A HISTORY OF WARTIME RESEARCH aND DEVELOPMENT OF MEDICAL FIELD EQUIPMENT by John B. Johnson, Jr. 1st Lt., M.A.C. and Graves H, Wilson. 1st Lt., M.a.C. (This is not the final form in which the subject of research and development of medical field equipment will be covered in THE HISTORY OF THE MEDICAL DEPARTMENT DURING WORLD WAR II. This monograph has not been reviewed by the Historical Division, 'War Department Special Staff.) WAR DEPARTMENT OFFICE OF THE SURGEON GENERAL 30 June 194-6 TABLE OE CONTENTS List of ALL re vi at ions Used in Footnotes •• »• xiii List of Illustrations »•. * ». • ♦. xv PART II - MEDICAL DEPARTMENT VEHICLE PROGRAM Chapter V Truck,. 6 -x 5,. Surgical • ' 295 Chapter VI The Army Mobile Medical Laboratory 354 Chapter VII The Mobile Dental Laboratory . 407 Chapter VIII Truck, 2-|-Ton, 6x6, Optical Repair Unit • * . • '. 444 Chapter IX The Mobile Dental Operating Unit 9‘ 486 Chapter X Truck,,2^-Ton, 6 x 6, Surgical Operating •. *. * • • . 534 i Chapter XI Comparative Summary and Analysis •' 578 Appendices * *. •- • - 636 LIST OF ABBREVIATIONS- USED IN FOOTNOTES A. G. (or T. A. G.) The Adjutant General A. G. F, Army Ground Forces a. G. 0. Office of The Adjutant General A. M. C. Army Medical Center A. M. P. 0. Army Medical Purchasing Office A. M. R. & D. Bd. Array Medical Research and Development Board A. S. F. Army Service Forces CBI China-Burraa-India Theater of Operations, United States Army G* G. (or T. C. G*) The Commanding General ETO (or ETOUSa) • European Theater of Operations, United States Army PM Field Manual M. D. E. L. Medical Department Equipment Laboratory M. D* T. C* Medical Department Technical Committee M. F. S. S. Medical Field Service School NaTOUSA North African Theater of Opera- tions, United States Army 0. Q. M. G, Office of The Quartermaster General POA ' Pacific Ocean Area P. 0. E. Port of Embarkation S. G, (or T. S. G.) The Surgeon General S. G, 0. Office of The Surgeon General S. 0. S. , Services of Supply SWPA Southwest Pacific Area T/o & E Table of Organization and Equipment W. D. G. S, War Department General Staff W, P. B* War Production Board xiv RESTRICTED LIST OE ILLUSTRATIONS • -i Part II - Medical Department Vehicle -Program Figure Following Page 21 Exterior View of Surgical Truck Improvised 1Sy First Armored . Division .* ... • .♦ *302 - • 22 Interior Vifew of-Surgical Truck Improvised "by First Armored < ' •* Division . * .*■;;•.* • , • 302 ♦ ** . *;<5 J v . 23 Exterior View of Medical Depart- • , * ment Surgical Truck. . , :r>.* * ,* 320 ♦ f , • r ‘ 24 Interior View of Medical Depart- ment Surgical Truck ., , 320 25 Exterior View of Army Medical Laboratory Truck,* * .* .* , * 3S1 25 Interior View of Army Medical Laboratory Truck., .. 391 27 Exterior View of Dental Labora- tory Truck .* , ,* 426 23 Interior View of Dental Labora- tory Truck , ,* , 426 29 Exterior View of Optical Repair Truck ,* 473 30 Interior View..#f Optical Repair Truck , . * .* 473 Figure Following Page 31 Exterior View of Dental Operat- ing Truck (Medical Department Model) •••♦*♦. 505 32 Interior View of Dental Operat- ing Truck (Medical Department Model) .•«••••• 505 33 Exterior View of Dental Operat- ing Truck (Army Air Forces Model) « 517 34 Interior View of Dental Operat- ing Truck (Army Air Forces Model) * 517 35 Mobile Surgical Operating Uniti 1 Truck, Tent, and Trailer • • • • 551 36 Interior View* of Service Test ’ . Model, Surgical Operating Truck 551 37 Interior View of Tent for Surgical'. Operating Truck * « •* ; • 551 ' XTi PART II MEDICAL DEPARTMENT VEHICLE PROGRAM • CHAPTER V ; i TRUCK, 2-y-TON, 6x6, SURGICAL I. Introduction; The Armored Division. Once the potency of the armored division had been demon- strated by the early successes of the German panzer divisions and once the counterpart of these enemy units had been adopted as an integral part of our fighting forces by the American high command, the Medical Department of the United States Army was immediately challenged to devise means to fulfill its mis- sion of providing close medical support for the highly mobile Armored Force, As viewed in this study, the first apparent evidence that the Medical Department quickly accepted its new responsibility is to be found in its provision of a tentative table of organ- ization, dated 19 July 194-0, for an armored medical clearing company—Table of Organization 8-78P, which was shortly super- seded by the publication on 1$ November 194-0 of Table of Organ- ization 8-78, Medical Company, Clearing Battalion, Armored This organization consisted of a company headquar- ters and two clearing platoons? and for transportation it was authorized the following standard Quartermaster vehicles Motorcycle, solo , 4- Trailer, tank, water, 250-gallon 2 Truck, -jr-ton, command 5 Truck, 2^ton, cargo, including 18 Kitchen (2) Maintenance (l) Personnel (14-) Supply (l) It was early apparent, however, that the Quartermaster vehicles would not satisfactorily fulfill the functional requirements of the. armored clearing company. Consequently, on 20 August 194-1? The Surgeon General wrote in his ’’Foreword" to the Medical Department manual titled Research and Develop- ment Program. Fiscal Year 1942: In the field of combat medical equipment it ■is.-essential that a medical service be developed for armored and other fast moving units at the earliest possible date. The present organization, tactics, and equipment of combat medical services have been built up around the concept of.relative- ly static warfare. Within the past two years radical now theories and techniques of waging war 295 have been tested and proved. The Medical Depart ment must keep abreast of military developments by the testing of new ideas and new techniques in order to assure an adequate and efficient medical service for all types of units,3 Later in the same report The Surgeon General included certain proposed projects whose initiation was contemplated during the fiscal year 194-2, and he extensively justified their inclusion in these words: In order to perform its function adequately and efficiently the Medical Department must be prepared to meet the new military developments occasioned by the present war. This will require not only the changing of much of its present equip- ment, but the development and testing of entirely new motor transport , , , at times as far forward as the casualty site* • • * Unusual means of transportation may have to be resorted to. Means of communication, protection from the elements and heat and cold, and rapid, effective treatment of the wounded ... are required, as well as all other methods to meet the rapidly augmented tempo of modern warfare and its great distances. The development of such a program will require close liaison with the arms and services, including the armored force, * • * It is believed that every effort should be made to use some of the transportation now a com- ponent part of combat units, with a minimum of changes to meet Medical Department requirements, 4- As will be seen more fully in retrospect later, the simple realization of The Surgeon General that research and develop- ment of new equipment would be mandatory 11 to meet the rapidly augmented tempo of modern warfare and its great distances*1 was probably of no greater significance than the note of urgency that The Surgeon General injected into this asseveration, quoted at such length, which concludes with the following advice! In view of,the fact that the Medical Depart- ment should now develop adequate and efficient material for the care of the sick and injured of the armored and other fast moving units with the least practicable delay, it has been recommended that a sum of for the fiscal year 19A3 be appropriated for the purposes which are out- lined in the proposed projects F-15 to F-22 inclusive. If this sum is forthcoming, there is a possibility that a portion of it may be made 296 available for use during the fiscal year 194-2, on account of the urgent nature of these pro- jects. It is therefore incumbent upon officers engaged in research and development to careful- ly prepare ’’paper plans” and full justification therefor, including fiscal estimates, to the end that work can begin immediately should 194-3 funds become available this year.5 Necessity—urgent necessity—for revolutionary types of medical equipment for the Armored Force, therefore, Was the prime motivator of much research and development during the months that followed. And one of the first, one o£.the most urgent, and—because of its wide applicability'as. a hasid for at least four other subsequent projects—one of the most significant studies undertaken is the immediate subject of , this account; Development Project F-15.03, Truck, Ton, 6x6, Surgical—11 in reality a mobile- clearing station inasmuch' as its equipment is not elaborate and it provides space for surgical equipment within the body of the vehicle,”9.. The development of this mobile clearing station for the Afmored Force was deemed to be so urgent that at times development outstripped preliminary research, and procurement—through action that was commendable in its intent but irregular in its execution—actually antedated processes that normally would have been its prerequisites; namely, (l) development and (2) standardization, ,, II, Project Initiation, Within approximately two months after The Surgeon 'General had declared the existence of a critical requirement, funds needed for the initial phases of development of the surgical truck had evidently been assured; for on 16 October 194-1 The Surgeon General's Office requested of The Adjutant General that "the Medical Department be authorized to initiate a project to be known as Surgical Truck for Clearing Company, Armored Force” and that the Medical Department Equipment Laboratory "be authorized to spend a sum not exceeding $6,000 from current available funds for the development of this project,Deviation from the prescribed routine of process- ing such requests through the Medical Department Technical Committee—a deviation probably indulged with good conscience by The Surgeon General’s Office in an attempt, abortive though it was, to expedite the project—not only occasioned a delay of one month but also evoked, as will bo seen in a moment, a directive from the War Department General Staff to get the request back into the proper channels. The purpose of the project as announced to The Adjutant General, however, was to "Determine the feasibility of 297 permanent installation of surgical equipment into a properly selected truck"-*-a vehicle which would have "good cross country mobility and suitable speed to keep up with the Armored Force" and for which'the following military characteristics were proposed : ■ a. Operating unit; to be enclosed in light weight steel body. b. Operating' equipment to be•permanently instal- led. c. A 6x6, cargo truck to provide chas- sis for this unit.o At: the same' time' it was indicated that "preliminary investiga- tion has revealed that no such project has been conducted by this /the Medical Department/ or any department previously" and that "no preliminary experimental work has been done on this unit."9 Despite the expressed desire of The Surgeon General that "paper plans" be prepared, there appears to have been no ■research plan except vjhat may be inferred from this letter to The Adjutant General and from a nebulous declaration relative to the 194-2 plan for the prqsecution of that general undertak- ing then designated as "Project F-15—Combat medical service for armored divisions," ?/hich had been published two months before: 194.2 Plan. To study all available information upon similar developments in foreign nations, and to prepare pre- liminary plans for all phases. rof this project. To initiate actual development to such extent as is possible with funds made available, particularly with reference to observations and practices during army maneuvers.10 Having received the letter of .16 October 19/l in which The Surgeon General’s Office requested of The Adjutant General authority to initiate formally the development of a surgical truck for clearing company, armored force, and realizing that the functions'of* the Medical Department Technical Committee had previously been preempted, the War Department General Staff, Supply Division, G-4. expressed its desire on 27 October 194-1 that the proposed project "be processed through the Medical Corps Technical Committee, as required by Paragraph 9, Army Regulations 850-25".^- 298 From that point on, processing the proposal proceeded orderly and with no more delay than was occasioned by thorough- ness. On 4- November 194-1 its sub-committee recommended to the Medical Department Technical Committee, for example, that the research project be initiated and that military characteristics already enumerated be approved5 and bn 17 November 194-1 the Medical Department Technical Committee, approved the report of its sub-committee and recommended that the project be estab- lished.^ Returning, to The Assistant Chief of Staff, G-4* the original communication sent by The. Surgeon .General1 s. Office to The Adjutant General requesting authority to initiate the pro- ject, an assistant to The Surgeon General on the following day reviewed the auctions that had culminated in approval of the project by the Medical Department Technical Committee and. informed G-4 that "Approval from your office was not obtained at this Technical.Committee meeting, due tp the fact.that your representative was not • Seemingly overlooking this implied impatience of the Medi- cal Department to get the project formally'under way and observ- ing strictly the provisions of AR 850-25* which required coordi- nation of any proposed development with the using arms, withheld final approval of the surgical .truck,project, for about a month—or until it had had time to obtain from the Armored Force an expression of its opinion on the validity of the pro- ject and the desirability of its initiation. , Thus, on 27 November 194-1? the. Armored Force Liaison Officer in Washington, D.C., sent to Fort Knox, Kentucky, a memorandum for the Chief of the Armored Force with which he inclosed the file of ’’papers relative to the Medical Battalions of the armored force” and indicated that ”G-4- Division, WDGS, would like your informal comment on the subjects of this com- munication. ”15 Two weeks later the Armored Force replied that ”In view of the fact that inclusion, in the proposed table of organization for the Medical Battalion, Armored Division and the Medical Regiment, Armored Corps contemplates the utiliza- tion of a truck with inserts, adapted to the purposes of a forward surgical unit to be operated by Composite Medical Cam- bat company personnel,” the research project ’’presented for . . , surgical trucks should be initiated without delay.”1^ The Armored Force—which had already experimentally developed a similar surgical truck, as will be seen in a moment—further expressed its desire that the following points in addition to the military characteristics approved by the Medical Department Technical Committee be considered in the development of the surgical truck for the Armored Force: 299 a. Maintenance of flotation and maneuver- ability of the 2-Jr-ton, 6x6, Cargo Truck by avoid- ing construction of a too heavy body or high silhouette. ' b. Development of a light trailer designed to carry a generator for light, heat, and sterilization, c. Separation of the driver’s cab in its entirety from the body of the truck, • ; d. Gas proofing. g. Inclusion of some attachment on tops of unit to permit erection of paulins between units as shelter for unit personnel or patient over- flow.^ A parenthetical--though only momentary—digression is appropriately suggested by this last recommendation. A tent finally was developed for use with the surgical truck. Since ■ its development—though accomplished only after continuous liaison with the Medical Department—was technically a Quarter- master project, references made to the surgical tent in this account are only incidental. The War Department General Staff, G-A, having been assured by the Armored Force that the proposed development of a surgical truck was not only desirable but also1 urgent, The Adjutant General, on 30 December 19A1, gave-his final approval and directed that ’’Standard Quartermaster vehicles will be utilized”- in this project, Receipt by The Surgeon General of this directive at year-end effectively terminates what, may be considered as the phase of project initiation. The fact’that the correspondence was forwarded by The Surgeon General’s Office to the Medical Department Equipment Laboratory for its information and for attention to the comments of the Armored Forced .is added only as a footnote to the significant suggestions made at Fort Knox, to which action the Director, Medical Department Equipment Laboratory, however, replied simply with the routine cliches ’’Noted and returned in compliance with preceding endorsement,”20 III, Development Phase. A. Improvisation of First Armored Division. Formal approval of the proposal to develop a surgi- cal truck for the Armored Force was finally received, then, during the closing hours of 19A1. That the Armored Force should have promptly concurred in such a proposal or that it should 300 have been ready with concrete suggestions is easy to understand, for the 4'/th-;Medical Battalion of the First Armored Division had several months previously constructed an experimental surgi- cal truck very similar to the one now proposed for formal devel- opment, (See Figs, 21 and 22.) Just when the First Armored Division unit had con- structed its experimental model is not revealed in the cor- respondence under review. But because photographs of it, official photographs of the Armored Force Board,21 are dated 25 July 194-1 and thus antedate by nearly three months formal initiation of the development project and by nearly a month, even, publication ■of The Surgeon General1s Research and Develop- ment Program, Fiscal Year 1942. it would appear that no little credit for developing the surgical truck should go to the 47th Medical Battalion of the First Armored Division, ■ In the form of correspondence, the first apparent evidence that the Armored Force had been experimenting with the construction of surgical trucks came on 7 January 194-2. On that day an assistant to The Surgeon General sent a memo- randum to the Finance and Supply Division, Surgeon General’s Office, in which he reported that on the preceding day the General Staff Liaison Officer for the Armored Force had tele- phonically indicated that "the 1st Armored Division will require, by February 1, 1942, six (6) surgical trucks as provided in recently approved revision of tables of organization for The Armored Force, He further reported that "The 1st Armored Division has experimentally constructed such a truck using the standard 2*|--ton, 6x6, chassis” and that the Surgeon of the Armored Force had revealed by telephone that if The Surgeon General’s Office would "provide funds, not to exceed $3000,00, the’ Armored Force at Fort Knox, Kentucky, will con- struct the bodies necessary to complete the requirement”j and he recommended, finally, that In view •of-V- , the short time available to fabricate or procure these bodies, except as stated above, , , . funds, in the amount of $3000,00, be made available to The Armored Force, Fort Knox, Kentucky, for,the purpose of fabri- cating bodies to provide the needed surgical trucks for- the 1st Armored Division at that station,23 Although .as a result of the emergency the $3000 was granted,24- a subsequent request of the Armored Force for $20,000 with which to construct locally similar equipment for four more of its was, for reasons which will be examined later, disapproved,^ 301 B. Preliminary Planning and Initial Designs, * Authorization of Development Project F-15,03 having reached Both The Surgeon General's Office and the Medical Department -Equipment Laboratory before the end of the first week of January 1942, formal,development could proceed. But ’ •- despite the fact that The Surgeon General, as has already been noted, had recommended the preparation of "paper plans" so that there might be no delay once approval of this and certain other contemplated projects had been little anticipatory labor-r-on this project, at least-had been expended. Thus, mainly generalizations were forthcoming when, on 18 January 1942, the 4.8th Armored Medical Battalion, with the 2d Armored Division at Fort Benning, Georgia, made the following request' of the Medical Department Equipment Laboratory; 1, We are very desirous of having a plan or plans, which you may have developed, for the con- struction of a Surgical Truck, we apparently being required to construct our own. Realizing that you have been working on this plan for some months, we would like any suggestions you may have to offer by return mail.