CHAPTER IX
Europe: Preinvasion Buildup in the United Kingdom
PRELUDE
Beginning in May 1941, the U.S. Military Mission to London,called the Special Observer Group, had been quietly and carefully planning thedisposition in the United Kingdom of a tentative U.S. troop strength of 87,000men and their accompanying equipment.
Following Pearl Harbor, the observer group rapidly began toput their formerly secret plans into operation. The projected troop strengthrose to 105,000 men with the plan, MAGNET, which called for a much larger U.S.force in northern Ireland to defend against Axis attack. Early in January 1942,U.S. Army Forces in the British Isles replaced the Special Observer Group, thusestablishing the first U.S. Army command in the United Kingdom. Shortlythereafter on 26 January, the first contingent of 4,000 U.S. troops debarked atBelfast, northern Ireland. The buildup of a U.S. Air Force in the British Islesbegan in late February with the establishment of a bomber command (VIII BomberCommand); by mid-June, plans were made for the direct participation of U.S. airunits in the war against Germany.
To supply the planned assault, Headquarters, Services ofSupply, under the command of Maj. Gen. John C. H. Lee, was activated on 24 May1942.1
MEDICAL SUPPLY
Early Organization of the Supply Division
The Finance and Supply Division (later the Supply Division),Chief Surgeon's Office, ETOUSA (European Theater of Operations, U.S. Army),was established by verbal order of the Chief Surgeon, Col. (later Maj. Gen.)Paul R. Hawley, MC, on 13 June 1942 at 9 North Audley St., London. Lt. Col.(later Col.) Earle G. G. Standlee, MC, was designated chief and purchasing andcontracting officer.
Shortly after the Finance and Supply Division was created, itwas moved to Ben Hall Farm at Cheltenham, Gloucestershire, about 100 miles westof London, where it shared facilities with several other divisions of the Chief
1For further details on the background and operations of the Special Observer Group, see: (1) Ruppenthal, Roland G.: Logistical Support of the Armies. United States Army in World War II. The European Theater of Operations. Washington: U.S. Government Printing Office, 1953, vol. I, pp. 13-51. (2) Potter, Hubert E.: The Medical Department: Medical Service in the European Theater of Operations. United States Army in World War II. Ch. I. [In preparation.]
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Surgeon's Office and the other technical services of theArmy. Facilities consisted of a group of temporary camouflaged buildings thathad been constructed originally to house parts of the British Ministry of War inthe event of invasion or the destruction of the London headquarters. The move toCheltenham hindered operations of the division because most of its transactionswith the British War Office were conducted in London; hence, it became necessaryto appoint a London liaison officer. The fact that a Chemical Warfare Serviceofficer served as the liaison officer until a Medical Department officer becameavailable was an early symptom of medical supply's basic weakness ofinadequate personnel. Originally, the Supply Division consisted of two MedicalCorps officers and one enlisted man, but it was later augmented by a fewadditional officers, of whom several were untrained in medical supply work.
Within 10 months, there was a succession of four divisionchiefs. After Colonel Standlee was relieved to go to North Africa in the latterpart of August 1942, Lt. Col. (later Col.) Clarence E. Higbee, SnC, was chieffor a short period before being replaced by Lt. Col. Howard Hogan, MC. In July1943, Colonel Hogan was replaced by Col. Walter L. Perry, MC. These frequentchanges were not conducive to increasing effectiveness.
Early Functions and Purposes
The first task of the Finance and Supply Division was to computethe requirements for Operation BOLERO, the initial plan for the invasion ofEurope; this involved considering material available from British and U.S.sources, and acquiring the necessary depot space for storage and issue ofmedical supplies and equipment. Plans for medical care under BOLERO included arequisition of supplies and equipment needed to build up the United Kingdom as abase, and acquisition of supplies and equipment required for the assault on theContinent. Accordingly, material in the form of bulk stocks (resupply) and unitassemblies to match troop lists, plus reserve stocks, began to arrive in theUnited Kingdom by mid-1942.2
Operation TORCH
The Supply Division had barely started the development of BOLEROwhen it was assigned the difficult task of furnishing medical supplies andequipment for Operation TORCH, the assault on North Africa. This assignmentbegan in August 1942 and lasted until early 1943, when the Zone of Interiorabsorbed full resupply responsibility. During this period, all combat units,including medical units, embarking for the United Kingdom were furnished basicTOE (table of organization and equipment) equipment and a 15-day initial supplyof medical items.
Medical units equipped to meet the sailing schedules for theconvoys moving from England to Africa consisted of four 250-bed stationhospitals, one
2History of Medical Service, SOS, ETOUSA, From Inception to 31 December 1943. [Official record.]
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400-bed surgical hospital, three 750-bed evacuationhospitals, one 750-bed station hospital, two 1,000-bed general hospitals, onemedical depot company, and 22 medical maintenance units for resupply. To insureaccomplishment of this task, the Chief Surgeon established a special MedicalPlanning Group, consisting of Lt. Col. (later Brig. Gen.) James B. Mason, MC,Lt. Col. (later Col.) Clark B. Meador, MC, and Lt. Col. John Douglas, ADMS(British).
In fulfilling TORCH supply requirements, it was necessary tostrip many units, including operating hospitals, of major items of medicalequipment and vehicles. In addition, 30 incomplete medical assemblies in depotstocks were disassembled to build the hospitals required to support TORCH. Thistask was complicated by the fact that the personnel of the only medical depotcompany (the 1st) in the United Kingdom were dispersed to five differentlocations; also, the assembly of materiel for TORCH requirements had to beaccomplished concurrently with attempts to provide newly arrived hospitals andother medical units with their basic operating equipment. Inexperiencedpersonnel and a scarcity of stock and packing materials magnified supplyproblems beyond their normal dimensions, and preparations for TORCH were barelycompleted as the task force embarked.3
Procurement in the European Theater, 1942-43
Procurement of medical materiel from the British was a burden onthe economy of Great Britain, whose industrial sections were severely damagedafter 3 years of war. The available labor force was predominately older men andwomen, who, in addition to their jobs in industry, were engaged during off-dutyhours in civilian defense activities as ambulance drivers, wardens, policemen,and firemen. Industry was necessarily closely controlled by the government, withthe Ministry of Supply responsible for allocation of manufacturing facilities,manpower, and materials.
The Procurement Section, Medical Supply Division, was locatedin London within the office of the General Purchasing Agent, ETOUSA, which hadsupervisory responsibility for all procurement from British sources. While thislocation had some advantages, it hindered close liaison with the Requirementsand Requisitions Branch in Cheltenham.
In the first year of American participation in the war, 1942,serious shortages of military supplies, including medical items, persisted inthe European theater. Transatlantic shipping facilities were inadequate, andGerman submarines were taking a heavy toll. As a means of compensating for thoseserious handicaps, the British agreed to supply U.S. forces in the UnitedKingdom, wherever possible, through a reciprocal aid program, commonly calledReverse Lend-Lease.
The medical portion of this program was substantial andimportant. Through construction or use of existing buildings, the British notonly made available many hospitals (fig. 67), but also supplied a predeterminedlist of
3See footnote 2, p. 266.
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basic housekeeping equipment, including such items as beds,bedside tables, and mess equipment. Technical medical equipment for hospitals,furnished partly by the British and partly from the United States, was to beassembled within the ETOUSA medical depot system. Requirements for medicalmateriel, over and above the initial establishment of fixed hospitals, werecomputed by the Supply Division, and an additional demand was placed on theMinistry of Supply for those items which could be furnished from Britishresources. Otherwise, a requisition was sent to the United States. In doubtfulitems, the demand was duplicated in the U.S. requisition, but was subject tocancellation if the British agreed to accept the demand. This added proviso wasa manifestation of the prevailing uncertainty. Since acceptance at either sourcefrequently required several months, prolonged confusion and duplication werecommon.
Problems in Procurement
Although English was the common language, it was learnedgradually through experience that there were essential differences innomenclature of like items: GI cans were "dustbins" to the British;excelsior was "wood wool"; requisitions were "indents." Foralmost every item of medical mate-
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riel, British and American specifications were at variance.The same drugs often had different names and different unit packaging. Surgicalinstruments proved to be a problem as the design, weight, and balance wereunfamiliar to American surgeons and frequently were unacceptable. Some itemswere similar enough that they could be carried under the U.S. nomenclature andcatalog item number, but the majority had to be specifically identified asBritish. It was necessary to publish a British-American catalog of equivalentsand a list of acceptable British substitutes. These publications were preparedand published by the Supply Division under the guidance of the professionalconsultants to the Chief Surgeon, ETOUSA.
U.S. materiel requirements often represented fantasticquantities by British standards. As an example, initial U.S. demands for dentalburs were greater than the total annual British requirements for civil andmilitary needs. Conversely, some quantities were small compared to Britishallowances. Furthermore, requirements fluctuated with the continual alterationof plans, which was inevitable in a buildup of BOLERO's magnitude.
In July 1942, large requirements were placed on the British,to be delivered in increments from 1 August 1942 to 1 April 1943. In Septemberand October, further demands were made, with deliveries to be phased fromDecember 1942 to September 1943. Each new demand injected changes into previousones, creating much confusion. These requirements included not only supplies forhospitals and troops in the United Kingdom, but also many supplies for the NorthAfrican assault.
In early 1943, the general policy provided that itemsrequiring extensive labor in their production but a small amount of tonnage wereto come from the United States, whereas items with little labor and largetonnage were to be procured in the United Kingdom. By mid-1943, U.S. productionwas in high gear; shipping had increased, submarine sinkings were declining, anda number of items were excess to needs in the United States; hence, lists ofthese items were sent to the European theater so that United Kingdom procurementcould be curtailed. In several instances, it was discovered that the Britishwere securing items from the United States under lend-lease procedures whileU.S. forces in the United Kingdom were placing demands on the British for thesame items.
Late in 1943, deliveries of technical medical materiel fromBritish sources dropped off appreciably because of increased labor shortages andincreasing British needs to equip their own forces for D-day. Fortunately,shipments from the United States were constantly increasing during the latterpart of the year.4
4(1) Letter, Lt. Col. Howard Hogan, MC, to Deputy Chief Surgeon, ETOUSA, 14 Jan. 1943, subject: Data for Consolidated Annual Report of the Chief Surgeon's Office, SOS, ETOUSA. (2) Circular Letter No. 30 (Supply No. 5), Office of the Chief Surgeon, Headquarters, SOS, ETOUSA, 17 Sept. 1942, subject: Medical Supplies and Services Procured Under Reciprocal Aid (Reverse Lend-Lease). (3) Circular No. 1, Headquarters, ETOUSA, 4 Jan. 1943, section II, subject: Policy to Govern the Procurement of Supplies in the United Kingdom. (4) Annual Report, Supply Division, Office of the Chief Surgeon, ETOUSA, 1943.
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Approximately 75 percent of the total tonnage of medicalsupplies received by U.S. forces in the United Kingdom came from British sourcesin 1942, with only 25 percent from the United States. During 1943, almost 56percent of total tonnage received, including program C (housekeeping) items,came from the British (table 2).
