gulf Command was designated a separate theater on 10 December 1943 (map1).
The first American hospital in the Persian Gulf Areas was the2d Station Hospital, which began operations on 6 June 1942. This hospitalacquired its initial supplies and equipment from various sources.
The Advance Depot Platoon, 7th Medical Supply Depot, arrivedat Khorramshahr, Iran, on 25 January 1943 and, 2 weeks later, opened a depot atAhwaz.23 While the platoon was at Ahwaz, a fire broke out on 21 June1943, destroying medical supplies valued at $350,000. However, large quantitiesof medical supplies had just arrived from the United States and these were inKhorramshahr at the time of the fire. The losses at Ahwaz were thus minimizedand fortunately did not hinder the flow of supplies to various units andhospitals.24
By September 1943, the depot was preparing to be moved toKhorramshahr, where a subdepot was established as part of the general depot(fig. 43). The move was made in November 1943, after which the unit wasredesignated the 22d Medical Depot Company. A 6-month supply of initialmaintenance,
23(1) Report, Section I, Advance Depot Platoon, 21st MedicalSupply Depot, to Commanding General, Persian Gulf Service Command, 30 June 1943,subject: Initial Historical Report. (2) Annual Report, Section I, Advance DepotPlatoon, 22d Medical Depot Company, 1943.
24Annual Report, Persian Gulf Command, 1943.
199
comprised of medical maintenance units, was shipped to thePersian Gulf Command. Units retained 3 months' stock and the depot tookcustody of the other half. As in USAFIME shipments, these medical maintenanceunits were far from 100 percent complete on the initial shipments andback-ordered shortages followed for several weeks. Additional shortages resultedfrom poor packaging and rough handling in transit.25
Paralleling the USAFIME experiences, hospital unit assembliesshipped to the Persian Gulf Command were frequently fragmented. In one instance,a field hospital unit which had arrived in December 1942 received the bulk ofits unit assembly in periodic shipments and not until 1 May 1943 had sufficientportions been received to set up operations. These imperfections were occasionedby shortages of stocks in the United States and by failure to load all availablecomponents of the unit assembly on one vessel. As a result, hospital personnelwere either immobilized or placed with British or U.S. functioning hospitals. Ahospital was often temporarily improvised by drawing on local
25(1) Essential Technical Medical Data, Persian GulfCommand, for August 1943, dated 11 Sept. 1943. (2) Essential Technical Medical Data, Persian GulfCommand, for September 1943, dated 15 Oct. 1943.
200
civilian facilities or U.S. and British sources. Materialsobtained from the British in the area, under reverse lend-lease, from 1 January1943 through April 1945 were valued at more than $23,000. A significant portionof these materials were dental supplies and equipment, which were extremelyshort in the U.S. Army medical supply system.26
During the period of scarcity of equipment and facilities,the ingenuity of the unit personnel was equal to the situation.
To combat spoilage among vaccines and serums, a satisfactoryDry Ice was manufactured from cylinders of carbon dioxide.Approximately 17 pounds of ice could be produced in 30 minutes from thecontents of one 15-gallon cylinder of the gas.
Medical treatment facilities were equally adaptable. Asinterim measures, operating lamps were made from large metal kitchen mixingbowls; a bicycle pump served to maintain pressure in a steam autoclave; and aFrench fryer mounted over a plumber's blowtorch made an excellent instrumentsterilizer. This becomes more significant when it is realized that the PersianGulf Command improvisations were without the benefits of a medical maintenanceshop. In time, improvised material was largely displaced with standardequipment.
A survey was conducted early in 1943 to determine highmortality of repair parts, and requisitions based on the results of that surveywere submitted to the Charleston port. Although at that time hospitals werewithout assigned repair technicians, many units had personnel who could makerepairs. In the Persian Gulf Command, the local engineer and ordnance shops wereused freely by personnel in repairing and fabricating medical equipment.Repairable equipment beyond the capability of the Persian Gulf Command wasreturned to the United States as replacements were requisitioned.27
The shortage of medical supply catalogs in the Persian GulfCommand was alleviated in April 1943 when an overseas medical supply catalog,which provided guidance for requisitioning supplies, was compiled in the Zone ofInterior and was made available to all units. The manual included lists of itemsthat comprised the medical maintenance units, final reserve units, and similarlists with identifying catalog numbers, nomenclature, and unit of issue. Thesewere duplicated and distributed to all units in the Persian Gulf Command.