^ By indorsement dated 21 January 1942, the officer replying for the Medical Department Equipment Laboratory stated that 1. • . .we have only just received authorization on' the above project and while we have given it some thought we have not as yet progressed very far. I have just returned.from Ft, Knox, Ky., where I had been to get some, ideas as, to limits of the size of the body-. 2. The standard 2^-ton, .6x6 chassis is to be used and it appears we can develop .a body ’ about 13 ft, long, 88 inches'widej 76 inches high. The equipment and arrangement therein have not been worked out. It is stated that the arrangement made at Ft. 'Knox works quite well, and I believe if you will write Major L. Holmes Ginn, M. C, he will’ be able to send you photographs of their layout together with their canvas arrangement. Their water supply, I believe, is too great and can be greatly reduced, I am very sorry that I am unable to give you any suggestion as to value at this time, It is apparent from the first, then, that the Armored Force, which had itself improvised a surgical truck by fitting 302 a special body onto a standard' Quartermaster vehicle, was to play a: significant role in the formal development of the Medical Department’s Truck, 2-g-ton, 6x6, Surgical, Close coordination among The Surgeon General’s Office, the Medical Department Equipment Laboratory, and the Armored Force—not to mention the Quartermaster (later Ordnance) Department, .whose interest in the project cannot be minimized since the basic vehicle, was a Quartermaster item—was therefore to be expected, C. Early Development, The Surgeon of the Armored Force, cognizant of his organization’s dire need for the equipment, was eager to speed the project along, for on 13 January 1942—just two weeks fol- lowing formal authorization of the project—he wrote The Sur- geon General for information "as to progress being made in initiation of production of truck, 6x6, 2^-ton, special operating body."30 Since development by that time could not have progressed much further than a very tentative planning stage, this request for information on production seems a little unreasonable. But. despite that fact, by re-emphasizing the Armored Force’s needs his letter may have been instrumental in accelerating development. In any event, on 26 January 1942, the Director of the Medical Department Equipment Laboratory, recalling that authority for the. project had been received .by the Laboratory on 5- January 1942* reported that Preliminary drafting of possible type bodies for standard 2*1 ton, 6x6 chassis, was accomplished and taken to; Fort- Knox by the, undersigned when the matter of clearance,, overall height, etc., were discussed with the Surgeon,' Armored Force, and -the Surgeon, 1st Armored Division, also with 1st Armored Division Equipment Board, Based upon these discussions, we are now working on body- plans and equipment layout and hope to be able to begin actual construction in a short time.31 Foresight was demonstrated from the very first in the development of Project F-15 (which covered generally com- bat medical service for- the Armored Force) when it was decided to design the body for the surgical truck as a pur- pose van body "suitable for nearly all Medical Department Mobile units except ambulances -and ward trucks,"32 of con- siderable importance, then, is the statement in the Medical Department Equipment Laboratory’s Monthly Progress Report for January 1942 s "The design of a multiple purpose van body to be mounted on a 2^--ton, 6x6 cargo, truck was completed"! and satisfactory progress is to be observed in the further state- ments that "Design of the interior equipment of the surgical 303 truck to be installed in the multiple purpose van body was .begun" during January and "It is estimated that this design .will be completed and will be submitted to The Surgeon General .about February 7, 1942."33 Fulfilling this prophesy to the day, the Director of the Medical Department Equipment Laboratory forwarded to The Surgeon General on 7 February 1942 copies of the Equipment Laboratory drawings and specifications covering the design and construction of both the multiple purpose van body and the interior equipment for the surgical truck. He pointed out at the same time that Inasmuch as the construction of several dif- ferent Mobile units (such as the Surgical Truck and the Mobile Aid Station for the armored force and Medical and Dental Laboratories for Corps and Army) has been authorized, the first consideration was the design of a suitable body that could be used for all of these units. From a standpoint of production and procurement the advantages of standardizing on a single body style is obvious. The 2-J-ton, 6x6, light chassis, with the long (l64 inch) wheelbase was selected as being the most satisfactory chassis in current production,34 Indicating further the desire of the Medical Depart- ment Equipment Laboratory to secure one complete surgical truck as a pilot model and the fact that funds for payment were avail- able, the Director of the Equipment Laboratory concluded with a recommendation to The Surgeon General that ’’the inclosed draw- ings and specifications /if approved/ be forwarded to the Holabird Quartermaster Depot for the purchase of one (l) com- plete Surgical Truck.”35 But before The Surgeon General’s Office could legitimately approve, the design proposed by the Equipment Laboratory had to be coordinated with the using agency, the Armored Force, Some three weeks later, consequently, The Surgeon General’s Office routinely forwarded the documents drafted by the Medical Department Equipment Laboratory to Headquarters, Armored Force, Fort Knox, Kentucky, with the indorsement: ’’For comment and recommendations. Please expedite.36 The Armored Force complied more promptly than The Surgeon General’s Office had acted. Hardly a week had elapsed when, on 12 March 1942, came suggestions37 from the Armored Force indicating its desire that the Equipment Laboratory tentative specifications be revised to provide for the fol- lowing ; 304 1, Open instead of closed oab, 2. Battery chargeras contained in Appendix A, T/BA #17. 3. An air conditioning unit Mfor the protection of patients and medical personnel in hot climatesn inasmuch as "No provision appears to have been made for cooling or forced ventilation,"3^ 4, , Outside electrical outlets, 5.,- Means of .'draining' the water tank, 6. A red cross, without white background, to be painted on the side, but not on top of the truck, although such action "may be a. contravention of the Geneva Convention."39 In regard.-to these Armored Force comments-,’ which had been forwarded to him by The Surgeon General’s Office for his information,Director of the Medical Department Equipment Laboratory .replied in details '. 1. With reference to the comments of the Armored Force contained in the 3rd Indorsement the .following is submitteds :i- a. It is not considered necessary to revise the drawings and specifications .to pro- vide for an open cab. This matter will be taken up by the Equipment Laboratory direct with the Holabird Quartermaster Depot at the time the pilot model is procured. Naturally, if only open cab model trucks are being procured for • the Armored Forcd the Quartermaster will pro- cure this model. b. If desired by the Armored Force • a battery charger can be carried-with the unit. No attempt was made by the Equipment .Laboratory to provide a stock list of equipment for the surgical truck. The battery charger should appear on the stock list along with the . operating table, drugs, dressings, and other - issue items| it. does not belong in the speci- fication, * c. Provision has been made for force ventilation of the unit. The Evans Model HV-2030Q2 combination heater provides' fresh air circulation when not used as'a. heater. Introduction of an air cooling, or 305 conditioning system is not considered practi- cal for a front line unit. An air cooling and conditioning unit for a truck body of this size would be large, bulky, intricate and would require -considerable electricity for its operation. d. There is no purpose in instal- ling outside electrical outlets. The unit is wired for six volt battery current. Should it be desired to use the battery charger recom- mended in Paragraph lb, Third Indorsement this - charger would be connected directly across the terminals of the truck battery when.in use.' The vehicle was not i/ired for 110 volt com- mercial house current inasmuch as it is incon- ceivable that such current vjould be available' ah the location where the surgical truck -.i's to bemused. However, if such current :were Avail- able the truck could be lighted by running a couple of drop cords with electric lights, .’into the vehicle. r r-! • e. It is possible to drain the water tank without undue difficulty or unusual ingenu- ity, This is accomplished by opening either'the hot or cold water tap of the sink, ,:.a r. - f. The Equipment Laboratory was • • directed by The Surgeon General's Office to mark all Medical Department vehicles in strict accordance with the Geneva convention.-’ 2, a. Inasmuch as the criticisms of the Armored Force as contained in the 3rd Indorse- ment 7/ere of a minor nature and in no way affect the general principle of the surgical truck, it is recommended that the drawings and specifications as prepared be forwarded to the Holabird Quartermaster Depot for the procure- ment of one pilot model of this vehicle. ""•b, After field test of the pilot model by the Armored Force consideration should be given to changes or modifications recommended by them before mass procurement of the vehicles is begun .4-0 The Surgeon General's Office approved the Equipment LaboratoryTs recommendation that the Holabird Quartermaster Depot procure one pilot model of this truck in accordance with the drawings and specifications as prepared originally 306 by the Medical Department Equipment Laboratory, and it immediately notified The Quartermaster General of concur- rence by The Surgeon General in this proposal.4-1 This decision of the Medical Department to get on with the procurement of the pilot model having been made during the last days of March, The Surgeon General ¥*as informed in the. Monthly Progress Report of the Medical Department Equip- ment laboratory for April 1942 that during April a confer- enc'd had been held "between the representative of the Equip- ment Laboratory' and representatives of the Engineering.. Section, Holabird' quartermaster Motor Base, to decide .upon the principal characteristics of the surgical truck-’1 and that "It Was agreed that procurement of one pilot model vehicle would be accomplished by the Holabird Quartermaster Motor Base substantially in agreement with the specifications submitted to them by this Laboratory."42 , More specifically, as a result of this liaison the fol- lowing agreements were reached? 1, The body cannot be shorter than thirteen (13’) feet to provide sufficient room for a concurrent recovery patient and a surgi- cal case. 2. The chassis, frame to be extended one (l1) foot to locate the pintle and bumpers in their relative positions with respect to the rear .of the body. ....... 3. The load to be carried in .the body during transportation will not exceed 3000. pounds• ‘4. The chassis extension to be effected by the body builder,. Chassis arc to be delivered standard 164".wheelbase,from the chassis producer's production line. 5., Holabird Quartermaster Motor .Base will:prepare the specifications covering the completed unit, which will be furnished by the body contractors as described in the specifications provided by the Equipment Laboratories, covering .the body and Interior Equipment.;: : . ... 6. .The pilot model will be the unit required, by the Armored Force..and has been tentatively approved by them from .experiments conducted with a similar unit constructed on j * i •. t.\ ::*,<■ • ... , a 2*§- ton twelve feet long cargo' body. r: •" 7, Equipment Laboratories representatives desire to inspect the body during construction, as well.as when the complete unit is ready for delivery,43 . A month laterr)The; burgeon General’s Office notified the. Armored Force*of this conference, saying that on 20 April 1942 the "Director of,the Medical Department Equipment•Labo- ratory , >■- . went to Holabird to inspect and coordinate, the manufacture of the Surgical Trucks for the Armored-Force" and reporting further that "Holabird is still working on this pro- ject and at this time no definite ansv/er could be given as to v/hen we would receive the, trucks."44 : Meantime—very shortly after the Holabird conference— The Surgeon General’s Office had forwarded to the Director of the Medical Department Equipment Laboratory, for his informa- tion and remarks, correspondence which had just arrived from the Office of the Surgeon, Armored Force, This correspondence transmitted plans, characteristics, and photographs of the improvised surgical truck, which had been designed by the First Armored Division and of which six units -had been con- structed locally with the $3000 recently made available by The Surgeon The Director of the Equipment Labo- ratory, however, was not favorably impressed by the 'plans of the improvisation; 1*.- -:,The inclosed drawings and specifications of the Surgical Truck constructed by the First Armored Division have been examined by the Engi- neers in the Equipment Laboratory, 2a, The body appears to be a rather fragile construction for field service and being built above the regular cargo body of the 2-y-ton truck results in a rather high silhouette. b. It is realized that adequate facilities for the construction of this vehicle were prob- ably not available. 3. It is believed that the essential features of this design have already been incorporated in the Equipment Laboratory and now under procurement by the Holabird Quarter- master Motor Base. Additional features included in the design by the Equipment Labo- ratory v/hich apparently are not incorporated in the vehicle constructed by the First Armored Division aroi 308 •a,,. All steel body, b. Relatively low floor height resulting in easy access to the vehicle and a lower over- all height. c. Insulated walls, roof, and floor. d. •' Combination gasoline, kerosene, fuel oil or wood burning heater which also provides for fresh air circulation when not used as a heater, e. Elimination of the detachable rear ladder by providing a rear step that folds into the door when not in use,4-6 D. Concurrence of Procurement with Development. Under more normal conditions one would probably have judged that the development of the surgical truck was proceed- ing as expeditiously as possible; but conditions in the spring of 1942 were not normal. Daily the necessity of having more and more men and their equipment ready to be committed in pre- ponderant number to both the actual and the proposed battle- fronts of the world was becoming more imperative. The time was fast approaching, as subsequent events revealed, when the armies of the United States were to mount the offensive. Knowing the role that certain of the armored divisions were to play in this changing military design, the Armored Force was growing impatient. It needed the surgical trucks. It wanted them at once. It could afford no further delay. And so, on 30 May 1942, the Commanding General of the Armored Force sent the, following telegram to The Surgeon Generals "INFORMATION IS REQUESTED AS TO WEEN DELIVERY OF SURGICAL TRUCKS FOR THIRD FOURTH FIFTH AND SIXTH ARMD DIVNS MAY BE EXPECTED,"47 A record of The Surgeon General's direct answer has not been found; but the Monthly Progress Report of tno Medical Department Equipment Laboratory for the period 1 May 1942—9 June 1942 indicated that The Hplabird Quartermaster Motor Base is in the process of procuring one pilot model surgi- cal truck in accordance with the design of the Equipment Laboratory, A letter was written to the Holabird Quartermaster Motor Base June 2, 194-2, inquiring as to the exact status of this project. No reply has been received to date,^ With no assurance that the trucks were to be delivered promptly, the Surgeon of the Armored Force on 18 June 19X2 requested through channels that The Surgeon General allocate to the Armored Force $20,000 for the local construction of twenty- four surgical trucks—enough to equip the four armored divisions 309 named in the telegram just cited, /'The exigencies of the situation, as they pertain to these divisions,1’ the Armored Force explained,' ’’are such as to preclude further delay in the procurement of these vehicles,”4-9 In its 1st Indorsement of this request, however, Headquarters, Army Ground Forces, recommended disapproval of the proposed allocation ’’provided the surgical trucks refer- red to will be ready for distribution prior to August 15, 1942”; otherwise, ”if there is any question as to the avail- ability of these trucks for distribution by that date, it is believed that the request should be approved,50 Pointing out that its latest information was that the pilot model would be .available ”on or before July 10, 1942,” and that manufacture was to begin 1 August 1942, the Army Ground Forces'added that ”It is not believed that the Armored Force could construct 24 surgical trucks locally prior to August 15, 194;2,” and con- cluded with the suggestion that, since the need for these vehicles was so urgent, ’’every available short-cut be taken to assure their .early procurement,”51 !v In its turn Headquarters, Service of Supply, dis- approved of ’’recommendation contained in basic letter” because The office of The Quartermaster General . , , informs this office that pilot model for-sub- ject vehicle will be available , , f by July 12,• 194-2, The construction of the twenty-four (24.) surgical trucks will begin after the’ ■acceptance of the pilot model and delivery is expected by August 15, 194-2,52 This chain of correspondence■ Y?as then forwarded to the Director of the Medical Department Equipment Laboratory for his information and was later indorsed back by The Surgeon General’s Office to Headquarters, Armored Force, without approval,53 t Although a month was required for this correspondence to travel the route indicated, the Surgeon of the Armored Force approximately three weeks in advance had learned informally of the likely disapproval of his proposal to construct the trucks locally. One day prior to initiating his formal t'ecuest for the $20,000 he had written a personal letter to an officer in The Surgeon General’s Office asking for ’’the latest dope on our surgical trucks and the black-out tents that go with them” and commenting that "we have got to get those things without further delay, in. view of recent developments concerning the employment of certain units of the Armored Force.54- Albeit the officer to whom this letter had been directed went on leave shortly after he received it, he did 310 instruct one of his assistants to furnish the information desired. Consequently, just after 24 June' 1942, the Surgeon, Armored Force,, received from the .assistant a personal letter which -read in part, as follows; "n Now, as for the latest dope on the Surgical, Trucks," I first contacted the Quartermaster General’s Office who-told'me that after they had been on the drawing board for a long period of time* the Headquarters, Services of Supply, had requested that they be sent to them, I then con- tacted the. Headquarters, Services of Supply,. Devel- opments, Branch, Requirements Division and they now have the complete drawings and indorsements on the case, : I believe we can look for some early action now that Headquarters, SOS, has taken hold of it,. It seems that they were short-circuited before and did not know anything about the case until recently. Major Kleff /in Headquarters, Services of Supply/ assures me that the pilot will be at Carlisle /T.e.j, at the Medical Depart- ■ment Equipment Laboratory/ by July 10th, and that standardization and all action will have to be complete by August 1st, so that we can go into procurement at that time. The Array Ground Forces just phoned me and , stated that they had received a request from Headquarters Armored Force for $20,000 to develop these trucks locally. I referred them to Major Kleff and he has requested that these papers be sent to him, I do not believe that Headquarters., SOS will agree to the local development of these trucks since they have progressed to the stage that they are no?