TABLE 2.-Medical supplies for U.S. forcesin the United Kingdom from British and American sources,1942-44
| Date | From the | From the |
| (Ships tons) | (Ships tons) |
| 1942 (after 19 June) | 28, 000 | 84, 000 |
| 1943 | 56, 000 | 71, 000 |
1944 (to 19 March) | 40, 000 | 13, 000 |
| Total | 124, 000 | 168, 000 |
In retrospect, procurement of British medical materiel served a useful purpose in 1942 and 1943 when U.S. production was slowly getting underway and shipping was scarce. Moreover, it was helpful in supplying housekeeping equipment before D-day for fixed hospitals in the United Kingdom. Program C items, which were nontechnical, remained fairly stable, so that detailed specifications were relatively unimportant. Deliveries were usually made directly to hospital sites, thus avoiding depot workload; and the items were bulky, which resulted in the saving of ocean cargo space.
Because requirements and specifications changed frequentlyand deliveries made to depots came in all sizes of containers, production delayswere frequent, and recordkeeping was difficult. Lack of personnel in theprocurement section of the Supply Division also added to the problems.5
MEDICAL SUPPLY DEPOTS
Organization
With relatively few exceptions, U.S. depots in the UnitedKingdom were general depots, designated by the letter G, followed by a number, 1to 100, and jointly occupied by more than one technical service. The commanderof each general depot was a Quartermaster Corps officer, and the officer incharge of the medical section was known as the medical supply officer. Medicaldepots were designated by the letter M, followed by a number from 400 to 499.
Depots in the United Kingdom were located generally inexisting buildings made available by the British. The medical section of DepotG-20 was
5(1) Cable, ETOUSA (Lee) to AGWAR, 22 Apr. 1944, subject: Medical Supplies Obtained by Medical Service as Reciprocal Aid. Program C items, also called accommodation stores, included such articles as beds, mattresses, blankets, and sheets for the hospitals, and kitchen and eating utensils, as well as furniture for the use of the hospital staffs. (2) See footnote 4(4), p. 269.
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FIGURE 68.-Quartermaster Depot G-50, Taunton,Devonshire, England.
located in a brewery while Depot M-401 at Witney waslocated in a barnlike structure on the grounds of a blanket-weaving mill.Adaptation of the TOE depot company with a fixed allowance of officer andenlisted personnel to these depots of varying capacities presented a seriousproblem. The only type of unit available in the European theater for thispurpose was the medical depot company, organized under TOE 8-661 of 1 April1942, consisting of 16 officers and 227 enlisted men.
Depot Units and Operational Sites
The first medical supply installation in the United Kingdomwas established in May 1942 at Belfast by a section of the 8th Medical DepotCompany. In December 1942, this unit became the medical section of Depot G-10.
The first complete TOE medical supply unit in the UnitedKingdom was the 1st Medical Depot Company, which arrived in England on 13 July1942. Additional depot companies did not arrive in the theater for more than ayear. During the interim, the scattered medical depots in England were operatedby cadres of personnel from the 1st Medical Depot Company, augmented by attachedofficers and enlisted men. This situation was not conducive to good morale. Aspromotions for officers and enlisted men were based primarily on TOEauthorizations, only a few were awarded. During this period, some depots had asmany as 100 officers and enlisted men in a casual status attached for duty.
During 1942, five medical sections of general depots (fig.68) were established in England (table 3), with emphasis on dispersion becauseof the danger from air attacks.
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TABLE 3.-Medical depots and medical depotsections in the United Kingdom, 31 December 1943
Depot | Location | Date established | Storage space (square feet) | |
Covered | Open | |||
G-45 | Thatcham | 13 July 1942 | 87,840 | 28,500 |
G-20 | Burton upon Trent | 2 Aug. 1942 | 83,213 | 35,000 |
G-35 | Bristol | 12 Aug. 1942 | 171,000 | 0 |
G-14 | Liverpool | 1 Sept. 1942 | 127,791 | 15,000 |
G-50 | Taunton | 1 Sept. 1942 | 110,680 | 25,000 |
M-400 | Reading | 12 Feb. 1943 | 25,201 | 0 |
G-40 | Barry | 24 May 1943 | 52,275 | 15,000 |
G-16 | Wem | 27 May 1943 | 70,560 | 15,000 |
M-402 | Nottingham | 21 June 1943 | 46,045 | 14,500 |
G-30 | London | 1 July 1943 | 117,692 | 31,072 |
M-401 | Witney | 10 July 1943 | 84,833 | 0 |
G-22 | Moreton on Lugg | 20 Aug. 1943 | 67,200 | 48,600 |
G-15 | Boughton | 5 Nov. 1943 | 20,344 | 25,000 |
G-23 | Histon | 5 Nov. 1943 | 84,000 | 20,000 |
M-403 | Launceston | 2 Dec. 1943 | 87,000 | 0 |
M-410M | Moneymore, N. Ireland | 23 Dec. 19431 | 61,600 | 15,000 |
1Redesignated M-410M on 23 December 1943, originally G-10-1 established on 18 May 1942.
Sources: (1) Annual Report, Supply Division, Chief Surgeon'sOffice, ETOUSA, 1943. (2) Annual Report, Medical Section, General Depot G-35, 1944.
Immediately following their activation, the sections weresaddled with the mounting of Operation TORCH. Depot G-45 at Thatcham had themajor responsibility, functioning as the primary assembly and distribution depotfor medical supplies. The other four depots assisted by building unit assembliesand 22 medical maintenance units for Operation TORCH. The workload for the issueof 15 days' accompanying supplies to each unit was distributed among the fivedepots. Despite the extremely heavy workload, the task was completed in theallotted time.
Until the summer of 1943, the North African theater, as themore active combat theater, had a priority on shipments from the United States.However, establishment of depots in the United Kingdom (map 11) in preparationfor Operation OVERLOAD continued. During 1943, 10 new depots were establishedand their medical sections were set up by five new medical depot companies-the6th, 11th, 13th, 15th, and 16th (table 3). The 1st Medical Depot Company, whichhad borne the brunt of operating the depots, was gradually relieved by the newlyarrived units, and was withdrawn early in 1944 to prepare for its role insupport of the First U.S. Army.
With the exception of Depot M-400 at Reading, which was arepair and spare parts depot, and Depot G-45 at Thatcham, which had anassembly mission, all depots during 1942 and 1943 were responsible fordistributing supplies to units in assigned geographic areas. Many had, inaddition, other missions, such as receiving shipments directly from ports ofentry and from
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MAP 11.-Medical supply depots in the United Kingdom,December 1943.
British procurement, manufacturing unit assemblies, andstoring reserve stocks.6
Depot Operations
Inadequacy of storage space, inexperienced personnel, and thegeneral lack of knowledge of medical supply operations in the early days in theUnited Kingdom can be illustrated by describing the operations of the medicalsection of Depot G-35 at Bristol. The depot was established on 12 August 1942in a five-story chocolate factory with about 63,000 square feet of space and twoantiquated elevators, which were frequently out of service. The railhead wasabout 4 miles from the depot, necessitating movement of stocks by
6See footnote 4(4), p. 269.
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truck through the crowded city streets of Bristol. The depotreworked unit assemblies (fig. 31, p. 136) received from the United States,filling shortages with items received from British procurement. In October andNovember 1942, a 750-bed evacuation hospital, a 1,000-bed general hospital, anda 250-bed station hospital were assembled and shipped in support of OperationTORCH. WO (jg.) Lewis H. Williams wrote in 1944 of his earlier experiences:
Lt. Stohl placed me in charge of assembling this unit and theonly things I had to help me was one Basic Equipment List and a prayer. Believeme, I needed both of them, as no one in the Medical Section at that time had anyidea of the procedure used in assembling a Hospital, and no one even knew whatan assembled Hospital looked like.
In February 1943, the depot's mission was to supply unitsin the area. About the same time, it acquired 90,000 square feet of space in anearby four-story building (with a single elevator), which necessitated thephysical movement of considerable stock. Early in February 1943, the firstdepot inventory was taken and a stock record system was inaugurated.
By June 1943, the depot was supplying 40 units in its area inaddition to packing unit assemblies. During the year, it built, to varyingdegrees of completion, several medical maintenance units and final reserveunits, one 1,000-bed general hospital, and two 750-bed evacuation hospitals.During October and November 1943, the depot was receiving and processing from700 to 800 requisitions a month. Before November 1943, if a requisition couldnot be filled, the requesting unit was instructed to requisition again at alater date. In November 1943, a system of back orders was established and byFebruary 1944, more than 5,000 back orders had accumulated.
Personnel were assigned as casuals to the depot from variousunits. Changes were frequent, as evidenced by the seven medical supply officersassigned from July 1942 until March 1944. With each change came new methods andprocedures. Although the strength fluctuated, there was a gradual buildup; by 31December 1943, 5 officers, 94 enlisted men, and 91 British civilians were onduty. Maj. (later Lt. Col.) Charles I. Winegard, MSC, on becoming medical supplyofficer in March 1944, wrote:
* * * It was organized confusion * * * There was no depotorganization-it seemed as everyone was doing what he chose to do.Responsibilities were not defined. The stock record section was undermanned andthru lack of knowledge of procedures were causing themselves a great amount ofconfusion and overwork. The Shipping Section was located on the top or 4th floor* * * requiring all shipments to be moved to the top floor, assembled,and held there until shipped or called for, when they had to be taken to theground floor.
In spite of all its difficulties, Depot G-35 performedvaluable work in supporting Operation TORCH, in equipping units, in furnishingsupplies in operating hospitals, and in manufacturing assemblies. Basically, itsdifficulties, like those of the system as a whole before March 1944, stemmedfrom the necessity of operating with inexperienced and, for the most part,inadequately trained personnel.7
7(1) Annual Report, Medical Section, General Depot G-35, 1943. The quotations are from (2) Annual Report, Medical Section, General Depot G-35, 1944.
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EARLY PREPARATIONS FOR OPERATION OVERLORD
Preshipment Plan
During 1942 and early 1943, plans for invasion of theContinent from the United Kingdom base were rather nebulous. By the summer of1943, with the North African and Italian campaigns well under way, the plansfor the invasion of the European Continent-code name OVERLORD-acquired anoticeable firmness. Medical plans called for the use of the U.K. base not onlyfor mounting the operation and for supply during the first few months, but alsofor considerable fixed hospital support throughout the campaign.
As mentioned previously, the British were to furnish U.S.forces with 105 fixed hospital plants to house 94,000 beds, complete withhousekeeping equipment and some technical equipment. The Supply Division wasresponsible for equipping these installations and the medical units arrivingfrom the United States and for maintenance support of all fixed and mobileunits.
During the last half of 1943, OVERLORD buildup gainedmomentum as supplies and equipment were being shipped in increasing quantitiesfrom the Zone of Interior to the United Kingdom. Under the preshipment plan,medical units deployed from the United States arrived with only basic equipment,which consisted of just that equipment necessary for unit housekeeping andlocal sick call; for example, mess equipment, some office equipment and medicalkits, and one Medical Department chest No. 2.