In January 1944, the level of supply for the command wasreduced from 210 days to 105 days. Automatic requisitioning was discontinued atthis time and thereafter medical supplies and equipment were requisitioned onthe basis of table-of-organization-and-equipment authorization and consumption.The reduction of the days' level of supply created overages in certain items,which were augmented by the abolishment of our final medical reserve. Excessesbeyond a 6-month supply were declared and properly disposed of.28
26See footnote 20, p. 194.
27(1) Annual Report, Persian Gulf Command, 1944. (2)Essential Technical Medical Data, Persian Gulf Command, for January 1944, dated13 Feb. 1944.
28See footnote 27(1), above.
201
The only interruption to the continuous flow of medicalsupplies to the theater occurred in April 1944, when two vessels loaded withmedical equipment were damaged during enemy action. Repairable equipment damagedbeyond the capabilities of the repair facilities at hand was returned to theZone of Interior while unrepairable equipment was disposed of by report ofsurvey.
During April and May 1944, Eastern Command, a tacticalcommand for which the Persian Gulf Command had supply responsibility, wasestablished in Russia. A considerable quantity of supplies and equipment wassupplied from Persian Gulf Command stocks. Requisitions for items which couldnot be furnished were extracted to the Zone of Interior and the equipment wasforwarded on receipt in the Persian Gulf Command. When the Eastern Command(fig. 44) was reduced some months later, the equipment was absorbed back intothe command stock or declared excess.
An optical repair unit was attached to the KhorramshahrGeneral Depot in June 1944. Before that time, all spectacle prescriptions hadbeen forwarded to USAFIME for processing.
As medical units were transferred from the command in 1944and 1945, excess items were recovered by the depot and reissued from time totime.
202
Other Commands
While the Persian Gulf Command was a key supply link toRussia and the Far East, the U.S. Army Forces in Central Africa withheadquarters at Accra, Gold Coast, had the primary mission of theconstruction, operation, and defense of Ferry Command and Air Transport Commandinstallations in Central Africa. Established on 16 June 1942, this command wasmerged with the U.S. Army Forces in the Middle East on 15 September 1943 andredesignated the West African Service Command (map 1).
The medical supply depot for the entire area was establishedoriginally at Accra, but when the command changed, it was placed under thecontrol of the 67th Station Hospital. The second depot, established at Dakar wasplaced under the control of the 93d Station Hospital.
As in the Caribbean and Persian Gulf Areas, heat and moisturecaused many problems. Many surgical instruments, unless coated with grease orstored in dry closets, rusted. Most surgical knife blades and needles packed inglassine paper and cellophane were rusty when opened. No rust was noted on thosepacked in wax paper.
Emergency lights shorted out within 2 weeks and batteriesalso deteriorated rapidly. Deterioration also occurred with hydrogen peroxideand X-ray film. Provision for the repair and replacement of parts was limited.To assure the availability of mechanical parts of motors, X-ray tubes,batteries, and oxygen, requisitions were placed well in advance of actual needs.29
Throughout 1944, the medical supply functions of the 93dStation Hospital were normal and receipt of supplies and equipment wassatisfactory. Effective on 1 March, supplies were requisitioned monthly on thebasis of a 45-day minimum level plus 30-day operating level, or a total of 75days' maximum level. This, plus the 110-day order and shipping time,constituted the requisitioning objective of 185 days.
The Medical Supply Depot, 67th Station Hospital, alsofunctioned as a base medical supply depot for the West African Service Command,U. S. Army Forces in Liberia, and ATC stations in Nigeria, Gold Coast, andSenegal. A stock record system, maintained since January 1943, was revised inMarch 1944. Stock levels based on actual consumption were established and themonthly submission of requisitions was put into effect.
29Essential Technical Medical Data, West African ServiceCommand, U.S. Army Forces in the Middle East, for August 1943, dated 11 Oct.1943.