/ in.55 This letter is quoted so fully not only because- it explains one reason for an exceedingly important if short- lived delay in the development of the surgical truck, but also because it accounts, for the directive that threw the machinery of development'•and subsequent procurement again into high.gear. This directive*,' written the same day as the letter just quoted— 24 June 1942—took the form of an indorsement from Headquarters, Service of Supply, to The Quartermaster General and runs as f oIIoyts ; I.- The';“Quartermaster General will complete the-' specifications and construct the pilot model of the proposed surgical truck prior to July 10, 1942. Direct communication with The Surgeon General* ds authorized and will be maintained to expedite' this matter^. 311 2, The pilot model will be tested at Car- lisle barracks /±,etJL at the Medical. Department Equipment Laboratory/,- Such tests, as are-, con- ducted will be expedited with■ af view -toward standardization and quantity'procurement initiated prior. Pq *.August' 1, 194-2 •: r:.* v 3. Every effort will be made to expedite this matter, Almost immediately after the.promulgation of this directive, the Cffice of The"Surgeon General informed':the Surgeon, Armored Force, of this turn in events and of the apparent splutipn;to other problems incident to the rapid development and\production of the surgical truck. Noting the inclosure of (a copy of the directive, the officer sending this information prefaced his comments with this observation? 11 It looks as though we are getting action at last on this truck,"5V Then follows a report that "The York Hoover Company in York, ’Fennsylvania is going to construct the pilot model" and that the Director of the Medical Department Equipment . Laboratory r : ‘ ; is going to be Liaison Officer so that any minor difficulties can be ironed out at the time, of construction. This should save time and make- the pilot model, as nearly as possible, the production model so that we can get into production as soon after July 10th as possible.58 , ... " The writer -further reported that he had , . .1* ■; conferred with the Quartermaster General’s Office today and this- Obncern was the only one who could consider taking on the. pilot model. They would only take the pilot' model if we gave' them a let- ter of intent for twenty-four (24.) of the.trucks.1 After receiving approval from Headquarters - Serv- ices of Supply, the Quartermaster is going to do • this,59 ’i'.- To the Director of the Medical Department Equipment Laboratory, too, was sent a similar letter which-inclosed a copy of the directive; informed him that the York Hoover Body Company would build the pilot model only if they received a letter of intent to purchase twenty-four trucks, although "They are so busy with other things that they ..did not want'to bother with it at all"; and notified him that "a-new directive will be out probably today and you will*be asked;to confer as liaison with the York Hoover Company so that except for minor changes, a pilot model can be, as nearly as possible, the production model,"80 ' ■ , v;p On the following day, 27 ‘June 1942, the Director, Requirements Division, Services of Supply, formally authorized The Quartermaster General "to issue a letter of intent to the York-Hoover Body Company, York, Pennsylvania, for-the purchase of twenty-four (24.) Surgical Trucks, pending the satisfactory • acceptance of their pilot model"6l and, by separate communica- tion reiterating that "Every effort will be made to expedite ‘ this matter," simultaneously directed The Surgeon General to "appoint a liaison officer with the York-Hoover Body Company during the construction of the pilot model of the Surgical Truck, in order to expedite the testing, standardization .and quantity procurement" of this vehicle,62 . V Despite all this expeditious and expediting action, another delay—-i.though fortunately a short one'—abruptly ocur- red, On 2 July 19/2 a letter to. the Surgeon, Armored Force, explained the brief delay thus: After the. York Hoover Body Company received... a letter of intent from the Cfficc of the Quarter- master General for twenty-four (24.) of the Surgi- cal Trucks, thpy rejected the contract and declined even to build the pilot model. For the past two days, the Quartermaster General’s Cffice has been in touch with a number of firms who build truck bodies, The names of six firms other than the York Hoover Company that had been approached Y/ere listed, followed by the declaration that the Krieger Steel Section, Incorporated, 11-11 34-th Avenue, Long Island, New York, had finally accepted and "promised to have the pilot model at.Carlisle by July 11th.”64 After Krieger had accepted' the contract, Headquarters, Services of Supply, was formally notified of the appointment by The Surgeon General of the Director, Medical Department Equip- ment Laboratory,_as Liaison Officer to "act in conjunction with the Creiger /sic/ Steel Section, Incorporated, , . . instead of the York Hoover .Body Company, who refused the contract,"65 And two days later. Headquarters, Services of Supply, formally con- firmed for The. Quartermaster General-a-.telephonic authorisa- tion nto use twenty-four (24.) of the. thirty-two (32) 2-y-ton, 6x6 chassis released- by the Chemical Warfare Service July allocation of 2i=rton trucks"—such chassis "to be used for the Armored Force surgical vehicles'that are urgently needed."66 Thus it will be observed that from this point, because of the exigency of the situation, development”and procurement for a time proceeded concurrently and that procurement, 'indeed, was actually initiated prior to standardization 'on even develop- mental testing of the, surgical trucks,. 'E.. Construction and Delivery' of Pilot Model. With the drawings and specifications completed, the supply of chassis assured, the contract for both the pilot and production models let, and a liaison officer appointed, the machinery of further development and production appeared well oiled and ready to roll. Consequently, as requested by the Krieger company, the liaison officer on 6 July 1942 visited the plant for a conference to clarify certain questions relative to the drawings and and .supplementary and additional information, requested by telephone, was supplied by letter from the Equipment Laboratory two days later.Evidence of the success of this conference as well as an indication that plans were being drawn to obviate any further delay are apparent in a letter from the Equipment Laboratory on B July 194-2, informing the Armored Force of the current status of the project.; At last wc are about to got a pilot model of the surgical truck. It is supposed to be here by July 10, but my. representative just came back from the factory and states that he doesn't believe they can have it by that time but won’t be far off. Now our directive is to test this and get- same standardized end ready for procurement by August 1,1942. ' • • • There will be some work and installation to,be done here and perhaps some changes, .'Now as, your organizations are primarily concerned, I am writing this to ask, if possible,' ‘that iyou send a representative here to us in making any desired changes especially in internal arrangements, also on installed .equipment so that we will all be better satisfied. 'Your r representative should be'here around the- 15th and be prepared to stay a few .... . Despite the i'act that development of the surgical truck was,.progressing with speed,.; the. letter -just cited boars evidence of an increasing awareness that construction of the pilot model could not.be completed by the date set by the Services of Supply directives namely, 10 July 1942. The Monthly Narrative Report.of the.-Medical Department Equipment Laboratory similarly, indicates that a further slight delay was anticipated, for it states: It 'expected that the body of this truck will be completed on July 13, 194-2, and that :the interior equipment which is to be furnished by various other companies ?/ill be installed and delivery made between the 15th and 20th of July 1942.70 The • truck was' actually, delivered to Carlisle Barracks on IB July•1942.71 F, Tests of Pilot Model and Changes Proposed by Medical Department Equipment Laboratory. Neither the nature of the tests that followed nor the. completeness with .which they were conducted is definitely known, for the usual formal report of this.-activity seems not to have been drafted. Perhaps it was omitted because, as will be_recalled, Headquarters, • Services of Supply, in providing that the pilot model be tested at Carlisle Barracks, had directed that"“Such tests as are conducted will be expedited with a view toward standardization and quantity procurement initiated prior to August 1, 1942 Nevertheless, notes in the files of the Medical Department Equipment Laboratory indicate that a conference among representatives of Krieger Steel Sections, Holabird Quartermaster Depot, and the Medical Department Equipment Laboratory was held at Carlisle Barracks on 21 July 194-2 and that certain changes—v/hich with one exception were substantially like those to be cited in a moment—were concurred in,73 Once the conference was ended, the I.'ledical Department Equipment Laboratory immediately made known the results of it to the Armored Force, whose representative had inspected the pilot model, though he apparently was not present at this conference: nWe have just completed the road testing of the Surgical Truck and find that.it performs quite well.,,f% Being informed of the conference held the day before, the Surgeon of the Armored Force was also told that The only changes we are making in the body is the relocating of the spare tire and the elimination of the apron which had no value except for appearance. 'r This latter change insures that the body will clear anything the frame will behind. New drawing in duplicate showing body design is inclosed, .We believe there is ample clearance behind as we have a thirty-one degree angle of departure to the rear' frame. The bumper spade cuts this a little but the spade will cut through readily and we .left it as is as it gives , more bumper space. We are rewiring'the body leaving only two dome lights on the battery circuit, so you can requisition your Homelight small generators and also the operating tables. 315 In order to get production under way and to have your units by August 15 as I have been directed, I have given the Compaq/ the go ahead 'signal on the bodies and I understand that the Quarter- master has already delivered seven chassis to the firm,^5 Just a week later the Armored Force gave its approval of the body of the vehicle but objected to one of the other changes that had been recommended, namely, subdivision of the cabinets as detailed in Appendix C: | - I -received today the blueprints and, specifi- cations on the surgical truck. I think, with the changes indicated, that it is .going to be satisfactory insofar as the general construc- tion of the body is concerned. However, I do not like those small compartments in the cabinets. They should:be large enough to receive items of unit .equipment, such.as surgi- • cal sets, and deep enough to accommodate shell dressings, other dressings, linens, etc. :i Those little drawers remind me somewhat of a hardware shop which utilizes similar'drawers for keeping different sizes of nuts and bolts.. They are too small for any practical •purpose-. I am submitting these plans ■■‘immediately to thev Armored Force for their approval, which, I think, will be forthcoming, I will advise: you : just as soon as I get the green light. Time is indeed of the essence, and production of the twenty-four trucks on contract:by Ausus t . '15th, as I understand it, .will: not. be ..affected: by any change: that may be directed by-the Armored Force, After the initial contract has been satisfied, if the Armored Force desires changes other than: those.'mentioned, a -hew con- tract will-,' of course, have to be initiated; ; Thanks for your efforts in our behalf, The Director of the Equipment Laboratory agreed only partially with the Surgeon of the Armored Force in his criticism of the cabinets; nevertheless, he instructed his representative then at the factory that 11 if not too late . • • one-half of the small drawer cabinets on the one side be changed to one cabinet with shelves, The Director still felt, however, that even without changes the cabinets would 316 "work out all right,"'since "In the presentset-up!-,; . ,' there are at the rear several drawers long enough and deep enough to take instrument cases and packs, also a large cabinet on one side" and since there could ho made available enough additions:! shelf space for all linen and packs once the present plan for "moving the was.h hapin over In. front" was executed.78 •*. • .••• . This change was apparently,decided upon after the conference of 21 July, for the notes on that conference, pre- sented in Appendix C, indicate that the mixing faucet'.and sink were to remain unchanged. Simultaneously, several additional changes in plans were also explained, "We have had tp add a.small water heater," the Equipment Laboratory told the Armored Force, "as the coil in the Evans heater, presented the difficulty of giving heat to the truck if operated for hot water, and.also in cold weather when operating for heating the truck, it produced too;:much hot water and steam"5 furthermore, "VJe have revised it and made provisions for portable light inside (other than the operating light) which will be the same as the outside tent lights and can be hung in several places inside of direct light /sic7 where needed,"79 The Director of the Equipment Laboratory seemed well pleased with the product that had be.en developed, for although he conceded that "There may be minor changes necessary which can be found out only when /the: truck is/ put to use in the field," he believed that "this truck:will do the work,"80 . ’ •*. " As a consequence of the decisions reached by repre- sentatives of the manufacturer, the Holabird Quartermaster Motor Base, and the Medicaf Department Equipment Laboratory in the conference at Carlisle Barracks on 21 July 1942 and as a result of having coordinated these decisions with the Armored Force, the Director of the'Equipment Laboratory sent the fal- lowing letter to The Surgeon General on 1 August 194-2 to inform him of the changes which were desired in the.production models; • •••"• ' 1; Subject contract with the Krieger Steel Sections, Inc,, 11-11 Thirty-Fourth Avenue, '.Long. ■ Island City, N. Y., covers the procurement of- twenty-four (2A) Medical Department Surgical Trucks in accordance ¥/ith the pilot model : delivered to this■station July 18, 2. Inspection and tests, of the pilot model, by the Equipment Laboratory and representatives of the Armored Force had indicated the desirability.of making certain changes and additions to the produc- tion vehicles not called for in the original 317 specifications. These changes will involve, additional expense to,the,vehicle manufacturer and are as follows: ;. : a,' Install 5 gallon hot water tank and gasoline operated.hot water heater in accord- ance with Equipment Laboratory'Drawing No. C-357 and SK-52. b, Install complete 110 volt wiring , system in accordance with Equipment Laboratory Drawing No. SK-51. c, Vehicle manufacturer to supply six (6) gooseneck;,lamps in apcordance with samples ‘ furnished by the Equipment Laboratory, fro- . Vision to be made for mounting four (L) of' ’ these lamps on the outside of the vehicle in the location shown on Drawing No. F-35B and two (2) of the lamps on the interior wall, forward of the parcel rack, ; : . d, Provide one (l) funnel in acbord-. ance with sample furnished by the Equipment Laboratory, with each truck for filling water storage tank, “ 3. The following changes and modifications not involving any additional expense to the con- tractor are to be made on all production models: a. The water -heating coil to be eliminated from the Evans vehicle heater, b, All Evans heater fans to be operated from 110 volt 60 cycle alternating current,’ • • ’ c. Body skirting to be eliminated, d-, Spare tire to be located on the left hand side of body in accordance with instructions furnished by the Holabird ’ ' ‘: Quartermaster Motor Base, ■ . ■v •' ... ■ , ■: „ ■ ■ ■ . e. Filler- neck on gasoline: tank to ; ;• provide easy access. , ;:; f, Install removable/ service plate fob;the folding rear st.op-vmechanism :bn each rear door, . g. Install shelves in wood cabinet at■ front of truck, - w h. Close left end of wood cabinet and install divider in center, i. . Flat rim sink to be installed at extreme left end of ?/ood cabinet as shown on.draw- ing No, 4-257, revised, j. Contractor should check: the rear win- dows to be sure there is sufficient spade for the installation of black-out curtains; if necessary decrease size of window, k. Steel ladder to be installed on body in accordance with Equipment Laboratory No. F-35B, l. Install parcel racks in accordance with original specification. m. Steel cabinets to be in accordance with latest revisions of Medical Department Equipment Laboratory Drawings No, 2258, 4-259, 3260, 3261, 2263, D-295, D-296, D-297 and D-298. . * *- ; . *• 4-. - The Krieger Steel Sections, Inc,, have been notified of all changes and modifications listed in Paragraph 2 and 3. They have also been furnished the latest revisions of Equipment Laboratory Drav/ings referred to above as well as samples of the water heater, filler funnel,-and gooseneck lamps. 5. Inclosed herewith in.duplicate Equipment Laboratory Drawings No. 2258, 4259, 3260,-3261, 2263, D-295, D-296, D-297, D-29B, SK-51, SK-52, 4257, G-357, and F-358.. 6. The Purchasing-arid Contracting Officer, Holabird Quartermaster. ;Motor!Base and the Krieger Steel Sections Inc,, are being furnished copies ■of this correspondence,Bl G, Description of-Pilot Model Surgical Truck. The pilot model of the surgical truck, at this stage of its development, consisted of a van body—estimated to weigh, with equipment, 2400 pounds—which was based on a standard 6x6, 2*|--ton truck. (See Fig, 23.) Mounted within the van body, which was wired for six-volt current only, were a 50-gallon 319 water tank; an air-circulating fan; a, sink' with hot and cold water outlet; cabinets for equipment, supplies, and accessories; and three six-volt dome lights, two general purpose and one operating, (See Fig, 2A.) Other equipment was Medical Depart- ment issue and was to be installed in accordance with specifi- cations prepared by the Medical Department Equipment Laboratory, : Outside the van-body yrere a combined air-water heater on the loft front of the body; a six-gallon gasoline fuel tank for the air-water heater, located above and to the right of the cab; and electrical connections for a generator or other source of current, A tent spacious enough" to shelter as many as 20 litter patients was designed to. be:stretched over the truck and to be extended both to the sides and to the rear. This was the vehicle had been so urgently desired by the Armored Force and which the Armored Force Board now had an opportunity to tost.. • H, Tests Conducted by Armored Force Board. Before the end of. August the pilot model of-;the surgical truck had been'.sent'.-first to the Quartermaster Depot, Jeffersonville,•Indiana, "to provide a proper model over which is to be fitted a surgical tent as., designed by the Armored Force, and then to Fort Knox,; Kentucky, "for work ip con- nection with standardization of this vehicle for the Medical Company, Armored Battalion,’ At Fort Knox tests involving cross-country operation,, pitching and striking of tent, black- out characteristics, and inspection by Armored .Fopce Medical Officers and demonstrations to Medical personnel were conducted "to determine the suitability of the surgical truck and tent for the Armored Force, ’ *’ The Armored Force Board was generally .very favorably impressed with;-the surgical truck and, incidentally, with the Quartermaster-developed tent. With an eye on the cross-country characteristics of the truck itself, for example, it observed that "the truck is well under its payload capacity" and that "the truck has excellent cross-country abilityi equal to that of the standard 2vr-ton, 6x6, truck," although "The added height of the van body (approximately one and one-half (!