The intent and theory behind this supply procedure werelogical, but the method of execution left much to be desired. Upon debarkation,units were immediately shuttled from the U.K. port to their destinations beforetheir basic equipment could be unloaded. To circumvent this problem of delay,port assemblies, consisting of one Medical Department chest No. 1, one MedicalDepartment chest No. 2 (fig. 69), one small blanket set, one splint set, and twolitters, were stocked as assemblies at ports of debarkation for issue to eachmedical treatment unit. These assemblies enabled medical units to provideemergency medical care for their own personnel and for personnel of surroundingunits upon reaching their destination. The original equipment of the units wasforwarded by the port medical supply representative as soon as it wasdischarged from the ship, and upon delivery and issue of full TOE, recipientsturned in their port assemblies. This procedure was frequently complicated,however, when all or portions of the equipment became lost in transit,particularly if units had included personal items.8
Shipment of Unit Assemblies
Unit assemblies for many units were to be shipped from theUnited States under the preshipment plan. Because most assemblies shipped fromthe
8(1) Larkey, Sanford V.: Administrative and LogisticalHistory of the Medical Service, Communications Zone, ETOUSA. Ch. VIII, Annex 8:Medical Plans, Mounting the Operation [OVERLORD], 1944. [Official record.] (2)See footnote 4(4), p. 269.
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FIGURE 69.-Medical Department chests Nos. 1 and 2,packed for shipment as part of a port assembly.
United States before 1944 were incomplete in varying degrees,this did not work out in practice. Many split shipments, in which parts of anassembly were placed in the holds of different ships, frequently arrived in theUnited Kingdom at widely separated ports. Often on arrival, parts of assemblieswere then shipped to different depots. Complete assemblies and split shipments,arriving in the United Kingdom, frequently were not recognized by the U.K.depots as components of unit assemblies. This led to component items beingpicked up on depot stock records and stored as bulk stock. Receipts of T/E(table of equipment) equipment for tactical units, the components of X-ray sets,and minor assemblies were treated similarly, meaning that components were placedin depot stock for issue. Stock status records and requirements computationssuffered as a consequence. This failure was directly related to unfamiliarity ofsupply officers with the marking and composition of unit assemblies and to thecomplex shipping documents.
Entreaties to curtail split shipments were made to ZI portsand to the Surgeon General's Office by cables and letters wherein the causesand problems were outlined. Reassurances were offered, but improvement was slowand
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sporadic. Maj. Abraham Freedman, MC, who had spent 5 weeks inthe United Kingdom as liaison officer from the Port Medical Supply Division, NewYork Port of Embarkation, recommended in his report of 22 March 1944 thatassemblies and sets should be bulk stowed in one hatch rather than beingdispersed throughout the ship. With the approval of the deputy port commander,as of 31 March 1944, this recommendation was put into effect, thus enabling thetheater to handle each hospital expeditiously at the port of debarkation.9
From the experience of the North African campaign, it waslearned that the use of colored markings on shipping containers led to themixing of medical bulk stocks with unit assembly components, which resulted inthe loss of assembly identity. This procedure was eliminated on unit assemblies,and a specific design was imprinted in the assigned color. This exception solvedonly one of the many problems concerning the unit assembly. It did not providethe rigid controls required for a unit assembly to remain intact from point oforigin to eventual destination.
Documentation for all shipments, including unit assemblies,was supposed to be airmailed from the ZI port of embarkation so as to arrive inthe United Kingdom well in advance of the shipment dissemination to depotsscheduled to receive the shipment. Tardy shipping documents, coupled with thefact that all component parts of a unit assembly rarely arrived at the receivingdepot at one time, made it difficult to keep an assembly segregated and intactwithin the depot, upon receipt. All of these factors allowed loose controls andled to reassembly of equipment for each medical unit; this was an unanticipatedworkload.
Depot stock records, moreover, were grossly inaccurate, notonly as to basic on-hand or inventory figures, but also as to the due-in anddue-out figures. This situation, in turn, meant that the consolidated theaterstock records in the Chief Surgeon's Office were also erroneous.10
Equipping First U.S. Army Units
The Commanding General, First U.S. Army, had been designatedas commander of U.S. forces for the Normandy assault. In September 1943, Col.(later Brig. Gen.) John A. Rogers, MC (fig. 70), Surgeon of the First U.S. Army,arrived in the United Kingdom with the advance party which included his deputy,Lt. Col. (later Col.) James Snyder, MC, and the medical supply officer, Capt.(later Lt. Col.) Kenneth E. Richards, MAC.
Shortly thereafter, the advance section was joined byadditional staff members from the United States and by a smallcombat-experienced cadre from North Africa. This cadre included Lt. Col. (laterCol.) William H. Amspacher, MC, who became the Surgeon's operations officer.The Surgeon,
9Quarterly Report, Port Medical Supply Division, New YorkPort of Embarkation, to Commanding General, NYPOE, 1 Jan.-31 Mar. 1944.
10(1) Personal letter, Brig. Gen. Paul R. Hawley, to Col.Francis C. Tyng, MC, OTSG, 8 Mar. 1943. (2) Personal letter, Brig. Gen. Paul R. Hawley, to Maj.Gen. Norman T. Kirk, TSG, 9 Sept 1943. (3) See ch. VIII, p. 203. (4) See footnote 4(4), p.269.
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FIGURE 70.-Brig. Gen. John A. Rogers.
with his staff, immediately tackled their herculeanassignment. Problems encountered in North Africa were carefully reviewed, andconsideration was given to detailed planning, to adjustments for inexperience,and to the adequacy of requirements estimates.
With this approach, the First U.S. Army Surgeon's point ofreference was anticipated casualties under assault conditions rather than troopstrength, with medical units being assigned greater missions than contemplatedunder the unit tables of organization and equipment. From a supply standpoint,this procedure permitted translation of estimated casualties into materielrequirements. The First U.S. Army developed augmentation lists of items, by typesof units, for incorporation into the organic equipment of First U.S. Armymedical units, including equipment of other technical services; for example,Engineer generators, Quartermaster tentage, and similar items. Although theseaugmentation lists were made final late in 1943, items were constantly added ordeleted as specific units underwent mission or organizational changes. Changesin assigned missions, changes in commanding officers, or augmentation ofprofessional capabilities greatly influenced materiel requirements.
The original augmentation lists and their justification withmateriel requirements were submitted to appropriate technical services. Inthose instances where requirements were approved but were not available in theUnited
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Kingdom, the technical service had to institute a specialproject to ship the item requirements from the Zone of Interior. The First U.S.Army, in estimating its needs, solicited the assistance of General Hawley andhis consultant staff.
Concurrently, all tactical medical units in the UnitedKingdom were furnishing medical service to neighboring units and participatingin maneuvers and training exercises which resulted in the consumption, loss, ordamage of supplies and equipment. Units, therefore, were constantly submittingrequisitions to maintain their mandatory 100 percent state of readiness.Although the quantities were unusually small, the requisitions increased theline-item workload at depots, virtually saturating the budding U.K. medicaldepot system. This further diminished the depots' ability to cope with T/E andaugmentation requisitions, with the equipping of hospitals in the UnitedKingdom, and with the assembly and reassembly program for OVERLORD.
The inability to obtain firm and reliable information on thestatus of its requisitions for organization and maintenance materiel was a greatconcern to the First U.S. Army. Confronted with the responsibility of reportingthe state of readiness of medical supply to support an invasion timetable, theSurgeon, First U.S. Army, frequently discussed the contingencies with GeneralHawley, thus maintaining excellent overall knowledge of ability to supportcombat.11
MOUNTING CONCERN OVER SUPPLY
The apprehensions of General Hawley regarding the medicalsupply situation began building in the fall of 1942. In a letter of 3 Novemberto The Surgeon General, the medical supply situation was pronounced critical.12Because of the unreliability of British sources and the failure ofcomplete units to arrive in the United Kingdom, it became necessary tocannibalize more than 30 hospital assemblies to complete the equipment for 11hospitals embarking on the North African operation.
Throughout 1943, General Hawley frequently corresponded withThe Surgeon General about the U.K. medical supply operations. The problem ofsupplying the First U.S. Army in addition to local units forced General Hawleyin December 1943 to state in a letter to Maj. Gen. Norman T. Kirk, The SurgeonGeneral, that the desperate situation was almost beyond hope. It was certainthat correspondence would never reconcile the differences between the SurgeonGeneral's Office's recapitulation of shipments to the European theater andthe quantities his supply division had recorded as received in the theater. Hehad pointed out that if his difficulties were not rooted in the ZI system, thenthey had to be in the ports, in his own supply organizations, or possibly in acombination of the three. Basically, General
11Annual Report, Medical Section, First U.S. Army, 1943.
12Letter, Brig. Gen. Paul R. Hawley, Chief Surgeon, SOS,ETOUSA, to The Surgeon General, U.S. Army, 3 Nov. 1942, subject: Medical Supply.
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Hawley's problems stemmed from an insufficiency ofqualified supply personnel, lack of stock, and inadequate systems andprocedures.13
VOORHEES MISSION
Rapid Survey
In January 1944, The Surgeon General decided that a teamshould visit the United Kingdom to survey the medical supply system. Headed byCol. Tracy S. Voorhees, JAGD, Director, Control Division, the team included Lt.Col. Bryan C. T. Fenton, MC (fig. 71), Chief, Issue Branch; Lt. Col. (laterCol.) Leonard H. Beers, MAC, Chief, Stock Control Branch, who were all from theSurgeon General's Office; and Mr. Herman C. Hangen, consultant to The SurgeonGeneral. Major Freedman, of the New York Port of Embarkation, accompanied theteam to survey U.K. port activities. The team, with orders for temporary dutyfor 60 days, arrived in London on 27 January 1944, and proceeded to visit thesupply division office in Cheltenham the next day.
After spending 2 days in Cheltenham studying each supplyfunction and evaluating the personnel handling each operation, the team visitedthe depots at Taunton and Bristol and the First U.S. Army Headquarters atBristol on the following 2 days. Colonel Voorhees then returned to London forconsultations while the others visited depots, hospitals, and ports.
Recommendations
On 6 February, the team reassembled in London to determine acourse of action as it was evident that recommendations for drastic changes hadto be made. The group realized that they could be subject to severe criticismfor making such recommendations after spending only a few days in the theater;however, it was clear that if more time was spent in verifying conclusions, itprobably would be too late to remedy the situation. Therefore, a meeting wasarranged for the morning of 8 February, when Colonel Voorhees and Mr. Hangenreported orally, from penciled notes, to General Hawley on the conclusions madeby the team over the weekend. The proposals were not experimental as the supplycondition in the theater closely paralleled those in the Surgeon General'sOffice and the U.S. depots 15 months earlier. The recommendations were patternedon the systems that had proved successful in the United States.
Depot Workloads
The first of the three recommendations concerned measures tolighten depot workloads. About 50 percent of depot work was expended in buildingassemblies and filling shortages of previously built assemblies, resulting in aneglected distribution function. Insufficient stocks did not permit a depot to
13Letter, Brig. Gen. Paul H. Hawley to The Surgeon General,U.S. Army, 7 Dec. 1943.