■§- feet) will cause some difficulty when travelling through wooded . areas,"85 Accessories, equipment, and facilities on .or within the body of. the, truck, too, were found to- be adequate except that they , left the" following features-.to be desired: ; 1. Provision for external sources of electricity with the consequent rewiring of the truck for current| 2,. ..Wiring for current available from the truck power .‘supply as well as from external sources; ,3..-riFour brackets on the outside of the truck body to facilitate lighting of the tent;: ... : i.r;n . A. Cutlets..within the body;. 5. An additional ventilating fan or.,, as an alternative, separate air and water heaters; 6. Larger drawers on certain cabinets; 7. More substantial and more readily operated drawer latches; B. Improvement of the latching device on burner- lighting door of air--water heater; *' ■ r , 9. Improvement of spring-operated draft-regulating door of heater; ‘ . ■ V; ' 10, More rugged and,better protected fuel metering valve assembly; 11, Factory-installed brackets for attachment of tent straps; and, finally, 12, Relocation of sink drain pipe.'^ Although many, of these changes, it will be observed, were of a very minor nature, one in particular— outlets for 110- volt current—had been desired from the beginning, though the Armored Force suggestion that it-be provided had, at first, been rejected by the Director of'the Medical Department Equip- ment Laboratory, 'Evidence of its satisfaction..over results of the tests is seen in the fact that the Armored Force Board, on 26 August 194.2, recommended that "The truck, surgical, 6x6, be standardized for issue to the.Armored, Force after modifications as indicated above have been made i . I, Project Termination. Evidently believing that it had successfully developed the truck desired, the Medical Department Equipment Laboratory— 321 even prior to the tests conducted by the Armored Force—took the final step that would normally have ended.the project; It sent to The Surgeon General’s Office, on 8 August 1942, drawings and specifications of the And four days later, in a letter transmitting its Monthly.Narrative Report, the Equipment Laboratory requested that Project F-15.03 be dropped inasmuch as it had been completed,°9 Although the request was repeated in the next narrative report, The Surgeon General’s Office withheld concurrence until the Third, Fourth, Fifth, and .Sixth Armored Divisions had servicattested the vehicles for several months,90 Then, on 14 January 1943- just a few days more than a year after the project was officially begun--The Surgeon General’s•Office formally authorized termination of Development Project F-15.03.91 J. Delivery of Trucks. As late as 9 August 194-2 the Medical Department Equipment Laboratory had ’’anticipated that delivery of the 24- surgical trucks by the Krieger Steel Sections, Inc,, . , . will be made by August 15, 1942”;92 but ,a delay in the delivery of cabinets being supplied the manufacturer by another firm93 made this estimate somewhat over-optimistic. Meantime, after close coordination with the Armored Force concerning its desires relative to disposition of the completed trucks,94- The Surgeon General allowed certain armored divisions priority95 and issued the necessary shipping authorizations and instructions,96 Subsequent; inspection, acceptance, and shipment by rail of the completed units from the factpry on or before the dates scheduled occurred as follows! Six (6) -to Third Armored Division, Rice, on 1 September 19 4-2; 97 Six (6) to Fifth Armored Division, Freda, California, on 8 September 194-2 and ,. Six (6) to Sixth Armored Division, Boyce, Louisiana, on 15 September 1942—-three days ahead of schedule, 99.,.- ■ • Six (6) vehicles, driven by military personnel, t were delivered to the Fourth Armored Division, Pine Camp, New York, on 23 September 194-2. From these facts'it will be observed that in contravention of the purpose of standardization as expressed in AR 850-25. to be discussed directly, substantial procurement— even delivery—of the surgical truck was consummated prior to standardization of the newly developed vehicle. 322 RESTRICTED IV, Standardization Phase. A. Delay in Initiating Standardization. .. .) * . » }■ ■ - • • 11 i - ' "The importance of avoiding delay .inythe .pracess of- standardization of items of equipment," according ija the edition of AR: 850-25 under which research and development, programs were' then* conducted, "should be realized, -by all concerned. The 'classificatioh 'of an item as .standard enables the basis of issue to be determined and procurement.planning for necessary production ... to be inaugurated,"3 Neverthe* less,, the procedure here implied to be virtually obligatory was conveniently ignored in the interest of prompt quantity procurement. It is not to be assumed, however, that those responsible for the development of the surgical truck were unaware of the importance attached to early standardization. Headquarters, Services of Supply, had no doubt realized its importance when it directed the appointment of a liaison officer to expedite the standardization of this The Surgeon General’s Office also was cognizant of it when it informed the Armored Force that "standardization and all action will have to be completed by August 1st, so that we can go into quantity production by that time."5 And the Director of the Medical Department Equipment Laboratory knew it when he, likewise writing to the Armored Force, ; remarked that ”our directive is to test this /pilot model of the surgical truck7 and get same standardized and ready for procurement by August 1, 194-2, Despite this evidence of a general realization that standardization legitimately precedes procurement, authority to standardize the surgical truck was not forthcoming until a month after the favorable report of the Armored Force had been submitted. And so on 25 September, 194-2 Headquarters, Services of Supplyy directed The Surgeon General "to standardize the Truck, Surgical, 2p--Ton, 6x6, for issue to the Armored Force after modifications have been made as indicated in Armored Force'Board Report on Project No. 291, dated August 26, Although this directive was issued two days after the last lot of six from the original order for 24 surgical trucks had been delivered to the Armored’ Force, the delay id not considered blameworthy; for, it will be recalled, the Surgeon of the Armored Force had indicated his understanding that whatever changes might be deemed desirable by the Armored Force Board after it had tested the pilot model would in no way affect procurement of the 24 trucks then under contract,8 323 Just as standardization is a desirable though not always a necessary prerequisite to procurement, the process is also a proper but not always an indispensable step in determining the basis of issue for a new piece of equipment. Thus we find that‘as early as 1 March 1942 the Table of Organization appropriate to the Company, Armored Medical Battalion—through revision that evidently anticipated successful development of a surgical:truck—had authorized for this medical unit two trucks, with ’’operating room body’!: one for use in the operating room;section, the other for use in the casualty treatment section.9 It was on the authority of this Table of Organization that the 24 trucks procured prior to standardisation of the item yjere distributed to the Third, Fourth, Fifth, and Sixth Armored Divisions, - B, Process of Standardization, Development of the vehicle having been completed, The Surgeon General’s Office at once turned its attention to standardization of the truck—the record of which action reflects no deviation from the procedure required. Thus by the time the directive of Headquarters, Services of Supply, had arrived, standardization proceedings were well under way. First,' the Subcommittee on Field Equipment of the Medical Department Technical Committee met on 16 September 194-2 and recommended a. That the Ordnance Department be charged with procurement of the. standard 2-g~ton truck, 6x6, long wheelbase chassis, b. That the Medical Department be charged with the procurement of the special type body to be installed on this chassis. c. That the Medical Department be further charged with storage and issue of the ■ complete Surgical Truck. ;i r d. That the Surgical Truck, for the Armored Force be standardized and classified as; ... Required type .. .• Adopted, type •: - ,’1' • ,,Standard article < T Qk- That the basis'of issue for this item be: 2 per Medical Company, Armored Medical Battalion,. The,report of the Subcommittee further indicated-that, if the proposed basis of issue were approved, 84 trucks costing a total of $344,400 would be required; that funds were not available; and that 24 units costing $94*400 had already been procured.H These recommendations were approved by the Medical Department Technical Committee on 5 October 1942 and were forwarded two days later to Headquarters, Services of.Supply, for its concurrence,^ After the Procurement Assignment Board, Head- quarters, Services of Supply, on 21 October 1942, had : assigned procurement responsibility for the complete item to the Medical Department and purchase responbility to the Ordnance *the Requirements Division, Services of Supply, classified the Truck, 2“|--ton, 6x6, Surgical as standard; charged the Medical Department with storage, and issue; approved the proposed basis of issue as two perj Medical Company, Armored Medical Battalion; and established monthly maintenance figures of 1.7 per cent for the Zqne of the Interior and 4.2 per cent for Theaters of- Thus the process of standardization was formally completed., on 28 October 1942. :>- • C• Proposed Post-Standardization Changes. Following standardization, however, ■ a->htimber of significant modifications were proposed—one nominal, the others structural. Chronologically,- the proposals materially to change the surgical truck came first* Some of these /• . proposals resulted in change;-,.others did not*. ; ’ ~ . : ' . x ■ •. ‘ ,:'vT.-C In correspondence that. was protracted• ,oyer a. period of four months, the first,such suggestionr-to. omit, the ladder from the body of the truck—finally was,]adopted.:.f- the Ordnance Department repliedvthat "contract requirement DED- 14-6 prepared to cover the procurement of 203 surgical trucks requisitioned for the Medical Corps includes the provision that the steel ladder located on the right front corner of the body shall be omitted" and indicated further that the 'Equip- ment Laboratory had been requested "to delete from their drawing F-358 the ladder•in question,"19 A recommendation by The Surgeon General’s Office that the Medical Department Equipment Laboratory make the necessary changes in its drawings was complied with on 1 March 1943. Unless one is to suppose that once the-most immediate requirements of the Armored Force had been satisfied there was no longer great need for haste—-an assumption that seems entirely unwarranted in view of the statement by The Surgeon General’s Office on 23 February 1943-; that.-; "48 trucks are urgently needed by the Armored Divisions;named in the attached requisition"^—it is difficult to understand why such an apparently simple decision,.should have Required, four months to; make, • . • ; r ., ' . t Suggestion for a second change came to The Surgeon, General’s ;Cffice ina telephone- conversation with a representative of-the Developments Section, Headquarters, ■ • Services of Supply, who in an obvious desire to conserve shipping space "requested that steps ’be taken to provide that the Truck, ,2-|--ton, 6x6,-Surgical be-made so that it can be of the knock-down type - ■ . Consequently, The Surgeon- General’s Office, on ■ 22 March 1943'asked the .Armored Force to make, studies to determine whether a .knock-down, surgical' truck were practi- cable;. and ."requested that .the, following cubatures be furnishedj,• V;e.hicle complete, ' b. Vehicle with chassis and body packed - ;v- separately, ■ • » ' « * • * c. Vehicle with body knock-down and contents packed separately"; but at the same time it informed the Armored Force that "This Office does not feel that it is practical to knock-down the body of this vehicle due to the installation of permanent 326 equipment contained therein and has so informed the Head- quarters, Services of Supply,11 Without actually furnishing the cubatures requested, the President of th,e' Armored Force Board replied that his board "does not believe- that any overall advantage would" result from converting the Truck, 2-J-ton, surgical to a knock- down type" and offered the following arguments in support of this conviction; ’ ‘ a. It is doubtful whether a knoCk-do’W-n : type of truck would result in any saving of shipping space when it is considered that the following accessory equipment which could logically be shipped inside the truck would have to be packed separately if the body of •* the.truck were knocked down. (1) Water storage tank, (2) Hot water heater and tank, (3) Fuel tank for heater, (A) Sink. (5) Cabinets and drawers. (6) Miscellaneous equipment such as surgical dressings and instruments,- 1 (7) Surgical truck tent. (8) Ventilating fan. (9) Plumbing and’ electrical fixtures', (10) Operating table, (11) Electric generator, ” 4’‘ : 1 ■ ’ b. A considerable amount of equipment' and fixtures is built into the body of the surgical truck, ..... c. Additional'time and effort would''be:- required to develop and test a body of the1 knock-' down type, d. Only six (6) surgical trucks are required per armored division,. , 'J‘; 327 e. It is probable that considerable difficulty would be encountered in. setting up a knock-down body and installing its equipment in the field, f, It appears probable that a knock-down . type truck' body would be more expensive and less satisfactory, in general than the present standard- ized surgical truck, As a consequence, the Armored Force Board "recommended that no further consideration, be given the development of the Truck, 2g--ton, surgical of the knock-down type, ”24- The indorsement which followed indicated the concur- rence of Headquarters, Armored Force, with the Armored Force Board and then continued: 2, In addition to reasons given in above indorsement for the undesirability of a knock- dovm type of surgical truck, the following are givens a. The permanent fixtures and instal- lations now on the present standarized surgical truck are definitely needed and ¥/ould have to be provided for a knock-down type of surgical truck. These would make numerous- items to store, to ship, to install when putting the truck together, to get lost, -and make the whole matter complicated. b. A great deal of time would be taken to put the knock-down truck together, thus making it necessary to use the same truck chassis all the time once the knock-down body was installed. This fact nullifies the possible advantage of being able to uSe' any* 6x6/ 2^--ton, truck chassis in a reasonable time for conversion into a surgical truck and vice versa, using the surgical truck for other purposes, 3. It is recommended that no further - con- sideration be given, to.the.development of the truck, 2-g—ton, surgical, of the knock-down- - type ,25 *• : Although this communication adds very little to what had already been bet.ter expressed in the preceding, more articulate indorsement, it probably did fulfill the purpose for which it was doubtless intended: namely; to emphasize the fact that Headquarters, • Armored Force, wanted a knock-down type of truck no more than the Armored Force Board, : ,. Using these third and fourth indorsements as references., The Surgeon General's Office then recommended to Headquarters, Army Service Forces, "that no further consider- ation be given to the development of the 2-J-ton Truck, 6x6, Surgical of the knock-down type, for reasons stated in indorsements referred to above,"26 and Headquarters, Army Service Forces., on 27 April 194-3 approved this disposition of its original proposal;^7 The proposal of the third structural change subsequent to standardization of the surgical truck could have been rendered unnecessary by the exercise of foresight. Fortunately, the modifications found needful could be effected so simply that little time or money was lost through making them. The changes deemed desirable had been discussed at a conference on 3 April 1943 between representatives of the Ordnance Department and the Medical Department Equipment Laboratory, Thre.e days later the Equipment Laboratory informed The Surgeon General's Office of the nature of the problem and of the decision reached to resolve it. "Since the width of the cab of the open cab type truck" such as that being received by Krieger Steel Sections, Incorporated, "is Y/ider than the cab of the closed cab type 2*g--ton, 6x6 truck heretofore utilized for this type of vehicle," the conferees had.decided that "both the Evans heater and the hot water heater /should/ be moved av/ay from the cab a suffi- cient distance, to permit proper operation of both"—a recom- mendation -which, if followed, would" require'-"a small alteration of the Evans heater.and 'the shell for the' water heater,"^ The report further indicated that-no change was desired at that time in the fiver-gallon gasoline tank' Y/hich supplied fuel for the Evans unit; but it was'recommended that "the Evans heater and the water heater' of surgical trucks now under pro- curement be. relocated a great enough"distance away from the cab to insure proper ti. ■ One-who has followed carefully the historical details of the development of the surgical truck wonders why the neces- sity of solving this problem should ever have occurred. Let us hurriedly re-read the story to'see Why a difficulty of this sort might have arisen-. ‘ ■.; Early in March of 194-2., The Surgeon General's Office .had forY/ardcd to the Armored Force for comment and recom- mendations copies of the Equipment Laboratory specifications for the proposed surgical truck,’ That was more than a year 329 before the conference called to consider relocation of the Evans and of the hot water heater; that was while Development Project F 15.03 still was in its preliminary planning phase; that was months before the pilot model was completed and delivered to the Medical Department Equipment Laboratory; that was even three months before the arrangement was made whereby Chemical Warfare Service agreed to release 24 chassis from its- July, allocation for conversion into the surgical truck. Even at that early date the Armored Force, objecting that the Equipment Laboratory specification called for a closed cab, explained that 11 It is understood by this head- quarters that future procurement of trucks, 2->V-ton, is to be with open cab,"30 The obvious answer to this objection by the using agency—a very.simple one to effect—'would seem to have been an unequivocal revision of the specification challenged. The Director of the Equipment Laboratory, nevertheless, rejected the proposed modification: 11 It is not considered necessary to revise the drawings and specifications to provide for an open cab,n he wrote, for "This matter will be taken up by the Equipment Laboratory direct with the Holabird Quarter- master Depot at the time the pilot model is procured. Naturally, if only open cab model trucks are being procured for the Armored Force the Quartermaster will procure this model,"31 Had the Laboratory revised its specifications as the Armored Force initially proposed, however, the difficulty,; that now arose doubtless would have been foreseen and obviated,. Though not in the form of;an actual proposal, a fourth suggestion that other structural changes in the surgical truck were desirable came from the Surgeon of the Armored Force. In June, 1943, The Surgeon General1s Office anticipated initiation of a project to develop a surgical operating truck for the AuxilliaTy Surgical Groups, based on the Truck, 6x6, Surgical, previously standardized for use by the-Armored Force,32 • Cobscquehtly it directed the Medical Department Equipment Laboratory to, conduct experiments to test the feasibility of making certain changes in the surgical truck.33 Upon receipt of The Surgeon General’s letter, the Director of the Equipment Laboratory informally sent an information copy of the directive to the Surgeon of the Armored Force, who gratefully acknowledged its’receipt and ' indicated that he had "a good many ideas concerning certain changes or improvisations for this truck which-'would improve its functioning” and which ho hoped shortly to be able to discuss with the Director of'the Equipment Laboratory*34 ■ He thought that consideration should be given, for example, to the overloading of the truck when personnel was aboard; a "suitable arrangement ... to lead off water from the • 330 sink”; "a ramp to permit the wheeling of. cases into -the body of the truck!’; and a number of other changes, involving surgical equipment, the Quartermaster tent, and so forth35—changes nob' directly related to, the structure of the truck itself. Since these ideas never became more than informal suggestions, how- ever, they are mentioned only for whatever of value.