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FIGURE 71.-Lt. Col. Bryan C. T. Fenton, MC, Chief,Issue Branch, Surgeon General's Office.
assemble more than 75 percent of the materiel required for ahospital unit. Back orders on components for unit assemblies were piling up andunits were unable to obtain essential hospital equipment. Colonel Voorheesrecommended that unit assemblies totaling 37,000 beds be shipped complete fromthe United States, thus relieving theater depots of a substantial workload andalso providing more completely equipped hospital assemblies. This number ofbeds, together with those already assembled in the United Kingdom, would fullyequip all hospital installations required in the United Kingdom by 1 May 1944and those hospital units scheduled for movement to the Continent shortly afterthe invasion.
Similar difficulties were experienced in assembling medicalmaintenance units. Packing could not be standardized because stocks ofcomponents were not complete in any one depot. Proper packing material forwaterproofing and easy handling was not available, and the units being packed inthe United Kingdom consisted of 70 pounds of packing material and 30 pounds ofsupplies. It was recommended that the First U.S. Army and the Chief Surgeon'sOffice agree on the number of standard medical maintenance units needed and havethem shipped from the United States. Units shipped from
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the United States would be complete, amphibiously packed, andwith a larger proportion of the weight in supplies.
A third means of lightening the workload was to relievedepots of the additional tasks caused by British procurement. Many items ofBritish medical equipment and supplies had proved unsatisfactory as substitutesfor American products and generally were not acceptable to professionalpersonnel. British items were unlike their American counterparts becausevoltages differed, units of measure frequently varied, and packing wasunsatisfactory. The mission recommended cancellation or postponement ofdeliveries on British procurement except for those items which were in shortsupply in the United States. On deliveries of other than shortage items whichhad to be accepted, it was recommended that storage space should be obtained tohold those supplies in reserve rather than as active operational stock.
Changes in Supply System
The major deficiency in the supply system was the lack of anaccurate central stock control system. In numerous instances, one depot wasfound to have a surplus of an item while another had many back orders. Eachdepot took a monthly inventory, but, as there were no due-in figures and nouniform cutoff between inventory, issues, and due-ins among the several depots,these inventories were of little value. A weekly report on critical items, whosepreparation by the depots required much work, had insufficient data to be ofmuch value. A third report, a daily one on items reaching a minimum quantity,was unreliable as there was little relationship between minimum quantities andcurrent issues.
To correct this condition, installation of a stock controlsystem similar to that used in the Surgeon General's Office was recommended.This recommendation provided for a biweekly stock report from all depots whichwould be consolidated in the Chief Surgeon's Office. The consolidated stockreport would form the basis for computation of quantities to be requisitionedfrom the United States, to distribute incoming stocks to depots more accurately,and to control stock levels.
In medical supply, many important items on which quantitiesissued were very small had been widely dispersed upon receipt, making itdifficult to locate the item when needed. A key depot system was suggested,whereby certain depots would be given priority on incoming shipments on one ormore classes of items. It was decided that dispersion of stocks would belessened with a maximum of 20 percent of an item stock to be located in onedepot.
Another serious deficiency was found in the lack of controlof the levels of supplies and equipment maintained in hospitals and field units.Units, having attempted to obtain an item from one depot only to have it placedon back order, frequently went to another depot and secured the item while theoriginal depot furnished the back ordered item when it became available. Toovercome this system deficiency, it was proposed that an issue branch of theSup-
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ply Division develop stock levels for hospitals and fieldunits, control requisitioning, and secure returns of excess stock in the handsof units.
All depots needed rewarehousing to save space and to makestock more accessible. There was no standardization of storage methods. Eachdepot packed according to its own design and there was no knowledge ofamphibious packing methods that had been developed in the United States. Tocorrect these conditions, it was recommended that a depot technical controlbranch be established in the Supply Division to develop standing operatingprocedures and to supervise all depot operations.
Changes in Organization and Personnel
In neither the Supply Division nor in the depots were theresufficient personnel to handle the workload. Efforts were expended in meetingemergencies without any time remaining to install proper systems and plans.Personnel were unfamiliar with the many improvements that had been made insupply management in the United States during the previous year. To improve theorganization, it was suggested that the Supply Division be patterned on theorganization in the Surgeon General's Office. This organization would requirean additional 15 officers and 44 enlisted men for staffing the Supply Division.14
Approval of Recommendations
General Hawley accepted the proposals in their entirety. Ateleprinter conversation with the Surgeon General's Office was arranged for 10February, and a summary of the facts and conclusions was furnished, togetherwith a request for personnel by name to fill important positions in the supplyorganization. The Surgeon General's Office agreed to send the personnel,including Col. Silas B. Hays, MC, for Chief of the Supply Division. ColonelsFenton and Beers and Mr. Hangen went to Cheltenham on 14 February and proceededwith the reorganization, pending the arrival of Colonel Hays. Colonel Voorheesand Mr. Hangen returned to Washington in March while Colonels Fenton and Beersremained as permanent members of the Supply Division's staff.15
REORGANIZATION FOR INVASION
Personnel Reorganization
On 3 March 1944, Colonel Hays, formerly of the SurgeonGeneral's Office, was designated Chief, Supply Division, Chief Surgeon'sOffice, ETOUSA. The division had been reorganized into four branches-Administrationand Finance, Stock Control, Issue, and Depot Technical Control. The staff was
14Report, Col. Tracy S. Voorhees, JAGD, and others: Surveyof the Medical Supply Situation in the European Theater, January-March 1944.
15Report of Teleprinter Conference with Representatives ofthe Surgeon General's Office and the Chief Surgeon, ETOUSA, 10 Feb. 1944.
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increased rapidly from 16 to 32 officers while enlistedpersonnel increased from 47 to 84. Thirteen British civilians also wereemployed.
In addition to staffing the Supply Division in Cheltenham,two officers-Maj. W. A. King, SnC, and Capt. (later Maj.) Joseph B. Parks,MAC-with four enlisted men were attached to Headquarters, Advance Section,Communications Zone, at Bristol. Their function was establishing stock controlprocedures for operations on the Continent as the Advance Section assumedjurisdiction of rear areas.16
Depot System Realinement
Under the direction of Maj. Robert R. Kelly, MC, Chief of theDepot Technical Control Branch, four new depot companies (the 63d, 64th, 65th,and 66th) were organized under TOE 8-661, and five depot companies (the 6th,11th, 13th, 15th, and 16th) were brought up to TOE strength. One company, the8th, was deactivated. Because of wide dispersion of stocks in small medicaldepots and medical sections of general depots, it was impossible to employ anentire depot company at one location. As a result, depot companies did notoperate as a unit in the United Kingdom, but rather were employed as anadministrative headquarters for the assignment and control of their personnel.
Before D-day, there were, in addition to the companies justindicated, the 1st Medical Depot Company which was attached to the First U.S.Army, and four companies (the 30th, 31st, 32d, and 33d), which arrived in Apriland May 1944, for a total of 14 companies in the United Kingdom.
The 30th and 31st Medical Depot Companies were assigned tothe Medical Service, Headquarters, ETOUSA, and designated for CommunicationsZone operations on the Continent after the invasion was underway. The 32d and33d Medical Depot Companies were assigned to Third U.S. Army. The 13th MedicalDepot Company was also designated for subsequent move to the Continent as soonas U.K. operations permitted. A key depot system was established within thedistribution depots in the United Kingdom during March 1944 to overcomeexcessive dispersion of stocks, expedite the handling of requisitions, eliminatethe large quantity of back orders, and drastically reduce extracting ofrequisitions to the Chief Surgeon's Office. The key depot system effectivelyaccelerated the delivery of available supplies (table 4).
Key depots were given the highest priority for receipt ofstocks from the United States. They were stocked to 100 percent of their stocklevels before incoming receipts were distributed to non-key depots. Whereinsufficient stocks were received to fill key depot levels, the items wereprorated to each key depot.
Except for assemblies, units and installations requisitionedsupplies and equipment from designated area distribution depots, which virtuallyeliminated "shopping around" from depot to depot. When non-key depotswere out of stock, the item was extracted automatically to the key depot for thearea. When a key depot was out of stock, a back order was established so that
16Annual Report, Supply Division, Office ofthe ChiefSurgeon, ETOUSA, 1944.
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TABLE 4.-Key depot system, United Kingdom,1944
Depot | Location | Supplies |
Medical Section, G-20 | Burton upon Trent | All items except for spare parts, lamps, batteries, teeth, blank forms, and veterinary supplies. |
Medical Section, G-30 | London | Veterinary supplies and blank forms. |
M-400 | Reading | Spare parts, batteries, and lamps. |
Medical Section, G-35 | Bristol | Drugs, biologicals, surgical dressings, and instruments. |
Medical Section, G-50 | Taunton | Laboratory supplies; dental, X-ray, hospital, and field equipment. |
Medical Section, G-45 | Thatcham | TOE assemlies. |
shipment would be made upon receipt of stocks. Periodically, the Chief Surgeon's Office directed key depots to extract their back orders to other depots where the stock status report indicated that stock was available.17
Medical Depot Manual
To establish uniform operations in all medical depots, amedical depot manual was published by the Chief Surgeon's Office during March1944. This manual facilitated storage and issue operations and provided thebasis for a biweekly stock reporting system, which was the feeder report forcompiling the theater consolidated stock status report. Quantities due-in,quantities on hand, and back orders for each item were recorded on depot stockreports. The consolidated report was the basis for determining theaterrequirements and for preparing and submitting requisitions to the Zone ofInterior.18
Stock Control
The authorized theater stock level of 75 days consisted ofquantities required for 45 days of operation plus 30 days' stock as a reserveor safety level. At the beginning of March 1944, depot stocks were badlyunbalanced; numerous items were on hand on which stock was small or depletedwhile on others, the quantities exceeded 12 months' requirements.
One major objective of the Voorhees mission was theestablishment of modern merchandising procedure to control supplies and balancedepot stocks. This requirement was tackled immediately by Colonel Beers, amember of the Voorhees mission. A new system which included the use of electricaccounting machines was soon installed. Fortunately, machines for compilation ofmedical statistics were already in operation at Cheltenham. By being workedextra
17See footnotes 15, p. 283; and 16, p. 284.
18Medical Depot Manual (Tentative), Office of the ChiefSurgeon, ETOUSA, 21 Mar. 1944.
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shifts, these machines were able to assume the additionalload of stock control. An authorized level of supply was established for eachitem that was to be stocked in the theater with a reorder point. The reorderpoint was the authorized level of supply for each item plus lagtime (the lengthof time from the date of the requisition to the Zone of Interior until thesupplies were received in a theater depot and available for issue).
A study on the stock position of each item was made each 30days. When stocks on hand plus due-ins were below the reorder point, arequisition was placed on the New York Port of Embarkation for replenishment inan amount sufficient to bring assets up to the reorder point. Current stocklevels, which would permit flexibility and allow adjustments for changingconditions, were established by this method.