- -.they may be to .the future, student of Development Project Fw15".03,' Truck, 2-y-Ton, 6x6, Surgical, We have seen that, from the moment the surgical• . - truck project was initiated the Medical Department had realized the importance of having one body that could easily be adapted to the purposes of virtually every type of mobile medical unit. This basic body., this important component of the surgical truck, was itself to be standardized as a sepa- rate Medical Department item. It is not surprising, then, that the last post-standardization change in the construction of the surgical truck should have come not from the necessity of modifying the vehicle as such, but from the need of making its body conform to characteristics of the multi-purpose van as developed for other mobile units utilizing as their basic ■ body the Truck, Van, Medical, 2f--Ton, 6x6 (-4dt) soon to be standardized. Consequently, on 18 April 19A4-, The Surgeon General’s Office explained to,the Surgeon, Army Ground Fqrc.es, what modifications would be involved when the multi-purpose van ’ body was used in fabricating, the surgical trucks, and -it ■ requested ,his concurrence or alternate suggestions. ':The; structural alterations that. the. Surgeon of the Ground Forces was thus'presented with were substantially as follows: : [ 1. Sink located, nearer -center of .front vi? of body, . , . >.H>i ; • 2. Number of windows increased from two to four£ . with changes ! in cupboards and .drawers "• necessitated in ,providing space for.two new windows• ...: — ;v;-.■........ 3. Provision for certain>;c,abinets -.to, he/. ' . of same height so as to provide a, :-con,tlnuous top. surface about 36" high—a . change which x;eqxiired , elimination of three deep drawers.. in -each drawer unit,36 , ;. The Surgeon of the. Army.-Ground Forces, reported that he had no objection to incorporating these modifications of body design into the surgical truck and thus .concurred,, on 22 April 19A4, in the use of the multi-purpose van body, in the manufacture of surgical trucks for the Armored Force,37 331 The final change in the item, following standard- ization was not structural but merely nominal. In formally approving classification of the vehicle, Headquarters, Services of Supply, had indicated that its nomenclature would be Truck, 2-g—Ton, 6x6, Surgical,This nomenclature must have become garbled during the next IB months, however, for on 29 April 194*4 the Catalog Branch of The Surgeon General’s Office recommended ’’that action be taken to effect change in nomenclature of subject item ’’Item 99590 Truck, Surgical to ’Truck* 6x6, Surgical, .* in order that nomenclature for this vehicle may be in conformity with the surgical and dental .trucks' recently standardized, ”3'9 .After this suggestion, had been properly processed through the Subcommittee of the Medical Department Technical Committee, Headquarters, Army Service Forces, gave its approval of the change the Supply Service, Surgeon General’s .Office, was'appropriately and the approved nomen- clature was read for record before the Medical Department Technical CommitteeThus was accomplished the last change authorized for the surgical truck. V, Procurement Phase. :The zeal and industry which had characterized the activity of -both military and civilian agencies during the earlier phases-of rapid development and emergency procurement of the surgical truck carried through unabated—except for the delay in processing the proposal to delete the ladder— into the later' phase of mass procurement. Even before’fabrication and delivery of the 24 surgical trucks on emergency order had been completed, for example, The Commanding General of the Armored Force—on 11*September 1942—-requested that The Surgeon General take, necessary action ’’for the procurement' of the surgical trucks and black-out tents for all medical units of the Armored Force on the same basis of issue as heretofore established for the armored medical battalions of the first six armored Consequently, on 6 January 1943 the Office of The Surgeon General prepared'a requisition for 203 trucks at a ’’total estimate” of $625/225, or at an indicated unit cost of $3-,075, a figure later proved to be underestimated by nearly $1100, The Ordnance Department was instructed to ’’SHIP AS SOON AS STOCK IS AVAILABLE” the first 48 surgical trueks7~six to PHe Seventh through Fourteenth Armored Divisions then stationed as indicated ?/ithin the Zone of the Interior; further information concerning ’’Distribution for the remain- ing 155 surgical trucks,” it was promised, ’’will be furnished upon notification of Office of Surgeon General, Purchases Division, by Ordnance Department that an additional number 332 of trucks is .available."44 Two months after the requisition had been drafted The Surgeon General requested Crdnance to furnish him with the "distribution dates for first 48 trucks" requisitioned,45 to which the Ordnance Department replied that the "present shipping schedule for the movement of the Chassis to the Kreiger'/sic? Steel Sections, Inc. is as follows; Week of March 8, 1943 - 40- •March 15, 1943 23 "■ . March 22, 1943 - 20 March 29, 1943 - 20 April 5, 1943 - 20 April 12, 1943 - 20 . April 19, 1943 - 20 April 26, 1943 - 20 May 3, 1943 - 20 203 TOTAL (Chassis)"4-6 The projected dates on which "the completed Trucks, 2j*Ton, 6x6, with Surgical Bodies will become available at the Kreiger 7sic7 Steel Sections, Inc,, Long Island, Uew York," was also indicated: • - - v "Week of March 21$ 194-3 ■ ’ 5 .March 28, 1943 . 5 April 4, 1943 v‘ 15 -A ' April 11, 1943 - 15 ’ April 18, 1943 - 20 ...c hi:-- April 2$, 1943 *—20 ..-v--■ r'*v ' May 2, 1943 - 20.' n:!" . ■ May 9, 1943 - 20 ,a*’ , ■ May 16, 1943 - 20 1 ' ;-;v; May 23, 1943 - 20, M ‘ ..n May 30, 1943 - 20 . ;* June 7, 1943 - 23 ..v , ; 203 TOTAlM? ■■■■••■ It is beyond the scope of this essay on research and development of the.surgical truck to examine the reasons for the lack of coordination during the mass procurement phase which resulted in at least a momentary over-production of the surgical truck. Suffice- it to record that within less than a week after The Surgeon General’s Office had been furnished the delivery schedules just quoted, it decided that it would be "necessary to store some of these trucks in available depots."48 Although it was explained that a number of these vehicles "will be required as replacements for trucks which are destroyed in or captured in combat,"49 it apparently was becoming clear that if the delivery schedule were met the Medical Department would have many more surgical trucks than 333 it had any immediate need for. In any event, after coordination had been effected both within The Surgeon General’s Office and with the Armored Force itself, a memorandum announced that arrangements had been made to ■ have "outside storage space" assigned at the,.Montgomery Holding and Reconsignment Point, Montgomery, Alabama, for trucks that were temporarily surplus and that a representative of the Ordnance Department had been advised "to ship vehicles he does not receive other distribution on" to that instal- lation, 50 Surely there was now no urgent need for more surgical trucks—not so long as there existed conditions like that hinted at in the following telegram which came to the Commanding General, Army Service Forces, from the Headquarters of the Ninth Service Commands . . . REPORT THAT CG DESERT TRNG GTR HAS TURNED IN TO SERV COMD MOTOR POOL SIX TRUCKS TOO AND ONE HALF TON SIX BY SIX WITH ELABORATE SURG INSTIL STOP THESE WERE TURNED IN BY DEPARTING UNITS STOP REQUEST INFO TO WHAT UNITS THESE SHOULD BE REISSUED OR WHAT OTHER DISP SHOULD BE MADE .OF THIS SPECIAL MOTOR EQUIP END. . . ,51 An exchange of telegrams having revealed that these vehicles were standard,trucks, 2j-ton, 6x6, surgical and not semi- trailer units , and that they had been turned in by the Ordnance Officer of the Seventh Armored Division, the telegrams were transmitted to the Surgeon of the Army Ground Forces as a question for Ms office to answer,52 With some trucks being assigned storage space at a hold- ing and reconsignment point and with others being turned in '• at motor pools by armored divisions to which they had been issued as organizational equipment, it is apparent that the . urgency once so 'provocative of,anxiety to those needing the surgical trucks had ceased to exist. If still further proof .of this trend in supply,were demanded, one could point to the 14 ,facts that planners of procurement in October 194-3 were con- -; sidering diverting 19 of 'the surgical trucks to the Medical • , Department. Equipment Laboratory for conversion into mobile ■ dental units 5 53 that-by the last of November 194-3 some 91 . surgical truck bodies , had been completed far ahead of schedule • and were being held at the Krieger Steel Section, Incorporated, . plant-awaiting delivery of chassis on which to mount them; 54- and that the only apparent objection to an Ordnance proposal that a number of chassis- sufficient to move these 91 bodies •, could be diverted from.other Ordnance contracts lay in the inability of the Medical Department to show that it had any immediate need for these 91 plant-locked units,55 The Medical Department, then, might justifiably be charged .with inadequate planning, inaccurate computation of requirements/'and, in this instance, of insufficient coordination—particularly when one realizes that Theaters of 'were authorized only 72 of the. vehicles' in’"" ' 19A4- and .only 90' in whereas a contract, had been let *; fo:r .203 units ip- addition to the 24. originally. ,ordered. ' And, conversely,'•any contention that the Medical Department was unable to Supply all the surgical trucks that were immediately required would' certainly be untenable. The Medical Department had, in fine, progressed far. in,develop- ment and procurement from that time when, less than., 18 months before, the Surgeon of the Armored Force,’unassured that he could depend on securing the trucks through regular channels,' had requested funds from The Surgeon General for the local construction of 2A trucks so urgently needed by the armored divisions. . . 1’ .. : VI, Evaluation. No appraisal of Project F 15.03—-Truck, 2l-Ton, 6x6, Surgical—can be considered just if it neglects to accord abundant consideration to three general features,of the developmental program that served, either individually or in combination, to impede its smoothest and most efficient operations namely, :(l) the necessity, relieved only by the rough improvisation of the First Armored Division, of :"start- ing from scratch"| (2) the difficulty of securing,, .until late in the course of the project, adequate, funds fpr.the develop- ment; and (3) the continuous demand for rapid development and speedy procurement dictated by the urgent requirements of the Armored Force. Although such a generalization can not be defended as being applicable- without exception,, it might be strongly argued that the inadequacies in 'the‘surgical truck which did exist and many of the faults that were manifested in the administration of its formal development resulted from the pressure created by one or more of these bhree difficult conditions which may be obse3?ved in the discussion belov/. A, The Item. A significant indorsement of the surgical truck itself, it would seem, appears not so eloquently in what was said in commendation of it as in what" was left unsaid—and undone. The fact that the changes, suggested as desirable by the Surgeon of the Armored Force, were never formally proposed tends to indicate that the surgical truck, though admittedly subject to refinements, was nevertheless considered quite adequate for the needs of the Armored Force, the sole user of the vehicle as such. 335 . The importance of the Truck, 6x6, Surgical— the ultimate refinement of that crude improvisation of the First Armored Division—cannot be minimized as a means of providing adequate medical support for units of the fast-moving Armored Force, Nevertheless, when the historian takes a com- prehensive yievir of the complete program of research and develop- ment of, medical field equipment, following the -first ominous rumblings of World War II, he must observe also that the con- current development of the body of the surgical truck as a multi-purpose carrier v/as even more important,'' Obviously' the successful development of the all-purpose van „ body would materially reduce the expenditure of time,-labor, materials, and money required for subsequent development of ..mobile units, which might' utilize substantially the same oar- 1 rier, The adoption of a standard van body to be used in •practically all mobile units of the Medical Department, further- more, would greatly facilitate the production and procurement of the vehicles, purchase responsibility for which had been assigned to the Ordnance Department, And finally—though this advantage did not become apparent until later, when difficulty developed in the procurement of carriers for the Mobile Dental Laboratory and other units, to be discussed in subsequent chapters—some of the surgical trucks then on hand but not immediately needed could, with a minimum expenditure of time and effort, be converted into carriers for other types of mobile units. Thus the decision to develop an all-purpose body for the surgical truck was indeed a sound one—so sound, in fact, that it led ultimately to standardization of the body as such* Bi Administration of Project4 Although results achieved sc promptly from Develop- ment Project F 15.03 are actually little short of remarkable, a fact which tends to allay severe criticism of any maladmin- . istration of the project, there are strictures of several apparently,inexcusable improprieties in the administration of the program that should be made if such evils are to be avoided in sirailar'future proj ects, 1• Procedural Asnects, In the first place, The Surgeon ■General’s Office deviated from the procedural requirements of AR 850-25 in initiating its request for formal approval of the project. An attempt to judge yjhether this "short cut" was inadvertent or. whether it was a deliberate effort to expedite the project would become only fruitless speculation. T/hatever the motive for the action, reprocessing the request through the Medical Department Technical. Committee in conformity with the provisions of AR 850-25 resulted in the loss of four weeks of valuable time, A second departure from customary procedure— though not in .direct contravention of the provisions of AR 850-25—occurred early in the phase of project initiation, when G-1+ Division of the War Department General Staff assumed the role with the Armored Force. Though G-l had a legal and command prerogative to appropriate this function, since Army Regulations then in force specifically charged the War Department General Staff with responsibility for supervising the preparation of research and development programs, the same regulations also charged the appropriate technical committee—in this instance, the Medical Department Technical, -Committee—with the actual preliminary coordination of the projects among all interested agencies,57 it is dif- ficult to understand, then, (l) why coordination with the Armored Force had not been completely effected by the Medical Department Technical Committee before it requested G-4 to approve initiation of the project; and (2) why, ’unless in the interest of expediting the project, G-A did not again refer the program to the Medical Department. Technical Committee instead of effecting the necessary coordination with the Armored Force which the technical.committee had seemingly failed to perform. But very little time, if any, was lost because of the singularity of-this-, procedurep and since the records apparently do .not sufficiently explain this unusual action, it is ..mentioned not in criticism either of the Medical Depart- ment Technical Committee or of the War Department Generai Staff, but merely-as a note?jorthy and apparently unnecessary departure from routine, procedure as established by AR 850-25. Negotiating for procurement at a time when standardisation (or, for that matter, even development) had not been accomplished was a third deviating procedural step taken, by the administrators of Development Project F 15.03. In this instance, nevertheless, the officeFS of the 'Medical Department deserve not-censure, but praise| for if the let- ter of intent, to purchase 21+ of the surgical trucks had not been .proffered—an action that was concurred‘in by Head- quarters, Services of. Supply-.-it is disturbing to contem- plate the further loss of time th.at might have occurred during the development and, procurement of the immediately- to-be-needed surgical truck and the resultant delay in its subsequent issue to combat units. ‘‘ u ■ 2. . Engineering and Procurement. So far, this evaluation of the administration of the project has been restricted to its procedural aspects. We now conclude by briefly revie?/ing the administration of v/hat might be termed the development (or engineering) and :procurement aspects of the program. r-v • The Surgeon General had expressly desired, one will recall, preparation of ’’paper plans” for the develop- ment of the surgical truck, pending authorization of funds that would allow formal initiation of the'project. Although these ’’paper plans” apparently were never prepared, initial planning,- once instigated, was generally excellent, as witness the foresight manifested in the concurrent development of the multi-purpose van bqdy. . . Furthermore, when later development was momentarily stalemated because of the Quartermaster’s delay in completing his> part, of the preliminary planning, the- unhappy situation was happily remedied by the intervention of Headquarters, Services of Supply, which directed almost immediately that the Quartermaster Department complete the specifications and promptly construct the pilot model. To preclude any further delay Headquarters, Services of Supply, again directed—this time at the instigation of The Surgeon General’s Office—that a liaison officer be appointed specifically for the project. From that point forward there was no really serious retardment either in development or in production; and the foresight manifested in formally desIg- nat ing a liaison officer to expedite the project, when coupled with the whole-hearted efforts and cooperation of the small Krieger company, undoubtedly accounts in very large measure for the delivery of the pilot model to the Medical Department Equipment Laboratory for testing only eight days behind a time-starved schedule. This achievement becomes all the more impressive when one recalls that the difficulty of securing a contractor did not arise until after the deadline date for completion of the pilot model. Less expeditiously resolved, however, were other difficulties that are basically indicative of faulty administration—difficulties that were, fundamentally, a result of a seemingly unsympathetic appraisal by the Director of the Medical Department Equipment Laboratory of virtually all suggestions relative to engineering development that came from a source outside his own organization. Many of the features of the surgical truck desired by the Armored Force which were at first summarily ill-regarded by the Equipment Laboratory were later accepted—seldom with much loss of time, yet frequently over protests registered by the Director of the Laboratory. Since this unsympathetic attitude of the Medical Department Equipment Laboratory is manifested not only here but occasionally in other similar projects, one wonders why The Surgeon General’s Office did 338 not at this time inaugurate a policy of more active and more positive direction of the entire program of Medical Department research and development. Just one observation need be made about pro- curement, Whereas the Subcommittee of the Medical Department Technical Committee had reported that 84 surgical trucks v/ould be required and that 24 had already been procured, contracts for 203 of the units were subsequently let. The apparent over- production that finally resulted is a matter of concern to the historian of the Supply Service rather than of research and development; but since the surgical truck could with fair ease be converted into other mobile units of the Medical Department later to be developed, the surplus of surgical trucks v/as actually a boon not only in the research and development program, but also in the procurement program of mobile units other than the surgical. Whatever the deficiencies to be observed in the prosecution of Development Project F 15.03, the real value of the undertaking lay in its power to deliver the desired goods, and to de-livep them on time. Since the Truck, 2*|— Ton, 6x6, Surgical, had not only been developed and standardized, but was also being delivered in substantial number to combat units within 12*15- months of formal initiation of the project, one, must conclude that considerable progress was made in achieving The Surgeon General's .objective, as stated on 20 August 194-1 f to develop -at the earliest possible date effective medical support for armored and. other fast-moving units. 