The theater stock level for each item was computed by usingthe authorized War Department replacement factor or, when this factor provedinaccurate, a theater replacement factor was computed on the basis of issueexperience. To the authorized 75 days' level of supply was added the lagtimefactor, averaging 105 days, to establish the reorder point. The reorder pointwas established at 180 days and the quantitative requirements were computed byusing the current troop strength for the requisitioning period. The product ofmultiplying the average troop strength by the replacement factor was thenmultiplied by the number of months for which the supplies were being computed toarrive at the reorder-point quantity. Under this system, theoretically, thestock on hand of each item would fluctuate between 45 and 75 days of supply.19
Stock Distribution
Stock levels for individual depots were based on the totaltroop strength served by the depot. Before the reorganization, there was nostipulated level of supply for each depot. In March 1944, realinement of stockswithin the U.K. depots to conform with the newly established levels under thekey depot system was accomplished virtually overnight. Depots submitted currentstock reports simultaneously, which were reviewed to determine the necessaryinterdepot transfers. Transfers were effected by trucks organic to medicalunits according to an exacting schedule that assured maximum payloads in eachdirection with a minimum of trucks and time.
Stock adjustments, sustained by accurate inventories plusimproved stock control and back-order procedures, quickly eliminated majorproblems in the inventory control system, except for problems connected withoverall stock imbalances. On 1 April 1944, stock status reports indicated that3,603 items were in the ETOUSA medical supply system. Quantities on handindicated that 1,473 items (41 percent) were in short supply, 214 items (6percent) were in good supply, and 1,916 items (53 percent) were in oversupply.
19(1) See footnotes 14, p. 283; and 16, p. 284. (2)Letter, The Adjutant General to Commanding Generals, all theaters, 20 Jan.1944, subject: Levels of Supply for Overseas Areas, Departments, Theaters,and Bases.
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Items in short supply were requisitioned from the UnitedStates and priorities were requested for prompt and early shipment. By 1 May1944, the stock position had changed materially and the buildup of stock levelswas underway. Reorganization of the stock control system had provided the ChiefSurgeon's Office with the means to determine the stock on hand and the normalrequisitioning requirements, and to control distribution of items in shortsupply. During May 1944, medical supply operations approached a near routinestate. In fact, except for a few last minute actions, there was a comparativelull in the Medical Supply Division, Chief Surgeon's Office, during the 10days immediately preceding the invasion, but the depots were still grinding outthe preplanned shipments for the buildup on the Continent.20
Resupply Requirements
Concurrently with the buildup of U.K. stocks in the spring of1944, planning for maintenance support of continental operations requiredimmediate attention. The Surgeon of the First U.S. Army was responsible fordetermining requirements for maintenance and replacement supplies for D-day to D+14, including Air Forces medical requirements on the Continent. The Surgeon,Advance Section, Communications Zone, was responsible for D+15 to D+41, with theSurgeon of the Forward Echelon Headquarters, Communications Zone, responsiblefor D+42 to D+90. Actually, representatives of the Surgeon, First U.S. Army,and the Chief Surgeon, ETOUSA, collaborated in this total work, inasmuch asneither the Advance Section nor the Forward Echelon was staffed with sufficientpersonnel experienced in stock control and requirements determinations.Computation and requisitioning of maintenance supplies and equipment wereparticularly difficult as only limited experience data were available for anoperation of this type. Estimated battle losses, shipping losses, and normalmaintenance based on casualty estimates were necessarily considered in computingrequirements.
Following D-day, the European theater was to be involved in adual logistical effort, with operations in the United Kingdom and those on theContinent being distinctly different in character. Separate maintenancerequirements had to be computed for each area. Those for the United Kingdom werelargely for fixed medical installations, such as general hospitals, while thosefor the Continent included the mobile units of the Armies as well as fixedinstallations in the Communications Zone. It was planned to support operationson the Continent from the United Kingdom for the first 90 days and then todepend largely on direct supply from the United States to continental ports.
Replacement supplies for D-day to D+14 were to consist ofautomatic shipments on a prescheduled basis from U.K. depots to beaches andports on the Continent.
Colonel Rogers, of the First U.S. Army, and his staffexamined the items in the standard medical maintenance unit in light ofanticipated casualties
20See footnote 16, p. 284.
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rather than the supplies required for a stated forcestrength. It was anticipated that peak casualties would occur during the periodwhen forces were numerically small. Moreover, it was determined that the type Astandard medical maintenance unit for 10,000 men for 30 days was inadequate anddeficient in various critical items. Additional maintenance lists developed bythe First U.S. Army included a divisional assault maintenance unit type D, whichhad two sections-one containing supplies to care for 1,000 medical casualtiesand the other having sufficient supplies for 1,000 surgical casualties-and asupplemental D unit containing supplies considered essential but not included,or insufficient in quantities, in the A and D units, to serve both as asupplement and a reserve. Divisional assault supplemental units carriedadditional quantities of material, such as plaster of paris, sheet wadding,cocoa, instant coffee, and medical gases, as insurance against extremeconsumption. Also developed was a type G unit containing supplies for treating1,000 gas casualties in the event that the enemy used poison gases.
In addition, bulk quantities of equipment were phased inwhich had not been included in other resupply units. Selection of the items thatcould possibly benefit the operation through D+30 was made by reviewing medicalunit assembly equipment lists and theater augmentation lists. Quantities, toa large degree, were governed by availability and by tonnage allocation. Someportion of each item was scheduled for arrival by D+5, but no attempt was madetoward uniformity of each day's shipment. Surprisingly, two of the items thatproved most beneficial were washing machines and sewing machines, which wereessential in maintaining the supply of linens, such as the towels and drapes forthe operating rooms.
Replacement of equipment lost or damaged by troops goingashore was also computed as a maintenance requirement. Except for airborneunits, it was estimated that 15 percent of the equipment would be lost on D-day,that troops going ashore by D+4 would lose 8 percent of their equipment, andthat by D+10, this factor would level off at a 5 percent loss factor.Airborne replacement requirements were estimated at 100 percent. These estimatesproved to be reasonably accurate.
Theater directives placed a responsibility upon the ChiefSurgeon to determine and provide automatic shipment of maintenance supplies,based on phased tonnage and priority allocations authorized for medicalsupplies, and the phased estimate of casualties by type. Requirements for D+15to D+90 were computed by the Supply Division, Chief Surgeon's Office.
Requirements for D-day to D+90 included 100 type Amaintenance units, 114 type D surgical units, and 22 type D medical units. Itwas intended that all type A maintenance units were to be assembled and shippedfrom the United States to the United Kingdom, but sufficient quantities did notarrive in time and many had to be built in U.K. depots at the last moment. The Dand the G units were assembled in U.K. depots.21
21See footnote 16, p. 284.
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Packing and Crating
The Voorhees mission discovered that the quantity andvariety of medical maintenance units included in First U.S. Army requirementsfor the assault imposed a significant packing and crating requirement. Also,training in the United Kingdom made it imperative that unit personnel open,inspect, become thoroughly familiar with, and repack, the equipment to be usedin combat (fig. 72). Because of the concentration of troops in the UnitedKingdom, OVERLORD medical units supplemented fixed medical facilities byproviding dispensary-type medical care to troops in the immediate staging ortraining areas.
For the reasons just stated, medical units, including smalldetachments and field and evacuation hospitals, opened their ZIwaterproof-packed equipment and supplies. The Voorhees mission realized that anexpanded packaging and crating program had to be generated swiftly in the UnitedKingdom under an experienced officer. Consequently, Capt. (later Maj.) WilliamB. Wagner, MAC, was recommended to The Surgeon General for assignment to theMedical Supply Division in view of his experience in developing the ZI depotpacking and crating program.
The ETOUSA packing and crating requirement had two separatefacets: first, accomplishment of the workload by depots in packingthe maintenance stocks and unit assemblies constructed in U.K. depots forshipment to the Continent; and second, instruction to unit personnel on packingtheir equipment for an amphibious operation. A scarcity of packing material anda narrow margin of time confronted Captain Wagner upon his arrival in the UnitedKingdom on 26 February 1944.
Waterproofing Boxes
An adequate supply of sisal paper, waterproof cement, lumberor boxes, nails, and binding equipment was a prerequisite to waterproofingsupplies. Since sisal paper and cement were not available in the United Kingdom,the program had to begin with available substitutes pending the arrival ofstocks from the United States. Binding and marking materials and acceptablewaterproof paper were available, which, together with hot tar and hot asphalt,served as alternatives. Careful reclamation of ZI fabricated boxes andinsulation material, augmented by box shooks and lumber obtained from theQuartermaster Corps, provided the balance of the required material. Someadditional material was obtained on the British market.
Skid Loads
To afford further protection to individual boxes of supplies,to facilitate handling in transit, and to prevent individual packages from goingastray, a skid-loading plan was developed which was patterned after that usedin the Mediterranean area. The skid consisted of a platform built from 2-inchlum-
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FIGURE 72.-Breakage of medical supplies on incomingshipments.
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ber to dimensions of 4- by 6-feet, mounted on two 6- by6-inch skids, which were tapered in sled-runner fashion. A heavy clevis wasattached to the front to aid towing. Skid loads were approximately 5 feet high,completely covered with canvas, and banded with one horizontal and threevertical 1?-inch metal bands. Slots were cut in the top of the skid runners toanchor the vertical bands and the load.
Processing Unit Equipment
Units anticipated the need for breaking out theirequipment, setting up, dismounting, and repacking for movement during combat.Mobility and the time factor would be particular problems for field andevacuation hospitals. Ordinary merchandise boxes would not suffice for repeatedpacking of equipment; a reusable container was required. Some units hadattempted to improvise by installing hinges and hasps on discarded ammunitioncases, rifle cases, and similar boxes. Generally, the improvised containers wereheavy, too small, and lacked permanent waterproofing features.
One of the first actions growing out of the Voorhees missionwas the dispatch of a cable to the Surgeon General's Office in February 1944for 10,000 Wherry boxes. Captain Wagner, working with the Wherry Luggage Co.,had previously promoted the development of a box that was permanentlywaterproofed, sturdy, lightweight, and equipped with nonprotruding handles,hasps, and hinges. The container was waterproofed by sealed seams and acombination of hasps and hinges which compressed the lid on four sides against afixed sponge, plastic, or rubber gasket.
The boxes, usually filled with supplies to conserve shippingspace, were requisitioned in February and began arriving in the United Kingdomduring March. They were distributed immediately to all medical units for therepacking of their equipment and supplies.22
Assembly for Prescheduled Shipment
By 1 May 1944, the maintenance supplies required for D-day toD+15 were assembled and packed on skid loads. All maintenance suppliesrequired for shipment to the Continent before D+60 were amphibiously packed towithstand wave action and 90 days of open storage. Many of these supplies werepacked in the Wherry boxes.
A total of 955 skid loads, approximately 725 long tons, wasassembled and scheduled for movement from specified depots to designated portsof preloading well in advance of D-day. Included in the skid loads were 30 typeA maintenance units, 92 surgical divisional assault units, 22 medical divisionalassault units, 30 divisional assault supplementary units, and 10 gas casualtyunits. An additional 2,400 skid loads of medical supplies were packed by U.K.depots and shipped to the beaches during the first 60 days of the invasion.
22See footnotes 14, p. 283; and 16, p. 284.
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Skid loads, although unwieldy and requiring a crane forloading and unloading, provided a means to keep a balanced functional supplyunit together during the early days of the invasion. Where there were surgicalneedles, there were always sutures; administration sets accompanied solutions.Instruments for surgical needs were kept together. Sufficient skids were builtfor the using units because many loads were eventually broken down, and theindividual items were placed in depot stocks on the Continent.23
Medical Tonnage Allocation
In planning the cross-Channel assault, combat elements andweapons commanded top priority in tonnage allocations and dictated the totalshipping space that could be assigned to supply support and for the buildup ofstock levels on the Continent. The allocation for medical supplies (notincluding unit equipment) was limited to 100 tons per week during the assaultphase.
In early April 1944, G-4, Services of Supply, directed eachtechnical service to submit a schedule showing the weight and cubage to beshipped to the Continent, based on the tonnage allocation for D-day and for eachsubsequent day to D+30, and identified with the shipping depot. Suchinformation was essential for determination of "goods wagon"requirements, rail shipping routes, traffic control, ship space, berthing ofvessels for preloading, and port of return for reloading of vessels.Unfortunately, the G-4 deadline for the technical service schedule came beforethe Medical Department could effect a final stock check and assign the totalassembly skid-loading program to depots. The skid-loading program had beenstarted by the Medical Department before the reporting date, however, and theexperience offered an excellent basis for calculating the weight and cubage ofdaily shipments. The shipping depot was not so easily determined.
Supplementary Means for Assault
The total calculated medical resupply requirements consistedof an average of .333 pounds per man per day up to D+51. The medical supplytonnage allocation priority during the assault phase, however, was considereddangerously close to the estimated requirement, leaving little margin for error.Moreover, Major Richards, the First U.S. Army medical supply officer, wasreluctant to assume that all allocated tonnage would arrive on the beaches asscheduled. Some alternate method had to be found to phase in auxiliarymaintenance supplies to assure support of the anticipated casualty rate duringthe first day of the invasion. As a result, new items were developed whichgreatly aided early medical support.
Mortar shell cases-The mortar shell case medicalpackage designed for the assault troops was comprised of a special waterproofedunit of medical supply which would float and would serve as a life preserver foran individual. A unit consisted of seven specially treated mortar shell cases,each of which
22See footnote 16, p. 284.
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contained several items (fig. 56, p. 234). These units wereissued as follows: one unit per infantry battalion, artillery battalion,chemical battalion, engineer battalion, and ranger battalion; two units perdivisional collecting company; four units per divisional clearing company; sixunits per medical battalion (Engineer special brigade). Additionally, unitswere loaded aboard every conceivable type of vessel moving to the far shorethrough D+5. Personnel on board were instructed to drop the units on the farshore or overboard close to the shoreline and to rely on the tide to carry themashore.
Assault vest and maintenance units-The assault vestwas merely a hunter's vest that the medical supply officer of the First U.S.Army had had fabricated to increase the carrying capacity of the medical aidmanduring the initial assault. The many-pocketed vest accommodated small medicalitems peculiar to the aidman's kit.
The two-man carry maintenance unit was designed to provide asubstantial quantity of fast-moving items to the medical units that accompaniedvarious assault forces. The items were packed in boxes that could be carriedashore and overland for a reasonable distance.
The purpose of these little units was to breach unforeseenweakness of the medical units' reserve supplies and to assure availability ofthe selected items through the first few days of the anticipated confusion. Theunits proved extremely valuable in the early hours of the assault because ofthe delay in unloading medical supplies. Many floating mortar cases were foundby the advance detachment of the 1st Medical Depot Company in establishing itsmedical supply dump on D+3.24
Army-Navy exchange units-Designed primarily asautomatic resupply of the property exchange items dissipated during the earlystages of evacuation to the United Kingdom, each unit consisted of 100 litters,320 blankets, 4 splint sets, 3 boxes of surgical dressings, and 96 units ofnormal human plasma. The proposed number of units precluded their movementwithin the space allotted to Medical Supply, so arrangements were made with theU.S. Navy to place one unit aboard each of the first 100 LST's (landing ships,tank) moving to the Continent. The Medical Supply Division was to find ways andmeans for delivering the remaining 200 units, which were moved as rapidly aspossible on hospital ships and other vessels embarking for the Continent.
Equipping First U.S. Army units with their authorizedequipment was the first major task during the buildup period. In February 1944,orders were issued by First U.S. Army Headquarters for a showdown inspection byall units to determine if any shortages of items were authorized by appropriatetables of equipment, tables of basic allowances, or by theater directives. Issueof equipment against unit shortages presented some problems. The heavy telephonetraffic, the lack of transportation, and the continued movement of units fromthe campsite to another in the United Kingdom made it difficult to placeavailable items in the hands of units within a reasonable period of time. To
24(1) Annual Report of Medical Activities, First U.S. Army,1944. (2) Annual Reports, 32d and 33d Medical Depot Companies, 1944.
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alleviate this condition, Major Richards arranged for the 1stMedical Depot Company to consolidate the shortage requisitions from all unitsfor presentation to depots and to pick up and deliver the items to the units.
The same method was used by Third U.S. Army's 32d and 33dMedical Depot Companies during April and May 1944. These companies, used asdistributing units in southern and central England, received and consolidatedrequisitions from units within their areas, presented the consolidatedrequisitions to depots, and picked up and distributed the supplies to the units.This procedure was eminently satisfactory as it reduced the pressure on U.K.depots and eliminated many distribution problems.
Problems Under the Preshipment Plan
The most serious problem on the preshipment plan was theshort period between the discharge of the cargo in the theater and the arrivalof the unit. The plan was predicated upon the arrival of the equipment at least30 days in advance of the unit, but changes in tables of equipment, frequentdelays in transit, and losses and damage to equipment caused many difficulties.Deficiencies in packing major items of equipment, such as X-ray, werefrequently experienced.
Constant reorganization of tables of organization andequipment of units by the War Department was a major problem. Frequently, theequipment was shipped under an old table of equipment while the personnel wereorganized under a new table. At times, the theater was not aware of the changeuntil the movement order for the unit was received identifying a new table ofequipment. This difficulty was eventually corrected by the establishment, withWar Department approval, of a list of T/E's, which were applicable in thetheater regardless of those listed in the War Department movement order. TheMedical Department promoted this method through G-4, Services of Supply.
Another difficulty during this period pertained to WarDepartment publications, including the Army Medical Bulletin, which oftenlisted and highly recommended various new items long before their availabilityin the theater. The Supply Division and depots were constantly besieged withrequisitions for such items, and professional personnel could not understandthe reasons for nonavailability of the item in view of the official publication.25
Augmentation Equipment for Units
Issue of field equipment to units was not complete, however,with the furnishing of initial equipment authorized by tables of equipment ortables of basic allowances. Supplementary lists of material for units andprovisional units had to be dealt with immediately. For the most part, medicalitems so authorized were filled from stocks available in the theater.
25(1) See footnote 16, p. 284. (2) Standing OperatingProcedure for the Issue of Initial Organizational Equipment to U.S. Forces inthe U.K., 28 Mar. 1944.
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An authorization for equipment in excess of tables ofequipment was established for such units as evacuation and field hospitals,infantry, airborne and armored divisions, convalescent hospitals, engineercombat groups, auxiliary surgical groups, and medical depot companies. As anexample, the medical battalion of the Engineer special brigade was authorizedX-ray and fluoroscopy units, oxygen therapy apparatus, anesthesia apparatus, andaccompanying auxiliary items. As this organization was to be the first medicalunit ashore in the assault phase, it needed the essential equipment to providemore definitive medical service.
During a similar landing operation in the Sicily Campaign, acritical need existed for X-ray equipment to determine the presence of shellfragments in wounds, and for inhalation anesthesia. The anticipated isolation ofairborne units from the main invasion body was another consideration infurnishing items in excess of allowances to those troops. Hence, missionrequirements became a determining factor in augmentation issues and inestablishing the need for additional quantities of medical supplies andequipment.26
Arrival of Third and Ninth U.S. Armies
When additional Army headquarters arrived in 1944, thetactical units were reallocated and each Army proceeded to determine its own T/Eaugmentations according to its mission and the Surgeon's estimate of thesituation. To some degree, this was equivalent to designing separate T/E's forthe medical units of each Army. Some complications resulted when units wereshifted between Armies before D-day, and a transfer of augmentation material wasnecessary. The three different standards for T/E supplementation suppliesnecessitated an increased line item stockage in Communications Zone depots.
The difficulties experienced in furnishing augmentationequipment to First U.S. Army medical units had some repercussions. Col. (laterBrig. Gen.) Thomas D. Hurley, MC, Surgeon, Third U.S. Army, contacted the SupplyDivision, Chief Surgeon's Office, immediately after his arrival in the UnitedKingdom with the advance party, on 23 March 1944, expressing anxiety overmedical supply. Before his departure from the United States, Colonel Hurley hadlearned of the Voorhees mission and the heavy supplementation program for FirstU.S. Army units, which caused him to question the capability of General Hawley'sSupply Division to render adequate medical supply support to Third U.S. Armyunits. It was necessary to assure the Third U.S. Army Surgeon that assets wereavailable and that the Supply Division was ready to support initial issue andsupplementary requirements. The same task was performed when Col. William E.Shambora, MC (fig. 73), Surgeon,
26Letter, Col. W. L. Perry, MC, Chief,SupplyDivision, Office of the Chief Surgeon, ETOUSA, to The Adjutant General(attention: Operations Division, War Department General Staff), 26 Oct. 1943,subject: Project No. 2, "Surg," Requisition A.287, 20 October 1943,for Auxiliary Mobile X-ray Units.
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FIGURE 73.-Brig. Gen. William E.Shambora.
Ninth U.S. Army, arrived in the United Kingdom with similarapprehensions.27
Supply of Units Reaches Peak
As preparations continued, all units became supersensitive tosupply problems and the Chief Surgeon's Office was flooded with requisitionsfor shortages. Requisitions were to be funneled through parent organizations inaccordance with theater directives. Despite these directives, the requisitionsof many units came directly to the Chief Surgeon's Office. Unfortunately, manyrequisitions were submitted before the units were alerted; then, upon beingalerted, units were instructed to hold showdown inspections and submitrequisitions for all items not on hand. Duplicate requisitioning resulted whenunits had not picked up the items at depots before submitting the secondrequisition. Furthermore, virtually every unit, regardless of size, submitted anumber of showdown requisitions before its departure from the United Kingdom.One division submitted 15 showdown requisitions within 18 days.
27(1) Annual Report, Medical Section, Third U.S. Army, 1944.(2) Annual Report, Medical Section, Ninth U.S. Army, 1944.