339 FOOTNOTES' TO CHAPTER V 1 ■ ' - ; c . . Table of Organization 8-78. Medical Company, Clearing. Battalion, .Armored Division» 15 Nov. 194-0. : • r,...... .( ■ '3 ■ ■ : ‘ ■ : Medical Department. U.S. Armys Research and Development \ Program. Fiscal Year 1942. 20 Aug. 194-1, CONFIDENTIAL, .-p. 1 (Hist, Div,, S.G.O.). Extracted in clear, 4ihid.. p. 52. Ybid. 6 • - * ■ 'V’:. Ltr, to T.S.G., fr. Research Coordination Br., Plans Div., S.G.O,, 12 Oct. 1943$ subjects "Monthly Status Report on Research and Development Projects for the Month of September " SECRET (Hist, Div,, S.G.O,), Extracted -in clear,- 7 Ltr* to T.A.G., fr. Exec, Office,'S.G.O,, 16 Oct, 194-1$ subject: ’.'Research Project—Surgical Truck,for Clearing Company, Armored Force”; et passim (A.M.R. & D, Bd,), Just what the ’’current available funds” consisted of is not explained. Obviously the $6,000 originally requested was not considered sufficient to complete the development, for even as late as April , 194-2, the Medical Department Equipment Laboratory reported that it would need for the development of Projects F 15.01, 15.02, and 15.03 (all components of the general project titled "Combat Medical Service for the Armored Force") a total during Fiscal Year 1943 of $68,4-00;—$3,600 for civilian personnel and s64-,800 for supplies and materials. (Monthly Progress Report. M.D.E.L.. Apr., 1942, p. 16—A.M.R, & D, Bd.) 8 Ltr, to T.A.G,, fr. Exec, Office, S.G.O,, 16 Oct. 1941$ subject; "Research Project—Surgical Truck for Clearing Company, Armored Force"\ et passim (A.M.R, & D. Bd,), 9 Ibid.: et passim. But see discussion of experimental truck developed by 47th Medical Battalion (Armored), Ft, Knox, Ky., pp. 300 ff., infra. 340 10 •: Medical Department, U.S. Army; Research and Development Program, Fiscal Year 19A2„ 20 Aug. 1941, GCNFIDENTIAL, p. 53 (Hist, S.G.O,).- -Extracted in clear, • 'Memo, to*T.S ;G;,-fr. Acting Asst, Chf, of Staff, W.D.G.S,, Supply Div,, G-4j 27 Oct, 1941|-subject; . ’’Reference of Proposed Development Projects to Medical Corps Technical Committee (Mobile Aid Station, Mobile Hospital Wards and Surgical Truck)” (Rec. Rra., S.G.O. 451.2-1). to- M.D.T.C,, fr. Subcommittee on Research Project— [-Surgical Truck^for Clearing Company, Armored Force, 4 Nov. 19411 subjects ’’Research Project—Surgical Truck for Clear- ing Company, Armored Force” (A.M.R, & D. Bd.), For proposed military characteristics, see p. 298, supra. oxix; cu-. 13 Min, of M.D.T.C., Meeting No,’ 3, 17 Nov. 1941, p. 3 (Hist. Div., S.G.O. 334.8-1). 14v'-[ :f • . . • . . 1st Ind.. to The Asst.( Chf. of Staff, G-4, fr. S.G.O., 18 Nov, 19415’ basics memo, to T.S.G., fr. Acting Asst. Chf. of Staff, W.D.G.S., Supply Div., G-4, 27 Oct, 1941 (Hec. Rm., S.G.O. 451.2-1)* ’ 15 . Memo, to the Chf, of the Armored Force, fr." Armored Force Liaison Officer, Office of the Liaison Officer, Hq., Armored r Force, ■ Washington, D*C.27 Nov, .1941 r =et .passim (Rec, Rm., ■ 'S ,G;0. 451;^!Carlisle Bks.-N). . . ., ,.. 16 1st Ind, to Liaison Officer, Armored Force, Washington, D.C., 'fr; Asst,’ A.Gi y Kq.:, Armored Force, Officeoof .the C.G,, Ft, Knox, Ky,, 11 Dec, 1941I -basics see n. 15, above (Rec. Rm,, S.G.O. 451.2-1 Carlisle Bks.-N). 17Ibid.- "• / . 1st Ind, to T.S.G., fr, T.A.G., 30 Dec. 1941| basics Itr. to T.A.G., fr. Exec. Office, S.G.O., 16 Oct, 19411 subjects "Research Project—Surgical ■ 'Truck5 for Clearing. Company, Armored Force” (Rec, Rra,, • S.G».0*, 451 • 2-l), : -:’ * 19 2d Ihd, to Dir., M.D.E.L., fr. .8 ..G»,G.., 1 Jan...194.21 basics see n, 18, above (Rec. Rra., S.G.O, . 20 3rd Ind, to S.G.O,, fr. Dir., M.D.E.L,, 7 Jan. 1942).: basics see n. 18, above (Rec, Rm., S.G.O, 451.2-1), 341 21 See Armored Force Board Photos 14-149 1420, 1421, "Surgical truck (Experimental), 47th Medical Bn, (Armd), 7/25/41, Fort Knox, Kentucky" (A.M.R, & D, Bd.) 22-4.": : • r n Memo, to Finance and Supply Div, /S.G.O./,. fr, Asst* to T.S.G.V 7 Jan. 1942 (A.M.R,* & D. Bd.), " 23 ■!44.; v;. 4>'t .. . . • ■ - ' - ' Ibid,; ett. passim. 2L • ' . Ltr, to T.S.G., fr. Hq., Armored Force, Ft. Knox, Ky., 15 Apr, 1942| subject; * "Surgidal Truck, Treatment Platoon, Medical Company, Armored," Incl, 2 (Rec, Em,, S.G.O, 45.1.2-1), 25 ■ •’ . 4 .4- . . ’ ' ’ 5. V.. ‘ ■ 1- Ltr, to T.S.G., fr. Hq,, Armored Force, Ftv Knox, Ky., 18 Jun, 19421 subject;' "Allocation of Funds' for Construction of Surgical Trucks" (A.M.R. & D, Bd,), •; ; ■ '' 26 5th Ind. Armored Force, fr. S.G.Q., 13 Jul, 1942; ■ basic: •sefe n,' 24, above '(A.M.R. & D,; /Bd-s-)-*; '- See, also, preceding 1st Ind, to T.S.G., fr, A.G.F,, Thru Hq., S.O.S., 25 Jun. 1942 and 2d Ind, to T.S.G., fr. Hq,, S.O.S., 6 Jul. 1942 (A.M.R. •.& D. Bd,)-, 27 ' ' 4 * .*'44..' 4, See p, 297, supra. *' **' ’ ;' , 4.4;4 2B Ltr. to M.D.E.L., fr, Hq., 48th Armored Medical Bn,, 2d Armored Div., 18 Jan. 19421 subject; • "Plans for'Surgical Truck Armored Medical Battalion" (M.D.E.L,). 29 1st Ind, to 48th Armored Medical Bn., 2d Armored Div., fr, M.D.E.L,, 21 Jan. 1942 (M.D.E.L.), 30 .... Ltr, to T.S.G., fr. Hq., Armored Force, Office of the Surgeon, 13 Jan. 1942|. subject; "New Items Organic Equipment, Medical Battalion, Armored Division—T/O !L,» January 1, 1942" (A.M.R. & D. Bd.). 31 2d Ind, to T.S.G., fr, M.D.E.L,, 26 Jan. 1942; basic; see n. 30, above (A.M.R,- & D. Bd.), 32 Monthly progress Report. M.D.E.L.. Jan., 1942, p. 17, et passim (A.M.R, & D. Bd.), 33 Ibid. 342 34 • ’ . *Ltr, to T.S.G., fr. Dir., M.D.E.L. ,*7 Feb. 194-2; subjects "Surgical Truck for Clearing Company, Armored Force" (Rec, Rm., S.G.O. 451.2-1 Carlisle Bks.-N), Evidence of the validity of this early but far-sighted reasoning, the conviction that a multipurpose van' body could be .designed for use with various mobile units of the Medical Department,is found in the formal standardization on 12 Sep. 1944- of the Truck, Van, Medical, 6x6 (4- dt), See 2d Ind, to Chf, of Crd., fr. Dir., Research and Development Div,, Hq., A.S.F., 12 Sep, 1944-1 basic;, not on file (A.M.R, & D, Bd.). ’ ; . • ' 35 Ibid. 36 2d Ind. to Hq,, Armored Force, Ft. Knox, Ky,, fr,. S.G.O,, 2 Mar, 1942; basic; see n. 34, above (Rec, Rm,, S.G.O. 451.2-1 Carlisle Bks.-N). 37 , 3rd Ind. to C.G., S.O.S., (Attn; Surgeon Gen.), fr. Hq., Armored Force, Ft. Knox, Ky., 12 Mar, 1942; basic; see n. 34, above (Rec. Rm., S.G.O. 4-51.2-1 Carlisle Bks.-N). 38 Ibid,; et passim. 39 Ibid. 40 • • , • ■ . • * ' ' A 5th Ind. tp S.G.O., fr. M.D.E.L., 24--Mar. 1942; basic.; see n, 34, above (Rec. Rm., S.G.O, 451.2-1 Carlisle Bks.-N). 41 7th Ind. to T.Q.MJl.., fr. S.G.O., 2B •Mar," 1942; basic;, seen, 34, above (Rec. Rm.,- S.G.O, 451.2-1 Carlisle Bks.-N), 42 , • ■ Monthly Progress Report. M.D.E.L.. Apr., 1942, p. 16; et passim (A.M.R. & D. Bd,). ‘ * • A , * • * ' *" 43 : : • . ■ •» Notes on conference held at Holabird QM Depot, 21 Apr, 1942; subject; "Surgical Truck for Clearing Company" (M.D.E.L.). The' Quartermaster General had not considered favorably "the mounting of the 13 ft. van body on the standard 2-y-tpn, 6x6 chassis (l64n wheelbase)" and had suggested to the, ; Commanding Officer, Holabird Quartermaster Depot, a ’’bolted- ■ bh extension if the pver-hang -(back of the rear wheels) is considered essential by the Medical Dept," (8th‘ Ind.‘ as synopsized "for record" on 11th Ind, to T.Q.M.G., fr. Hq,, 343 S. , Jiin. 1942' (A.M.R. &D. Bd,)| basics ltr, to T. fr, Dir., M.D.E.L., 7 Feb. 1942; subject: "Surgical Truck'for Clearing Company,'Armored'Force" (Rec. Km., S.G.O.,451,2-1). . 44. ' '■■■• 'Ltfi to Hq., Armored Force, Ft. Knox, Ky,, fr. S.G.O,, 21*May 1942; subject; "Surgical Truck for Armored Force" : (A.M.R. & D.- Bd.). 45 Ltr. to T.S.G., fr, Hq., Armored Force, Office of the Surgeon, Ft, Knox, Ky., 15 Apr. 1942; subject; "Surgical Truck, Treatment Platoon, Medical Company, Armorepl," Incl, 2 (Rec, Rm., S.G.O, 451.2-1); and cf. passim. 46 3rd Ind. to T.S.G., fr. Dir,, M.D.E.L., 1 May 1942; basic; ltr. to T.S.G., fr, Hq,, Armored Force, Office 'of/the Surgeon, Ft, Knox, Ky,, 15 Apr. 1942; subject: "Surgical Truck, Treatment Platoon, Medical Company, Armored" (Rec. Rm., S.G.O. 451.2-1), • ; .• ' • 47 : Telegram to T.S.G,, fr. Devers, Ft, Knox, Ky., 30 May 1942 (A.M.R, & D, Bd,), 48 Monthly Progress Report. M.D.E.L.. 1 May—9 Jun. 1942,'p. 13 (A.M.R. & D. Bd.). A.AA. 49 ■ . ... JR- Ltr. to T.S.G., thru’T.C;G., A.G,F; y fr. ’Hq;,‘ Armored Force, Ft, Knok, Ky;,’IS'Jun, 1942;'subject: "Allocation of Funds for Construction of Surgical Trucks" (M.D.E.L.), -50 ' ' ’ ’1 ' 1st Ind. to T.S.G,, thru T.C.G., S.0.3V, fr. Hq., A.G.F., 25 Jun. 1942; basic: see n. 49, above; et passim (M.D.E.L.), ; et passim. 52 ’2d Ind. to T.S.G., fr, Hq., S.C.S., 6 Jul, 1942; basic: see n. 49, above (M.D.E.L.), 53 • 3rd thru 5th Inds,, 7, 10, and 13 Jul, 1942, respectively; basic: see n. 49, above (A.M.R, & D, Bd,). 54 Ltr, to Lt, Col. Neil Page, S.G.O,, fr, Hq., Armored Force, Office of tile Surgeon, Ft, Knox, "Ky., 17 Jun. 1942; et passim (A.M.R,' & D. Bd.), 344 55 ..Ltr. to Gol. Albert W, Kenner, Hq., Armored Force, Office of the Surgeon, Ft. Knox, Ky., fr. John B. Klopp, Maj., M.C., , 24--Jim# 1942 (A.M.R. & D. Bd.). 56llth" Indv/to T.Q.M.G., fr. Hq., S.0.S.-/24 Jun. 1942?! basic: ltr, to T.S.G., fr. Dir., M.D.E.L., 7 Feb. 1942; subject; -"Surgical Truck for Clearing Company,.Armored Force" (A.M.R, & D, Bd,). 5' ‘ See n, 55, above (A.M.R, & D. Bd,), 58L ~ Ibid.; et passim. 59 . ■ .. . - - 60 Memo, to Dir., M.D.E.L., fr, John B, Klopp, Maj., M.G., : 26 Jun,''19421 subject: "Pilot Model for Proposed Surgical . Truck"- (A.M.R-. & D. Bd.). 6l 1 ’ . * ;V’: ; ’ ’ "Ltr. to T.Q.M.G., fr. Dir., Requirements Div., Hq., S.O.S., 27 Jun. 1942| subject: "Letter of Intent for Surgical Truck" (A.M.R. & D. Bd,). '■> ' "'V, In *-a note "for record" on this letter it is stated that A^hiS''company was selected because of their j/orkmanship and pioxlmity to Carlisle Barracks." ••••• ■' ' Ltr, to T.S.G., fr. Dir,, Requirements Div., ' Hq. ,7S.0,S., 27’.Jun* ‘■1942; subject: "Liaison Officer\During 'Construction of Pilot Model Surgical Truck" (A.M.R, & D. Bd.), 63 p, 8 (Hist. Div,, S.G.O.), 92 ■ ’ •, ... • • • • Ibid.. 10 -Jul. - 9 Aug. 1942, p.,12 (A.M.R. & D. Bd.). 93 Memo, to Mr. M.W. Ziegler of Krieger Steel Sec., Inc., fr, William.R. Cubbins*, Jr,Motor,Transport Service, 24 Aug. 1942| subject? "Contract No, W-2425-QM-260, Surgical Units" (A.M.R. & D. Bd.), 347 94 Memo, to O.Q.M.G., fr. S.G.O., 23 Jul. 194-2; subjects ’’Surgical Trucks, w/lst, 2nd, 3rd & 4-th Inds, (A.M.R. & D. Bd.). 95 - 1st Ind. to Hq., Armored Force, Ft* Knox, Ky., fr. S.G.O., 25 Aug, 194-2; basic (not on’file): Itr, to T.S.G., fr. Hq., Armored Force, 30 Jul. 194-2; subjects .’’Delivery of Surgical Trucks" (A.M.R. & D, Bd.). . 96 • ' r- Teletype to N.y_. Medical Depot, fr. Hays /Finance and Supply Service, 26 Aug, 194-2 (A.M.R. & D. Bd,). 97 Ltr. to T.S.G., fr,'M.D.E.L.-, 8 Sep, 1942; subjects "Contract 'W-2425-QM-260 (Surgical Truck)”" (A.M.R. & D. Bd.), 9B Ltr, to T.S.G., fr. M.D.E.L., 14 Sep, 1942; subjects "Contract U-2425-QM-260 (Surgical Truck)” (A.M.R, & D. Bd,.),. 99 .... Ltr, to Maj. Christie, Carlisle Bks., Pa., fr. Krieger Steel Sec., Inc., 16 Sep. 1942; and ltr, to T.S.G., fr. M.D.E.L., IB Sep, 1942; subjects "Contract W-2425-QM-260 (Surgical Truck)" (A.M.R. & D. Bd.). . ...1 • • ■ . . . Memo, to Personnel-Div., fr. Planning Div., S.G.O., 27 Aug. 1942 (A.M.R. & D. Bd.). ’ .. , 2 *’' . 'i --'-- '*•••*■ Ltr, to T.S.G., fr,- M.D.E.L., 20. -Nov, 1945; subjects ! "History, Surgical Truck for Clearing Company," Ind, 1, p, 20 (Hist, Div,, S.G.O.), 3AR 860-26. 23 Jul. 1936. , U Supra, p. 313. 5 Ltr. to Col, Albert W. Kenner, Hq., Armored Force, Office of the Surgeon, Ft, Knox, Ky., fr. John B. Klopp, Maj *,M*C., 24 Jun. 1942 (A.M.R. & D. Bd,). to Hq., Armored Force, fr, M.D.E.L., B Jul. 1942 (M.D.E.L.). 7 2d Ind. to S.G.C., fr. Hq., S.O.S., 25 Sep. 1942; basics ltr, to C.G., A.G.F., fr. Hq., Armored Force, B Sep, 1942 (A.M.R, & D, Bd.). 348 8 Supra, p. 316. 9 ' - ■ Table of Organization 8-77-. 1 Mar, 194-2.* ’‘This table supersedes t/o 8-77 and 8-78. both dtd. 5 Nov. 1940” - tables referred to on p. 295, supra. 10 • ; Rpt, to M.D.T.C., fr. Subcommittee on Field Equipment, 16 Sep, 1942, subjects "Surgical Trucks for the Armored Force, Medical Company” (A.M.R, &D, Bd,),‘ 11 lord. , , > .. 12 ' Ltr, to Hq., S.C.S., fr. Research & Development Div,, S.G.O., 7 Oct. 1942; subject; "Surgical Truck for Armored Force, Medical Company” (A.M.R,’& D, Bd,). 13 1st Ind. to Chf,, Development Br,, Requirements Div,, S.C.S., 21 Oct. 1942; basic: see n. 12, above (A.M.R, &-D; Bd,). 14 / p ' 2d Ind. to S.G.O,, fr. Requirements Div,, S'.O.S.j 28 Oct, 1942; basic; see n. 12, above (A.M.R, & D", Bdv), 15 Ltr. to C.G., A.G.F., fr, Hq,, Armored Force, Ft, Knox, Ky,, 31 Oct. 1942; subject; ’ "Elimination of Ladder t>h Surgical Truck"; et passim' (Rec. Rm., S.G.O. 451*2-1)’, 16 4. • " Ibid. •••■- 17 :,‘- 2d Ind, to T.S.G., fr, Hq.,.;S.0,S., 16 Nov, 1942; basic; see n, 15, above (Rec. Rm., S.G.O, 451,2-1). T v IB 3rd Ind. to Deputy Chf,, Ord. Tank-Automotive Center, Detroit, Mich., 4 Dec. 1942; basic; see n. 15, above (Rec. Rm,, S.G.O, 451.2-1),; * *. . 19 4th Ind. to T.S.G., fr. Engineering Br., Tank-Automotive Center, Detroit, Mich,, 3 Feb4l943| basics see n. 15, above (Rec. Rm., S.G.O. 451.2-1), 20 . . -• • Ltr. to Deputy Chf,, Ord. Tank-Automotive Center, Detroit, Mich., fr. S.G.O,, 23 Feb. 1943;* subject: "Truck, 24-ton, 6x6, Surgical” (Rec. Rm., S.G.O. 451.2-1), • The Armored Divisions named, in the requisition are the 7th, 8th, 9th, ICth, 11th, 12th, 13th and 14th. 349 21 Ltr, to the C.G., Hq., Armored Force, Ft. Knox, Ky., fr, S.G.O., 22 Mar. 19431 subject; ’’Truck, 2^*-ton, 6x6, Surgical” (A.M.R. & D, BdS}. . 22 ' ' ’ f ' Ibid.; et passim.. 3rd Ind, to C.G., Armored Force, Ft;: Knox, Ky., fr. Pres., Armored Force ■ Bd,, 6 Apr, 1943 y. basic; '’ see n.-' 21, above (A.M.R. & JVBd.-). ’ ' r 25 - '111'' 4th Ind, to :T,C.G., A.G.F., fr. Hq., Armored Force, 8 Apr. .19A31 basic; •’ see n. 21, above (A.M.R, & D, Bd.v). 26 6th Ind. to T.C.G., A.S.F., fr. S.G.O*, 23 Apr. 1943| basic; see n. 21, above (A.M.R. & D, Bd,). *27 ’ ■ ■ 7th Ind, to T.S.G., fr. Development Br.•, Requirements Div,, Hq., A.S..F,j 27 Apr. 1943? basic; see n, 21, above * (A.M.R..& D. Bd.). v 28 . . {rv } t ’i ,o *. Ltr. to T.S.G.,- fr. Dir,, 'I''I.D.E.L-. 6 Apr. 19431 subject; ’’Surgical Trucks” (AVH.R. & D. Bd.), - 29IMd. -‘S. 30 3rd Ind, to G.G., S.C.S., fr. Hq., .Armore,d. Force,* Ft. Knox, Ky,, 12 Mar. 19421 basic;' ltr. to T.S'.G.y fr.- Dir,, M.D.E.L. 7'Feb, 1942| subject: ’’Surgical Truck for Clearing Company, Armored Force” (Rec, Rm., S.G.O, 451.2-1), . - , 31 *. 5th Ind. to T.S.G,, fr. M.D.E.L,, 24 Mar. .1942p’basic; see n. 30, above (Rec, Rm,, S.G.O, 451.2-1), 32 See Chapter X, infra. 33 Ltr, to Dir., M.D.E.L., fr. S.G.O., 15 Tun. 1943, subject; ’’Tentative Changes in Truck, 6x6, Surgical” (A.M.R. & D. Bd.). 34 ntr. to Dir., M..D.E.L,, fr. The Surgeon, Hq., Armored Force, 28 Jun. 1943 (A.M.R. & D. Bd.), 350 35 , .Ibid, ( 36 Memo, to T|C.G,,‘A.'G.F., fr; Ghf., Operations Service, S.G.O., IB Apr, 1944| subject; ’’Truck, 2-g-Ton, 6x6, M, Surgical (Armored Force)” (A.M.R. & D, Bd.), . 37 1st Ind, to C.G., A.S.F., fr, Hq., A.G.F., 22 Apr. 1944| basic; see n„ 36, above (A.M.R. & D, Bd.), 3B 2d Ind. to Research & Development Div., S.G.O., fr. Hq., S.O.S., 28 Oct. 194-2; basic; Itr. to Hq., S.O.S., fr. Research & Development Div,, S.G.O., 7 Oct, 1942| subjects "Surgical Truck for Armored Force, Medical Company" (A.M.R. & D. Bd.). 39 Memo, to Chf., Operations Service, fr, Chf., Catalog Br., S.G.C., 29 Apr. 1944? .subjects "Item ,99590-Truck, Surgical" (A.M.R. & .D. Bd.). 40 1st Ind. to T.S.G., -fr. Deputly Dip., Plans & Operations, A.S.F., 12 May 1944? basic; Itr. %q C.G., A.S.F., fr. Chf., Operations Service, S.G.O., 9 May 1944? subject; "Item 99590, Truck, Surgical "(A.M.R. & D. Bd.), " *- • f * , # 41 ‘ ' •" Memo, to Chf., Supply Service, S.G.O., fr. Dir., Technical Div,, S.G.O., 20 May 1944? subjects "Item 99590, Truck, Surgical" (A.M.R. & D. Bd.). 2Min. of M.D.T.C.. 29 May 1944, RESTRICTED (Rec. ’Em., S.G.O, 451.2-1). Extracted in clear, 43 v Ltr. to T.S.G., fr. Hq., Armored Force, Ft, Knox, Ky., 11 Sep, 1942, subjects "Procurement of Surgical Trucks and Black-Out Tents" (A.M.R, & D, Bd,). No, S.G.O, P-305 General, 6 Jan. 1943 to Chf, of Ord., fr, S.G.O,5 et passim (Rec, Rm,, S.G.O, 451.2-1), According to- information obtained from the Detroit Automotive Motor Center, Army Ordnance Department, Detroit, Michigan, the cost of the body .was $2,259.89 and the cost of the chassis was $1,907,84—or a total cost for the complete surgical truck of $4?167.73. (Memo. tp.Maj. Tarbet, fr. George F.' Smith, Capt., Sn. C,-,- 29 Mar.- 1943 - A.M.R, & D, Bd.). Medical Supply Catalog:, Army Service Forces Catalog LED-3. 1 Mar, 1944? lists the unit-price as $4*167. 351 U5 Ltr. to Deputy Chf. of Ord, Tank-Automotive Center, Detroit, Mich., fr. S.G.C., 23 Feb, 194-3* subjects "Truck, 6x6, Surgical" (A.M.R. & D. Bd*), Ind, to S.G., fr, Tank-Automotive Center, Detroit, Mich,, 6-Mar, 1943* basic; see n, 44* p* 351 (A.M.R, & D. Bd,), 47 . • Ibid. ... • 48 Memo, to Col* S.B. Hays, Distribution Div., fr, Chf., Field Equipment Br., Plans Div., 9 Mar, 1943 (A.M.R. & D. Bd.), Ibid. 50 Memo, to Cols. Klopp, Fenton, Hays, and Ghormley, fr. R.L, Black, Lt. Colt, M.A.C. 11 Mar. 1943, CONFIDENTIAL (A.M.R,. & D, Bd.), Extracted in clear, 51 Telegram to C.G., A.S.F., fr, Joyce, C.G., Ft, Douglas, Utah, 6 Jul. 3suf/. . , • • • • 52 . ■' • ‘ . ' ... . 1 * Ltr, to C.G., A.G.F., fr, S.G.O., 12 Jul, 1943* subject: "Surgical Truckp.". (A.M.R. & D, Bd.), Note inclosed copies of telegrams dtd. 8 and 10 Jul. 1943, 53 • • . • • • • •' ’ ' - V.'• • y/.:i ; * ' C .' V Memo, to Dir,, Distribution & Requirements Div., fr, Chf., Field Equipment Development Br,, Plans Div,, 29 Oct. 1943* subjects "Request for Trucks, Surgical" (A.M.R. & D. Bd,), Although the request, contained in ;this'-memorandum, "that nineteen (19) Trucks, Surgical, now in storage, be shipped to the Medical Department Equipment Laboratory, . , , as soon as possible, for conversion" was quickly .cancelled- (Memo, to Dir., Distribution1 &'Requirements Div., fr* Chf,, Field Equipment Development Br., Plans Div,, 2 Nov, 1943* subjects ."Request fpr.Cancellation*of Memorandum, 28 Oct, 1943" - A.M.R, & D, Bd,), plans actually to convert surgical trucks into dental units, were not. abandoned, * (See memo, to, Chf*, Program Planning Br., fr. G.H, DavisQapt,, M.A.C., 24 ’Nov, 1943-1 subject; ’"Item 99590, Surgical Trucks" - A.M.R. & D. Bd.). 54 ,‘ •’ •' •. ' L. ‘:s' ; . Memo, to Chf., Program Planning Br., fr, G.H. Davis, Capt,, M.A.C,, 24. Noy, .1943* subject: "Item 99590, Surgical Trucks" ••(A.M.R. & D. Bd,).. ‘ : AC A ‘‘7.’ 352 55 1st Ind., to Procurement Div,, fr, Chf., Field Equipment Development Br., Plans Div,, 26 Nov. 1943; basic: memo, to Chf,, Field Equipment Development Br., Plans Div., fr. Chf,, Program Planning Br., 25 Nov. 1943; subject: "Item 99590, Surgical Trucks" (A.M.R, & D. Bd.), 56 For authorized distribution of the surgical trucks by theaters of operations, see the following communications: Itrs, to C.G., NATCUSA, fr. Chf., Supply Service, S.G.O., 26 Oct. 1944; subject: "Medical Department Trucks"; to C.G., ETC, fr. Chf., Supply Service, 26 Get, 1944; subject: "Medical Department Trucks", CONFIDENTIAL (Rec. Rm., S.G.C. 451.2), Extracted in clear. The following table shows distribution to the various theaters authorized to receive the trucks: By 31 Dec. 19LL By 31 Dec, 1945 POA 0 0 NATOUSA (MTOUSA) 6 6 CBI 0 0 South Pacific Base Command 0 0 ETC 66 84 SWPA 0 0 57 AR 850-25. 