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The significance of these actions can best be exemplified bythe fact that U.K. depots were carrying hundreds of items on their shippingfloor awaiting pickup. Major Winegard, at Depot G-35, first brought thissituation to the attention of the Chief Surgeon's Office, ETOUSA, in lateMarch 1944 by reporting that he had more than 2,000 items awaiting pickup. Apolicy of early cancellation of all such shipments permitted recovery of manyitems in short supply.28
Availability of stocks ceased to be a major problem towardthe end of May 1944. It was necessary at times, however, to pick up equipmentfrom discharging vessels to fill shortages in organizational equipment forhigh-priority units. Also, it was necessary occasionally to divert equipmentfrom low-priority units to others of higher priority. The perpetual problemthroughout this period was transportation. Rail transport of less than carloadlots was impractical. As a consequence, all U.K. depots were instructed to shipto field units by truck and, wherever possible, to have the items picked up bythe organization. The First U.S. Army organized trucking companies intodistributing units for pickup and delivery of supplies to units after unittransportation had been processed for shipment to the Continent and was notavailable for this purpose.29
SUPPLY IN FIXED INSTALLATIONS
In fulfilling the supply requirement for new hospitals andbed expansion to meet the anticipated casualty load, it was necessary to resolvetwo major problems concerning the proper distribution of equipment.
Split shipment of unit equipment when it was loaded on two ormore ships in ZI ports and discharged at separate U.K. ports was the firstproblem. This dilemma had been the subject of much correspondence between theChief Surgeon, The Surgeon General, and the New York Port of Embarkation. Arepresentative of the port visited the theater with the Voorhees mission tostudy the problem, which apparently was resolved by the New York port in April,when shipments of unit assemblies began to arrive in the theater intact.
A second problem concerned the retention of all components ofthe unit assembly in one place for shipment to its destination. This handicaprequired action within the theater. A study was made of the availability ofhospital plant sites, and the plausibility of shipping unit assemblies from U.K.ports directly to operating sites. Except for those assemblies which were to bestored in depots pending transshipment to the Continent, direct shipment ofassemblies to operating sites would permit bypassing medical depots which wereheavily engaged in preparations for Operation OVERLORD.
Consultations with port commanders at Bristol, Cardiff,Newport, Swansea, Hull, and Liverpool, and with the Transportation Corpsestablished
28(1) See footnote 16, p. 284. (2) AdministrativeMemorandum No. 56 (Supply No. 11), Office of the Chief Surgeon, ETOUSA,29 Apr. 1944, subject: Supply Policies and Procedures.
29See footnote 16, p. 284.
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the feasibility of the plan, and a standing operatingprocedure was developed, placing the plan in effect. The Chief Surgeon'sOffice was required to notify port commanders of the identity of the unitassembly and the appropriate destination so that a timely levy could be made onthe Transportation Corps for rail transportation. Railroad cars were switchedonto quay side so that the unit assembly was discharged directly from ship tocar. Each port was staffed with a Medical Administrative Corps officer andseveral enlisted personnel to assist in maintaining the integrity of each unitassembly.
Because construction of the new hospitals was incomplete,unit assemblies were shipped directly from the ports to the hospital sites andstored there, pending availability of the buildings.
Medical depots sent representatives to the site to tally-inthe equipment, check it against shipping documents received from the port,arrange for proper storage and protection of the assembly, and, finally, turnover the equipment to the unit upon its arrival. This procedure operatedeffectively and in no instance was the opening of the hospital delayed becauseof lack of medical equipment.
Sixty-eight hospital assemblies were received from the Zoneof Interior between 30 March and 25 May 1944, comprising 53,300 hospital beds.These shipments included twenty-nine 1,000-bed general hospital assemblies andeight 750-bed station hospital assemblies required to complete thehospitalization program in the United Kingdom.30
Supply of Air Forces Units
Supply of Air Forces units differed from ground and serviceunits. Dispensaries at Air Forces bases were operated under the direction of theAir Surgeon although all hospitalization of Air Forces personnel was providedby station and general hospitals in Services of Supply. Distribution of medicalfield equipment and maintenance supplies to Air Forces units was effected byaviation medical supply platoons, which drew their supplies from the U.K. depotsystem.
Problems between Air Forces authorities and General Hawleyover the equal distribution of supplies was the subject of many letters to TheSurgeon General during 1943. However, after numerous conferences, stocks in theU.K. depot system reached a reasonable level in mid-April 1944, and there werefew difficulties in furnishing support for Air Forces units.31
Special Supply Projects
Furnishing organizational equipment to units, including itemsin excess of allowances, did not completely fulfill the need for essentialequipment
30Memorandum, Maj. Gen. LeRoy Lutes, GSC, Directorof Plans and Operations, Army Service Forces, to Maj. Gen. Paul R. Hawley,29 Apr. 1944, subject: Medical Supplies; and 1st Indorsement thereto, 1 May1944.
31Link, Mae Mills, and Coleman, Hubert A.: MedicalSupport of Army Air Forces in World War II. Washington: Office of TheSurgeon General, U.S. Air Force, 1955, pp. 563-565.
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required for the medical care of anticipated casualties onthe Continent. The nature of the assault, a combined amphibious and airborneoperation, the magnitude of the troop strength, and the anticipated resistanceby enemy forces caused planners in the Chief Surgeon's Office and in the Firstand Third U.S. Armies to request additional equipment for medical supportpurposes.
PROCO Projects
A group of projects, established under the direction of G-4to support operations, were known as PROCO (Projects for ContinentalOperations) projects, which included medical as well as other technical servicesequipment required by medical units. These projects included the mounting ofX-ray equipment on trucks to provide six mobile X-ray units for support of theFirst and Third U.S. Armies, the provision of equipment for establishing bloodbanks in the United Kingdom and on the Continent, and the equipping of vehicleswith medical items for mobile surgical units. PROCO requirements for tentage,32tent stoves, and other items of hospital equipment rose steadily as D-dayapproached.
SUPPLY POINTS IN MARSHALING AREAS
Advance supply points, operated by detachments of the 66thMedical Depot Company, were established at Dorchester, Totnes, and Plymouth inthe Southern Base Section to support units massing for the assault. Three supplypoints were established also in hospitals at Govilon, Carmarthen, and Rhyd Laforin the Western Base Section, which played a lesser role in marshaling troops(map 12).
These supply points furnished initial equipment and suppliesto camp dispensaries and first aid stations. They also served as resupply pointsfor field hospital's and other medical units in the area. Small quantities ofequipment were made available at these points for units passing through themarshaling area. All embarking troops were provided with motion sicknesspreventive capsules.
The supply points had several postinvasion responsibilities,including storage and issue of penicillin and whole blood to area fieldhospitals, hospital carriers, and LST's returning to the Continent afterdischarge of casualties. Dumps for issue of exchange items were established inthe proximity of ports and quays.33
32Letter, The Adjutant General to Commanding General, NewYork Port of Embarkation (attention: Oversea Supply Division); TheQuartermaster General (attention: Military Planning Division, Operations Branch); Chief of Transportation (attention:Water Division, Ocean Traffic Branch),14 Apr. 1944, subject: Additional Tentage for Medical Project No. 5 "SURG"for the European Theater of Operations.
33(1) Annual Report, 66th Medical Depot Company, 1944. (2) Medical Department, United States Army. Blood Program in WorldWar II. Washington: U.S. Government Printing Office, 1964, pp. 531-534.
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MAP 12.-Supply points in marshaling areas, UnitedKingdom, May 1944.
ITEMS HAVING SPECIAL SIGNIFICANCE
Although the perplexities in equipping units and fixedinstallations and in establishing an adequate supply system absorbed the majorefforts of the Chief Surgeon's Office and the depots, some individual items,because of their characteristics and importance, required special handling ordifferent procedures. As each item required professional and technical guidancefrom the consultants to the Chief Surgeon, the procedures varied on the basis ofthe professional application or item characteristics.
Whole Blood
The Chief Surgeon directed that whole blood for treatingcasualties would be available at all evacuation echelons down to, and including,division clearing stations and that the shipment of this perishable productwould be handled through supply channels.
As a result, the First and Third U.S. Armies were authorizedto establish whole blood sections in their medical depot companies and torequisition the necessary equipment and personnel.
Plans provided for maintaining a supply of whole blood at thequays and ports for issue to LST's and hospital carriers for shipment to theContinent as well as for use during the evacuation of casualties.
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FIGURE 74.-Whole blood on its way-the first day of the"milk run to the Continent," 14 June 1944.
High priority air shipments of whole blood to the Continentwere arranged by G-4, Services of Supply, and 4,000 pounds of critical medicalsupplies were airlifted to the Continent daily (fig. 74). The medical section ofDepot G-45, 3 miles from the airfield at Greenham Common and 38 miles from theETOUSA Blood Bank at Salisbury, was the receiving and shipping agency. 2d Lt.(later Capt.) Robert E. Pryor, MSC, the officer in charge of air shipments,demonstrated initiative and ingenuity, a major contribution in moving many tonsof critical medical supplies to forward areas during the early days of invasionand, later, on the Continent.34
Penicillin
In addition to whole blood, the item that had a dramaticimpact on the care of casualties was penicillin. Early in 1943, the Europeantheater began receiving small quantities of this antibiotic. A professionalcontroversy ensued
34(1) Medical Department, United States Army. BloodProgram in World War II. Washington: U.S. Government Printing Office, 1964, p. 479. (2)Memorandum, Brig. Gen. Paul R. Hawley for Commanding General, SOS, 26 Nov. 1943,subject: Provision of Whole Blood for Battle Casualties. (3) Letter, Lt. Col.Richard P. Fisk, Asst. Adjutant General, to Commanding General, First U.S. ArmyGroup, 2 Jan. 1944, subject: Provision of Whole Blood for the Medical Service.
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because penicillin had not been tested adequately and itspotency period and prophylactic and therapeutic actions were not fully known.Moreover, the lack of experience concerning the proper storage and preservationof penicillin created some problems. During most of the war, it was stored underrefrigeration in the belief that this would lengthen its potency period.
Not until April 1944 was the supply of penicillin ample tomeet requirements; in June 1944, authority was granted to medical units toobtain the item through normal requisitioning procedures. General and evacuationhospitals were authorized stock levels of 100 ampules; station and fieldhospitals, 50 ampules; and dispensaries, 10 ampules. Plans were established forthe automatic daily shipment of 3,000 ampules of penicillin to the Continentbeginning on D-day. The daily quantity was increased to 5,000 ampules at D+17.
As the production of penicillin was accelerated in the UnitedStates, ETOUSA requirements expanded, as evidenced by the quantities receivedand requisitioned. A total of 3,500 ampules were received in March 1944, whichincreased to 15,000 during April and to 30,000 in May. Requisitions weresubmitted to the Zone of Interior for 550,000 ampules for June delivery and800,000 ampules for July. On D-day requisitions were submitted to the Zone ofInterior for 900,000 ampules for August loading and 1 million vials forSeptember loading.