23 Jul. 1936, passim. 353 CHAPTER VI THE AilMY MOBILE'-MEDICAL- LABORATORY I. Historical Background. A. The Semi-Mobile Laboratory. The Army Medical Laboratory which was in standard use for two decades following World War I was a far cry from the highly mobile, flexible, arid self-contained unit which is in such widespread demand today. In at least three important respects this earlier Laboratory, despite its motorized transportation, possessed limitations which pre- vented it from functioning as a truly mobile unit. To begin with, instead of being organized into several sections, the World War I Laboratory was constituted as a single inflexible unit, allotted on the basis of one per field Army. So constituted, it tended to remain largely in the Army area as.it was organically incapable of sending out sub-sections, equipped to function independently for short periods of time,- to provide ,Emergency field laboratory service for the Corps areas. In short, assistance to Corps areas could be rendered only at the expense of laboratory service in the Army area,-*- . . The mobility of the World War I Medical Laboratory was also limited in a second important resp'ect, The unit lacked completely any self-contained or even partially- specialized laboratory vehicles. As prescribed by the Tables of Organization £nd the.Tables of Basic Allowance which were in force during the-early twenties and which were only slightly modified thereafter, integral* transportation for the Army Medical Laboratory consisted of one light 5-passen- ger motor car, two motorcycles with sidecar, and three ij-ton light cargo trucksSince no provisions had been made for the carrying on of routine laboratory activities within any of these vehicles, all work.of this nature had to be performed in the field. This meant that in moving into a new location a great deal of preliminary labor had to be expended before the Laboratory could begin to function. Tents had to be pitched; utility equipment such as electric power generators, water tanks,.stoves, refrigerators and autoclaves, had.to be unloaded from the'trucks and reassembl- ed; all spedalizptd .laboratory instruments and supplies had to be unpacked, sorted, and arranged before systematic oper- ation was possible. . The third, and perhaps the most serious, defect of the World War-I Laboratory was the awkward and burdensome method which had been adapted for the packing and transport- ing of laboratory equipment. Such equipment had to be 354 painstakingly hand-packed in heavy medical Department chests. Due to the excessive handling involved, the possibilities of breakage were high and, even more important, loading and un- loading operations under such a system became onerous and time-consuming in the extreme; Furthermore, before moving the unit, culture media, certain biologicals, diagnostic sera, and stock laboratory solutions—all requiring consider- able time and effort to prepare—had to be discarded before their containers could be packed in the chest. Then upon arrival at the new location, valuable time was lost while the solutions which had been previously destroyed were prepared anew.0 Finally, there was the- ever present danger of acid damage. The breakage of a .small, 30 cent acid bottle which was contained in a $200 chest',filled with expensive equip- ment could prove disastrous. This contingency, it may be pointed out, was a source of worry to,Medical Department officials as.recently as 1937,4 ... . While the above disadvantages, at least from present perspective, might seem to have constituted ample justification for an immediate and drastic modification,of• the authorized equipment of the Army Medical Laboratory, the records indicate that only small-scale, and sporadic experimentation was engaged in until 1939* In the years immediately following World War I, -a special purpose . trailer was developed to function as a part of the Laboratory for -use in■the rear of the Army .An examination of Tables of Organization-and Tables Of Basic Allowance,,how- ever, shows that this item was never incorporated into official lists tf standard issue Laboratory equipment. In 1928, the Medical Department Equipment Laboratory at Carlisle Barracks built a second experimental trailer for the Laboratory but the trailer had no heat, light, nor a sheltered place for personnel, and after considerable, testing was rejected.® In 1935, The Surgeon General, after studying the needs of the Army Medical Laboratory, expressed a preference for a semi-trailer or bus type vehicle. Construction of a semi-trailer was thereupon authorized, but lack of funds for the work caused delay until late in the Fiscal Tear • * In short, throughout the period from 1919 to 1939, the Army Medical Laboratory remained virtually unaltered. Equipment list items continued to be packed in heavy laboratory chests, while the sole change in vehicu- lar equipment consisted in the replacement in 1927, of one of the three cargo trucks with a 3/4-ton cargo truck,8 B* The Mobile Laboratory. The fact that the Medical Department, in 1933, 355 rejected the Equipment Laboratory1s experimental trailer because it "had no heat, light, nor a sheltered place for personnelindicates that at least by this date serious consideration was finally being given to the need for a truly specialized and self-contained laboratoiy vehicle to take the place of the general-purpose cargo truck. In June, 1934, an important event occurred which gave both direction end impetus to this new approach to the problem. On that date. the'. Pennsylvania State Board of Health demonstrated before medical officers at Carlisle Barracks a radically new type of field It consisted structurally of a special York-Hoover body (19-feet 8 inches long, 7 feet 6 inches wide, and 7 feet 5 inches high), mounted on an elongated autocar chassis (16 feet 4 inch wheelbase), and equipped with single front and dual rear wheels. Inside laboratory space measured 16 feet by 7 feet by 6 feet 2, inches, and an aisle three feet wide, separated the low tables which lined the walls on both sides. The vehicle was, in effect, a virtually self- contained laboratory on wheels* Ceiling lights had been provided, the interior was wired for electricity which could be used .for heating purposes when commercial, ,powerwas available, and' gas tanks and storage batteries' were included as supplementary power sources, Among the other interior fittings were screened windows, a built-in sink and drain board with hot and cold water connection, side ventilators, tables, bottle racks, and special cabinets with drawer space- sufficient for the storage of all loose laboratory equipment. There was'under-floor-storage space for tools, and standard heavy equipment, such as stoves, incubators, refrigerators, and autoclaves, were installed in the. labo- ratory proper, Two solid rows of table tops provided ah ample working surface for laboratory personnel.,' ' The.advantages-of this :model mobile1laboratory were self-evident. With loose laboratory equipment stored in cabinet drawers, instead of heavy Medical Department chests (with acid bottles .segregated into a- separate drawer), not only was there virtually no packing involved in moving, from cne location, to another, but a considerable portion of the work could ;be performed right inside the 'vehicle. The dangers of breakage and acid damage were largely eliminated, the time and effort involved in leading and unloading were reduced to a minimum, and the unit was capable of oper- ation even in the most inclement weather, Furthermore, in view of the greatly increased mobility and self-sufficiency of this new vehicle, the notion of increasing the flexibility of the standard Army Medical Laboratory by subdividing it. into several laboratoiy sections appeared'suddenly.feasible. 356 (V Summary, Due to a lack of funds, the Medical Department was unable to .begin construction of an appropriately modified form of the above mobile laboratory until the year 1939.I1 During the evolutionary period which has Just been described, however, the direction of future research in this field had been- fairly well determined. The limitations of the old Army Medical Laboratory had become increasingly apparent, and now, since the demonstration of the Pennsylvania State Board of Health’s laboratory model, the general outlines of a practical alternative were fairly clear. All that was lacking at this point were funds and personnel to perform the indicated development work. . ... ■ "• II. Project Initiation (Phase I). A. Initial Project Proposal. • Included in the estimate of funds for medical research and development for Pis Cal Year 1939, was the sum of $500.to be allotted forrthe 'specific purpose of developing a mobile While, this sum, of itself, would have been insufficient for the major research undertaking that was necessa.iy, an unexpected turn of events opened up the possi- bility, of obtaining, cost'free, a completely constructed semi-trailer which would be ideal for experimental purposes. A 2-wheel, semi-trailer van had been procured for the Medical Department by the Quartermaster General with a view to its being converted into a mobile operating room, a unit of the new surgical hospital then under development'at, Carlisle Barracks. However, one such operating unit had already been completed and, until it had been thoroughly tested* it was considered inadvisable, to assemble a second unit. .Thus the semi-trailer van Just procured, was, for the time being, a surplus item. The Surgeon General’s Office acted quickly, to seize this opportunity, and on 24 January 1939 directed a letter to The Adjutant General requesting that authority be granted to use the semi-trailer van then at the Holabird Quartermaster Depot for the development of a mobile labo- ratory, In Justifying a full scale reopening of the research project which had been authorized in 1933 but had never been worked on, The Surgeon General’s Office emphasized the present desirability of having an Army Laboratory which, instead of the old single unit type, would consist of a base laboratory section to serve in the Army area and three mobile subsections to serve farther forward in the Corps areas* It was pointed out that the mobility of this unit was of greater importance than ever because the laboratory section origi- nally included in the service-, company of the medical regiment had been deleted from new tables of organization, with the view that the laboratory work previously per- formed by this unit could be better accomplished by the Array Medical ; • The inefficiency and relative immobility of the Army Medical Laboratory as then:constituted could, it was argued, be corrected by: (l) the use of cabinets, instead of Medical Department chests, for the storage of apparatus and equipment; and (2) the substitution of a:modern semi- trailer van, equipped with electricity, running watter, and other basic laboratory needs, in-place of the .currently employed all-purpose cargo truck. Thus modified the unit would be-able to move -at once from one location to another without having first to dismantle its equipment and destroy vital laboratory,;solutions, ■ Finally, attention was called to the present existence of a-suitable laboratory model— that of the Pennsylvania State Board of Health—and the fact that the adoption of such a mobile unit, would, be in keeping with the-modern practices of many other state „• health ..... This well argued petition by The Surgeon General’s Office for the reopening of Development Project, F-3. was successful, Within a few weeks The Adjutant"General granted authorization for the mobile laboratory project, provided the semi-trailer van that had 'already been purchased for the-.Medical Department and was then at Holabird Quartermaster Depot was used for the experimentation,-*'3 3. Procedural Aspects. According to data on-file•in The.Surgeon General’s Office, Development Project. F-3, was first initiated 13 April 1933,It. will be recalled, however, that although the construction of a semi-trailer laboratory was authorized in that year, -the funds were not forthcoming, and the pro- ject remained dormant until the beginning of 1939. ■*•3 The project request, submitted by the Medical Department.in January, 1939, represented, therefore, a formal reopening of the whole question. As such,.it was subject to all the usual procedural requirements of AR 850-25 governing project initiation proposals. While The Surgeon General’s letter of 24 January 1939 contained an admirable statement of the purpose and justification of the proposed development project and a clear indication of the specific Medical Department vehicle and the specific research funds which were to be used, there was one important omission, Ho statement of military charac- 358 teristics had been prepared, as required by Army Regulations. Moreover, this procedural error, was not corrected by higher echelons. As we have seen, The Adjutant General approved the project request without comment as to its incomplete- ness. It was n,ot, apparently, until more than two years later that full compliance with this provision of AR 850-25 was accomplished. On 3 April 1941, in presenting its proposed research program for Fiscal-'Year 1941, the Medical Department included the following statement of military characteristics for Development Project, F-3i Military Characteristics: To provide .preventive medicine facilities commensurate with an Army medical laboratory, by means of a mobile laboratory in a semi- trailer or bus-type vehicle, fully equipped for all epidemiological work in an Army area in time ’of war There' is no evidence at hand which would indicate that the above statement, which was subsequently approved without change by The Adjutant General’s Office, was ever formally processed through the Medical Department Technical Committee,' as. required by Regulations, As, for the substantive adequacy of this delayed formulation of military character- istics, the reader is referred for purposes of comparison to the military characteristics prepared during the' second-phase of this development project and, incidentally, carefully processed through all the agencies specified by AR 850-25.^ III. Development Phase I. A« Preliminary Survey. Because of circumstances beyond their, control, research and development personnel found themselves forced to plunge into actual development work without making even a token survey of all existing research possibilities. As we have seen, the Medical Department was already committed to confining its experimentation to. the semi-trailer van which was then on the shop floor of the Holabird-Quartermaster Depot..- .'This decision, limiting the. scope of the project to a single possibility,, had been made solely on grounds of expediency, yet it would be difficult to criticize the’ Medical Department for its action. The project, had been virtually dormant for six years due to a lack of funds, and here was an opportunity to pre-empt an unclaimed vehicle which might- be converted into at least a crude approximation of a genuinely- mobile laboratory. 359 With only $14,500 allotted to the Medical Department for all types of research and development for the Fiscal Year it is not difficult to see why, in this instance, research policy was so heavily influenced hy the mere availability of a cost-free vehicle. Whatever its immediate justification, however, such an opportunistic research polity possessed certain definite limitations. In the first place, due to the lack of funds, none of the commercially available alternatives to the semi-trailer van could be seriously considered. As we shall see, such possible alternatives included: (l) the Pennsylvania State Board of Health model; (2) the cargo truck-house trailer combination of the U, S. Public Health Service; (?) the General-Electric Century of Progress mobile unit. In the second place, haying .committed its-elf to experiment exclusively with the semi-tryiler van, the Medical Department, was unable to obtain: authorization to work on' any other vehicle, 'however promising, eventhbugh it also could bo made.available cost free,. The front-drive, bus-type ambulance, for example, was available for general experimental purposes as .early as July, 1940, -Research and development"personnel immediately expressed a desire to try to convert this vehicle into a mobile medical laboratory. The Surgeon General1s Office, in fact, formally attempted to substitute this- bus type'truck for the- s emi-trailer "specified for Project E-g. but this, request was refused by -The- Adjutant Generalrs Office which ruled that the project- had to- be completed as originally outlined.23 ' - A Had this project been adequately financed, a thoroughgoing study of all the above research possibilities^ could have been made before actual development work began. As it was, awareness cf promising alternatives to the semi- trailer van was coupled with inability, on .the part of research and development personnel, t.o.give serious con- • sideratibn to any of them. These- were far from ideal research conditions arid, as we shall see presently, they did not produce’ impressive results. ‘ B. Dgvelopnental Stage, As' soon as the Medical Depart-neat Equipment Laboratory at; Carlisle Barracks learned that*the-initiation ■ of BeVelopment Pro.jeCt. P-3* would he approved by'higher authority, it immediately took, steps .to • .-obtain a tentative list of the equipment and supplied which were to he- installed in the new 'laboratory." On 2 February 1939, the .following- • letter was- sent to Array Modical: Center,, Washington, 'D. C. A project has been authorized by Thb Surgeon General for the equipment of a large 360 semitrailer vantype body as a mobile laboratory. 2. This trailer is similar in size and> shape to the one'recently procured and equipped as an operating room for a surgical hospital, 3. It is requested-that this office.be furnished with a tentative list of equipment and supplies considered.by you to be necessary for work of this unit in the field. 4. In so far as the equipment -is concerned* it will not be necessary to furnish data'on voltage, power units, and so forth. Inasmuch as there were ample shop facilities at the Holabird Quartermaster Depot, where the semi-trailer was still being housed, it was decided that the bulk of the construction work could be performed at that point, with the Equipment Laboratory: at -Carlisle merely exercising general supervision,:' .Accordinglyin-a- letter dated 25 April 1939* the Laboratory, forwarded to the -Depot detailed instructions'' as to the changes which were to be made in the vehicle and agreed to allocate eight hundred-and'fifty; dollars from its local research funds to cover the costs- of the work,^ The structural changes specified- at this time included the.1 following: (l) side and end walls and ceiling to be insulated;: (2). ..four single plate—glass windows on each . side, and one plate-glass window for the front end of the body; side windows to slide up and down, and windows to open outward; (3) a row of ceiling electric light fixtures on each side of the trailer, ahd two forward ceiling fixtures in the center line; four wall sockets on each side and one on the front wall; (4) upright 50-60 gallon pressure water tank to be installed in left front corner of body; (5) one stainless steel sink, with drainboard* centered across the front of the body; sink to have only a cold water faucet; drainage by pipe through floor (6)'compressor-and small motor for maintaining water pressure at the faucet (?) the necessary piping and plumbing to connect water tank and sink; (8) exhaust ventilating fan in front end of body, right upper quadrant; (9) tempered pressweod covering for floor; (l) ceiling to be painted flat white, sides and ends sea-green; outside painting to be the same as for previ- ously finished 'bodies•' The working relationship which was maintained between the Equipment Laboratory and Holabird Quartermaster Depot during these early months was a'model of efficiency. The initial instructions' issued by the Laboratory had been both concrete and comprehensive, and as a result subsequent correspondence was held at a minimum. Before the close of May, 1939, construction details had been carefully blue- printed and some of the heavy equipment which was to be installed by the Depot had-already been selected.