Because of the meager production of penicillin in the UnitedStates in its earlier days, close control on its use was necessary. The ChiefSurgeon's Office, on 16 September 1943, issued instructions as to storage,issue, and administration of penicillin, limiting its use to three main groupsof cases in which the antibiotic was of greatest value. The cases indicated werethose in which life was threatened by an overwhelming infection; those which,though not immediately life-endangering, showed symptoms of acute or chronicinfection not curable by usual treatment procedures; and cases of chronicgonorrhea that were resistant to sulfanilamide. For the latter group and forchronic diseases not endangering life, outdated penicillin could be used, butshould be so noted on clinical records.
The dramatic effect of penicillin had even diplomaticreverberations. A stock level of 200 ampules was established at the medicalsection of Depot G-50 for issue to allied embassies and missions. This levelwas reduced later to 20 ampules as the need was not so great as anticipated.35
35(1) Informal routing slip, Chief Consultant in Surgery, ETOUSA, to Chief, Professional Service, ETOUSA, 15 Jan. 1944, subject: Attached Reportby 2d Lt. R. S. Kribs; and attachment thereto, dated 11 Jan. 1943. (2) Administrative MemorandumNo. 97, Office of the Chief Surgeon, ETOUSA, 21 June 1944, subject: Supply of Penicillin.(3) Letter, Col. S. B. Hays, MC, to Col. R. E. Hewitt, MC, Executive Officer, Supply Service, OTSG, 13 May 1944. (4) Informal routing slip, Office of the Chief Surgeon, ETOUSA, Supply Division, toChief, Professional Service, 23 June 1944, subject: Increase in Requirements of Penicillin. (5)Letter, Col. S. B. Hays, MC, Office of the Chief Surgeon, ETOUSA, to The Surgeon General (attention:Col. [Edward] Reynolds), 6 June 1944, subject: Request for Penicillin. (6) Informalrouting slip, Office of the Chief Surgeon, ETOUSA, Supply Division, to Executive Officer, Office of the ChiefSurgeon, ETOUSA, 7 June 1944, subject: Penicillin for Diplomatic Demands.
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Spectacles
Although Army and Air Forces personnel were issued spectaclesto correct visual acuity deficiencies before their deployment from the UnitedStates, there remained in the United Kingdom a large and increasing workload forreplacement and repair of spectacles.
Optical units of the medical depot companies wereconsolidated in 1943 into the ETOUSA Base Optical Shop at Blackpool. As thebuildup of the invasion forces progressed, the spectacle workload increaseduntil June 1944, when a total of 15,000 pairs of spectacles were fabricated, notincluding approximately 225 pairs per month of bifocal spectacles procured fromTheodore Hamblin, Ltd., in England. A total of 40,400 pairs of spectacles werefabricated in the first 5 months of 1944.
During this period, plans were developed to establish a baseoptical shop on the Continent and one for each medical depot company designatedfor continental operations. There was to be a mobile optical repair unit in thebase platoon and two portable optical units in each of the advance platoons.Experience by the British in North Africa and Italy and by the Fifth U.S. Armyin Italy indicated that facilities for repair and maintenance of spectaclesshould be provided to the Armies as far as possible, preferably in combatdivision areas.
The 1st, 11th, 13th, 15th, 30th, 31st, 32d, 33d, and 66thMedical Depot Companies each activated one mobile optical unit, consisting ofone officer and six enlisted men and two portable optical units of two enlistedmen each. The Base Optical Shop was responsible for determining that opticalpersonnel were adequately trained to function under field conditions and thatequipment was ready for operations.36
Gas Mask Inserts
Gas mask lens insert fitting cases were stocked by the ETOUSA Base Optical Shop and distributed to station and general hospitals inthe United Kingdom designated by the theater chief consultant on ophthalmologyto function as centers for fitting of inserts. Personnel requiring lens insertsreported to the nearest fixed hospital with their spectacle prescriptions andtheir properly fitted lightweight service gas masks for appropriate fittings.37
Artificial Eyes
Supply of artificial eyes was another item that requiredspecial procedures. During 1943 and early 1944, artificial glass eyes wereprocured by sub-
36(1) ETO Base Optical Shop. [Official record.] (2) Letter,Chester E. Rorie to Dr. Derrick T. Vail, Professor of Ophthalmology, Northwestern University, 3Apr. 1946. (3) Letter, Capt. C. E. Rorie, SnC, Commanding Officer, ETO Base Optical Shop, toCol. Derrick T. Vail, MC, OTSG, 9 Sept. 1944, with inclosure.
37Medical Department, United States Army. Surgery in WorldWar II. Ophthalmology and Otolaryngology. Washington: U.S. Government PrintingOffice, 1957, p. 117.
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mitting requisitions to the British Ministry of Pensions,with patient fittings arranged at the most convenient optical appliance depot.
In 1944, following the development of the acrylic eye, 13dental officers were trained in fabrication of the eye and then stationed at 13general hospitals in Great Britain. The material for acrylic eyes was generallyprocured from the British through reciprocal aid procedures. The Chief Surgeonissued instructions to all medical facilities that artificial eyes would beavailable in two types: the glass eye, and the acrylic or plastic eye.Instructions indicated that acrylic eyes were preferred and that patients shouldbe transferred as early as possible after enucleation of the eye to the nearestgeneral hospital that had dental officers trained in the construction of acryliceyes. In 1944, the Base Optical Shop stocked glass eyes and furnished hospitalswith an assortment of eyes from which the medical officer could select thecolor and size for each patient.38
Blank Forms
Because the chief of the Medical Supply Division consideredit essential to coordinate all requirements for certain basic nonmedical itemsfrom other supply services, 2d Lt. (later Capt.) Russell S. Kribs, MAC, wasappointed to coordinate blank form requirements with The Adjutant General. Theseforms, including emergency medical tags which were placed on casualties,clinical records, and laboratory and X-ray report forms, were essential forproper medical care and evacuation of patients.
Having been informed by Lieutenant Kribs that the stock levelof forms was seriously low, The Adjutant General transferred theresponsibility for these forms to the catalog and equipment list section of theMedical Supply Division. Those forms not available were sought in the Zone ofInterior, and small air shipments were made to temporarily sustain the U.K.operation. Local production of forms was imperative although the section'sprinting capability was concentrated in two borrowed and badly worn GestetnerMimeograph machines and a small supply of low grade sulfite Mimeograph paper.
A survey of local procurement sources revealed that neitherpaper nor time was available to print the thousands of forms required to supportcontinental operations. Lieutenant Kribs' appeal to friends in theQuartermaster section elicited four new Gestetners and a limited amount ofpaper. Through scrounging efforts and trading of two borrowed Gestetners andother less essential equipment for paper, production rapidly reached the U.K.consumption rate, but there were countless complaints about the quality of theprinting and the paper.
To improve the quality of the forms and to increaseproduction, a Multilith offset printer was "borrowed" from the AirForces, and needed plates
38(1) See footnote 36(1), p. 303, (2) Medical Department,United States Army. Surgery in World War II. Ophthalmology andOtolaryngology. Washington: U.S. Government Printing Office, 1957, pp. 108-110.
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were obtained on a loan basis from the Multigraph Corp.Paper was also obtained from AG Publications in exchange for "machinetime."
After shifting of personnel and many minor trials, theinitial requirements for medical forms were delivered to the First U.S. Armymedical supply officer for distribution 3 days before D-day.39
FIRST U.S. ARMY SCHEME OF SUPPLY IN COMBAT
Increase in Supply Levels
The First U.S. Army Surgeon considered the standard equipmentlists for field and evacuation hospitals and the tables of equipment fordivisional and smaller medical units as insufficient for those units supportingthe early assault because of the chance of temporary isolation. With that inmind, certain hospital expendables were increased from a 10-day to a 15-daylevel and all other medical units in the assault were raised from a 3-day to a5-day level. Without a counterbalance, the increased weight and cubage wouldhave violated the shipping allocation for tactical hospitals and exceeded thecapacity of organic transportation of all other medical units. Every means toreduce weight and cubage was exploited.40
Resupply Plans
Resupply plans indicated that from D-day to D+14, 2 days'supply of essential items would be available on the beaches, building up withthe various types of maintenance units to 7 days of supply by D+20. In addition,there would be the bulk shipments of critical items on which abnormalconsumption rates were expected-litters, blankets, surgical dressings, andother items to be laid down in the LST Army-Navy exchange units. Also, gascasualty maintenance units were to be delivered to the far shore and held inreserve by the 1st Medical Depot Company. If not used, they were to be turnedover to Communications Zone depots when the depots arrived on the Continent.41
Plans for Operation OVERLORD
All divisional units were to inform the division medicalsupply officer of their requirements, and he would consolidate divisionalrequirements and draw in bulk from the nearest Army medical supply installation,for breakdown and reissue to divisional units. Other units were to drawdirectly from the nearest medical supply points. Requisitioning was to be on aninformal basis, and oral requests would be acceptable. During emergencies, unitsnormally would use their own transportation to pick up medical supplies, butwould be
39See footnote 16, p. 284.
40Report of Operations, First U.S. Army, 6 June 1944-1August 1944. [Official record]
41(1) See footnote 16, p. 284. (2) Larkey, Sanford V.:Administrative and Logistical History of the Medical Service, CommunicationsZone, ETOUSA, Appendixes 3 and 5. [Official record.]
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supported by corps, army, and depot transportation wheresituations warranted such action.
Medical Department items in need of repair and maintenancewere to be turned into the base section of the depot. All generators would bemaintained by the Engineer maintenance companies.
Captured enemy medical supplies and documents were to bepreserved and reported to the Army medical supply officer, who would receivesamples of lots of biologicals and vaccines, for use in the care of prisonersof war and German civilians.
Although the blood detachment was attached to the depotcompany, it would be based with the major medical unit nearest the servicingairstrip. Deliveries of blood were to be made daily, upon receipt of the blood,based on premapped routes, and in quantities commensurate with the casualtyload of each medical unit.42
APPROACH OF D-DAY
Except for those depots scheduled for the rearmost phasings,U.K. medical depots had virtually completed the assembly of automatic supplyshipments by May 1944. Many prepackaged units of supplies were on their way tosouthern ports, with some already preloaded aboard ships. By 1 June, the supplypoints to support embarking troops were established and stocked as preinvasionactions were virtually completed.
General Hawley, in a letter to General Kirk on 3 June 1944,wrote:
We are all set for the kickoff and I, personally, feel asnervous as players usually feel just prior to the whistle. I have just completeda tour of inspection of all of our field hospitals and evacuation hospitalson beaches and hards and all the transit hospitals which will first receivecasualties from overseas. The arrangements are everything that I could desire.You would be very pleased to see the fine mobile units and how they are set upfor business. We have just barely squeaked through on our supply situation. Ishall not, however, breathe really easily about it for another month.
In a relatively short time, the actions taken by the SurgeonGeneral's Office, with their genesis in the Voorhees mission, had transformedmedical supply from an understaffed, floundering system in an untenableposition, to a proud and well-integrated organization that could detect itsproblems, and take the necessary and swift corrective action.43
42See footnote 4l(2), p. 305.
43Personal letter, Maj. Gen. Paul R. Hawley, to The SurgeonGeneral, 3 June 1944.