^7 Since the equipment lists which had. been requested from Army Medical Center had not yet been received,.the. Equipment Laboratory next turned', its attention to the question of cabinets, tables, and table top coverings. Cabinets with shelyes and drawers would be needed in: the mobile laboratory for the storage of chemicals and other equipment and supplies, but it'.’appeared- to be useless to attempt any elaborate designing of cabinets until the total amount and.variety;of equipment to be stored were known. However, there was no reason why the laboratory could not begin work immediately on the design and con- struction of suitable laboratory tables. It was already assumed that laboratory technicians would perform a largo number of their analyses inside the.truck; hence a broad, level working surface was necessary. After considerable discussion it was finally decided.that two long tables,, sufficiently high to fit over the storage cabinets which were to lino each side of the laboratory interior, would adequately serve this purpose. It was also necessary, however, to discover seme effective way.of treating the tops of these tables so that they would be rendered acid and alkali proof, and resistant to marring, . : ' . The development of a satisfactory table was a comparatively simple undertaking. After a brief preliminary study it was determined that the tables should be approxi- mately. 28 inches wide and 12. feet long, and should be, con- structed of tongue and groove maple’ .-Selection of a suitable covering for the table tops, however to be more difficult. Preliminary examination-.'seemed to indicate that either hard rubber or stainless steel might be satis- ... factory, but before arriving at a final- decision the Laboratory- took the precaution of a.onsulting a- number of well-known commercial-firms;,, Prom, the American Hard Rubber Company the Laboratory learned that hard rubber was attacked by strong sulphuric and nitric acid, and was also affected by the common rubber solvents. Only if these chemicals were quickly washed off with a quantity of water could the rubber be expected to render good Prom the Monsanto Chemical Company it, was learned that the only plastic which was acid resistant was a special molding compound , (Polystyrene) which would not be practical for the use Ebony finishes were also tested by the Laboratory, but were not found to be satisfactory.31 Finally, 3. P, Goodrich Company was contacted for infor- mation on MAcidsealn paint as a finish for the laboratory table tops,. The Goodrich Company suggested their #1045' paint as suitable, a sample was requested, and the paint subsequently applied to a maple table top assembled with waterproof glue. 362 This time the results- were satisfactory and acidseal paint was thereupon selected by the Laboratory as the best of the protective finishes.32 In the absence of any written directives from The Surgeon General’s Office clearly distributing responsibility for the various phases of'Development Project, P-3, the Equipment Laboratory had-, as we have seen, unofficially assumed the role of coordinator of research activities in addition to its regular "developmental duties. In our dis- cussion thus far, it would appear that the functions which the Laboratory had, so to speak, delegated to itself were well within' its province. The same cannot-be said, however, with'regard to certain procurement activities in which the Laboratory was also engaging at this time. In "a letter, dated 2 February 1939, responsibility for the preparation of a tentative equipment list had been assigned by' the Laboratory to Army Medical School.- Yet two days later, on 4 February 1939, the Equipment Laboratory circularized two manufacturers, the1 Coleman Lamp and Stove Company and the American Machine Gas Company, for information regarding portable gasoline: stoves,33 Negotiations were continued and finally a Coleman stove was purchased out of Laboratory funds for $46,1-6, Moreover, as we shall see in a moment, equipment purchases by the Laboratory were hot to be confined to this one relatively unimportant item but were to continue,-involving ultimately a gross expenditure of nearly $300. • • - ■ On 29 March 1940, Holabird Quartermaster Depot notified the Equipment Laboratory that its work on the mobile -laboratory had been completed, and, within a week the vehicle was delivered to Carlisle Barracks.31 In cooperation with the Director of Sanitation, Medical Field Service School, Carlisle Barracks, final drawings were made of the laboratory tables which were to be installed -in the trailer, and the necessary lumber, paint, angle iron, and hardwood were procured, . The table tops and framework for ' the tables, were then constructed: during April and Hay; Further-work was delayed pending receipt' of the equipment list which was to be prepared by the Army Medical School. It was felt that the inside of-the cabinets and drawers should be built around this equipment in order to insure its safety when the trailer was'moving from one- location to another■ • As for thfe -heavier "equipment which was to be individually installed- rather than packed in drawers, the Laboratory was hot so patient.-. Immediately upon •receipt of the trailer from-Holabird Quartermaster Depot, the' •Equipment- Laboratory obtained from the head -of the Department of Mbdicai FioId Service'School-,, a- list, of; rail so-called "fixed equipment0 which'would he-' needed. /Th& . following'items' were selected and-subsequently requisitioned by the laboratory.36 *• . Item 99782, Generator, gasoline-, 1500 watt ,. ••$400*00-- Item 73770, Refrigerator,'electric:.... ,75*66 Item 41390, Centrifuge ;. -K -1 ;•* .. ■: 18,00 Item 44010, Sterilizer, Arnold .. .V. ..«,V 20.00. Item 94010, Autoclave, field .. 20.00 Item 94320,, Incubator, field, tWo:-(2) V. ... 190.00 01 cl -L‘ • • • • • • 726.63V-; ; .• - I,t .should be -remembered, ■ of courser.', -that Anay? Medical' School" had already had-fourteen months-, in which- to •• prepare a* 'tentative:-equipment..list.,.. -but as. yet had apparently done nothing about- the matter. ' Such an extraordinary del.ay certainly furnl'shed considerable' p’rovocation for the action; which was now’.taken by the' Equipment'Laboratory. In view of later developments, however, it will be seen that a more; effective recourse would have been to appeal to The Surgeon , General’s Office, for a forceful, central direction of the project from'this point on. The absence-Of aiiy-real - research coordination at-the top had been a conspicuous administrative weakness from the beginning. In any event, on 10 May 1940, the Director of the Department of Sanitation at Carlisle Barracks was relieved and was replaced'by a new Director who,* soon'after his-, arrival, inspected the mobile laboratory and suggested that ■ the Director of Army Medical School come to Carlisle- and ■ see what work had been done thus far on the'trailerThe latter visited the Equipment Laboratory oh'26 June, inspected the vehicle, and, requested blueprints of the tables.1 which had boon constructed,' These were'furnished on 9,July 1940., .. Then the inevitable happened. -On 5 August 1940, the Director of the Equipment Laboratory received a memo- randum from the Director of the Army- Medical School , ', requestingJ' (l) that the -sterilizer purchased-, by, the.;■ Laboratory be replaced by a- nonstandard unit manufactured # - by the Bf'amhall Deane Company; (2) that the gasoline stov.e purchased from 'Laboratory funds be replaced by a -special ' boomer to be developed by the Jeffersonville Qpartemaster Depot; (3) that the refrigerator already requisitioned be replaced by a nonstandard item, the exact type to be selected at a'later date by the Director.of the Army Medical School; (4) that the kerosene-operate! incubators be replaced by electric ■ \. .. " In -additfoh 'to -' those written -r.ec’omehdati'ons, it ■ was lea me d i nf 6 rmal ly by - the' Equipment' Labe r a t ory, that. t ho 364 Director of the Army Medical School desired that the gasor line-operated.electric generator now Installed.in semi- permanent fashion, he so housed In the rear f: the trailer that/it hwou4.d not have to he moved outside- the vehicle at all’, and that the position of the exhaust, he-: changed in such a way that the fumes could he conducted out through holes in the.side of the trailerf It was also‘understood that'the procurement of an additional: gene rat or-was. con- templated by Army Medical School,^... Xxi < short, Army ,Medical , School was , recommending that virtually, all of the fixed equipment-'which had been procured or requisitioned by the Laboratory should now he discarded; to he replaced at some time in the future hy items selected exclusively hy Army Medical.’School. If these suggestions were adopted. Development -Pro Je-ct, IV3~,V would, in, effect, come to a virtual till; .for Army Medical School had not yet- submitted a list of equipment which was to he fitted into the. laboratory/ cabinets- and drawers,- although eighteen months had now elapsed .since it had first been requested to do so, ; • ;* t <* , , , p- .. . At precisely, this crucial Juncture.* - the. Equipment Laboratory received the following, lette.r from; The Surgeon General!s Office,...written, apparently* in unawareness of the serious deadlock which was then being- threatened'. ¥e are. interested jin-knowing how,the Laboratory Trailer. Project is coming along,, ■It of course . should be finished as soon as practicable so ... , • ;that .drawings,,and. specifications can be;pro-. ; . i • . . for.,the -purcpase of ■ a, numb©r of- these for Army.medical labpratories. The new table of•.■ . . . ' .organization for that.unit provides that each . ■ •.Army 'laboratory shall have ;as an-organic part of it three. of these mobile nnlt.s, each mounted in a truck or trailer body. It is difficult' to conceive,how The Surgeon General’ s .Office could have.- lost- touch with- Leveloament Project. i: to. the extent, suggested, by the’ foregoing" commentsThe changing cf- the table of organization- of the' Army Medical Laboratory - to provide for three' additional - mobile units per field army would 'seem, to have been based on an.all too sanguine expection that the project was oh the ve rge of. be ing succe s sf ully ■ cpmpJLet ed... I f" such was: indeed the case, the .Equipment. Laboratory lost no time in correcting the false impression.- On 3-September 1940, the Laboratory directed a-vehement -letter to The Surgeon. : General’s Officedescribing in detail.the serious'diffi- culties which it was having with Army Medical School, and concluding .with the foil owing .-vigorous /statement sib 4.;- It'ip impossible.'for theJiquipmOat Laboftory • .to. proceed with' this pypject, until. it'is - ihf ofjfeed definitely as to requirements, an dvi supplied with, the equipment to be-contained .therein, 1-It:-ha,s- . been .the de-sire -of this, laboratory ’td'dbfliplh’te «•» -this ! project, which it';C-puld. have donh’Easily in the past three (3) months * ..during this time there have ' been 'ho important !pipjec'ts requiring - the services of; the.1 carpenter and'the blacksmith* .5., It is believed that this project1 should Jbe; completed at once*: for -much work will be neces- sary and practically all the. facilities- of the .■ Equipment_ Laboratory made-available for experi-* mentation and'testing of the bus type ambulance and the nCw 4 x 4 ambulance, upon their-arrival;- -this. in. addition -to. the- projects' placed by' the- Office of The-'Surgeon/General. " >'■- • 6* Regardless '-of how this unit is built ■ insidq'and'how •equipped, inasmuch as it is-in an’experimental project, .certain minor changes well as ■••.changes in equipment n, .will' have- to be made .when the unit is tested;.;.' •; ' i ■* t , 9 regardless of- who-builds it or who, selects- the equipment *, ' :•'-■■■■ , 7*. He c omme nda t i ons * a. it is recommended this project be com- pleted as ofigihally planned and equipped •with the. equipment nbw in, the Equipment Laboratory selected originally and as -given in. paragraph 3 above, ' v b. And that the remaining .'.'equipment-'to-'be selected by a board ap.ppinted for'’that purpose,- or selected by the Director of"the"Army-Medi'caL- ■ - , School, be forwarded to .the Equipment laboratory without delay,, -in. order- that "this Laboratoryr ;,r may build proper ..-s$ace.s•-!&.>the' "Arnfy■ r ;■ laboratory, f or its :-st _ U' , -h.. ( ’ . .This s-tfohgiy-wordad'iatteh produced'-results.^t^n 13.September 1940, a'conference. Ka.s, hel,d‘at: fhe- Surgeon ; General Vp Office- ih• •Washiagtppv.at which' The : Surge.cn.:.- ■ ,Generai",s Office', ‘Army Medical- Schopl.,. and thb’ Medical;-- .. Department ’Shblpmentf La.bxara%r>ry>,jjrere 'ajLl* 'It ,.; was agreed that completion of ..the-. expertmental-• Army. Medical Laboratory should be attained at'the ■earliest ,• possible'moment I-that ,;.in':prder> to,.expedite the matter a requisition for all property to be'installed In--'the labo*- 366 cabory wpijid, be..submitted immediately "by the Director_ of Army Medical "Schpol; that this, requisition would. first go to The Surgeon General's Office for approval, then to the Medical Supply Officer-, Carlisle. Barracks, and finally to the Medical Section, New- York General Depot .for procurement—and that none of the. funds currently available to the Equipment, Laboratory, would be used for this purpose,' Xt.was further agreed that, if the special equipment desired by the. Director, Army Medical School,., was received tin time it would be installed instead of the equipment originally purchased by the Equipment Laboratory.42 _ ... • ,r Fiye .days later, on 18 September 19£0, Army Medical School carried out. its' conference commitments by forwarding to The Surgeon General Vs Office a complete list of regular and nonstandard equipment.for the mobile laboratory. In order to' avoid further the list had been made out on standard requisition forms, On the following day the Plans and Training Division of The Surgeon General’s Office approved the above-mentioned equipment list without change and forwarded, it, to the. Equipment Laboratory for action, Unf ortunately the Plans.and Training Division had', neglected to clear its action with, the Supply Division of, The Surgeon Generali Office'.'and this necessitated a short delay, involving ‘the, return of.the original equipment,list from Carlisle Barracks to Washington, and its re-transmittal to the Laboratory.^ By the latter part of November, 1940, however, the greater part of the requisitioned equipment was on hand and the Equipment Laboratory, wishing to get the project out of the way as quickly as possible so that other development work could proceed, urgently requested Army Medical School to send a representative to Carlisle Barracks to advise as to and possibly as to the elimination of several i terns,.Accordingly, on 3C November 1940, an inspection visit to the Laboratory was made by a repre- sentative of Army Medical School, and upon his return to Washington a revised trailer list was prepared by Army Medical School and forwarded, 6 December 1940, to the Equipment Laboratory•• The modified equipment list called for deletions of the electric centrifuge and hot air sterilizer included on the previous list, reduction of the original order for two gasoline burners to one of this item,- and additions of a new type of nonstandard centri- fuge and nonstandard precription scales,- It was- further recommended that the trunic which"had been installed,in the left rear qf the, trailer be, removed.entirely .from the laborat ory, and -that the space be ..used. instead as a cupboard to handle additional sup pi . , . ... . - These .proposals',- threatening to revive .once -again 367 tho supposedly settled equipment controversy, elicited an immediate and heated protest, from the Equipment Laboratory. In a second vigorous letter to The Surgeon General’s Office, the Laboratory enumerated in detail the many points of diffe- rence which had arisen between it and Army Medical School since the, initiation, of Development Project, F-g.t-and tho attendant ,’diffiepAti.es. a.nd. delays which had beset research and development, personnel throughout this period. The mobile medical, laboratory, it was pointed out,had been oh the, floor of the Equipment Laboratory for, over, eight months, and such work as had,been done on it had been subsequently changed, and now must be changed again; equipment, requi- sitioned and purchased, had. been changed, and was now being changed,again. The,latest' proposed, changes, the Laboratory, stated, could be made but only a.t additional cost, time, and labor. Some' assurance of. permanency was definitely'required and it was accordingly recommended,that absolutely no . further changes in equipment or interior construction be' made, other than, thos.e now specified. It was. also requested that. the.delivery of all equipment"under requisition, or under, special, procurement be expedited,^8 ... The above letter was forwarded by The Surgeon General *s:Office.to Army Medical School with the comment that it was,,.necessary'that the installation and equipping of the medical laboratory be completed without further delay,49 Army Medical School thereupon stated that it concurred with the recommendations of the Equipment Laboratory, namely that no further changes in equipment or interior construction be made and that delivery of all' remaining, supply items be expedited.To which, in replying finally’to the Laboratory, The Surgeon General !s Office added its own assurances that no further changes were contemplated by'that. office After this aggressive action, by the Equipment Laboratory no’further inter-office'complications of importance arose to defay completion., of, the project,/.By 21 January 1941, much of the specified equipment had arrived and a tentative packer’s list was prepared and forwarded to Array Medical School, Table tops were treated with acid-seal paint.and were fitted .into position, and hardware was installed on all cabinets and .drawers which had been finished. Aside from painting' the' woodwork, all that remained to be done was to' pack in the rest of'the supplies which were slowly filtering in,52 However,. Army Medical Schoolapparently not even yet wholly converted to the notion that the time for further changes had definitely passed, suggested on 28 January 1941 that cither a differ- ent type finish, for the table tops .be ..substituted for the already applied acl.d-seal paint, or that stainless steel be used instead of the painted maple wood,top.These recommendations the Equipment Laboratory conveniently ignored* 368 Slow equipment, deliveries continued to plague research and development personnel throughout the months of February .and March,- The Second Medical Laboratory, located at Fort Sam Houston,'.Texas, which had-been designated to service test the mobile medical laboratory, had requested information. In early January as to the approximate date at which it might expect shipment of the After delaying its reply for two months, The Surgeon Generalls Office finally - answered on 8 March 1941 that, while an ‘ early service test was desired by all concerned, no defi- ' nite statement could yet "be made as to; the: probable date when ''the new mobile .laborat ory'-would be. .available..^5 ■ 1 -By the first of April', 'TS41 /.-virtually all supplies ■'and- equipment;had arrived'at the Laboratory-.- -The Surgeon ’General’s Office chose this' occasion'to issue the following * •-’rather /cryptic directive: : •. y.. 1* In order to'complete- the experimental, motile laboratory-.and. get it out for actual practical ' extensile field tests", it is desired that: ■ ('a) •• The >Director of Army Medical Schools prepare ' the list of.apparatus and equipment which he. ’•* recommends . for-, this' unit, •' 'The. •list': to be in two parts,;, one, the apparatus to be .installed, as ■ •incubators ,, sterilizers , -etc.,-: the:-other loose or packed -equipment, as. retorts, test tubes,, dishes , •“etc. Lists, to give '.sufficient data to permit easy identification f or 'purchase or. issue. ■ (b) The Director, of the Equipment Laboratory at Carlisle Barracks to check-over the list and ’ determine-, the.•following; "■•■" *’••. •: • • . : •■■ (l).: Can.-,the apparatus arid equipment: as listed in v-'.-Ca) be- ins tailed'.'and carried' within- the- vehicle v-c.apaoity? • •• y, . ’ ’ _‘a. .? • (3) Gan the apparatus' 'be •; satdSfactorily.'-. operated from the utilities(available within.the vehicle? •■•(3).;.-• An: pxp.re ssi on ’as “ to'- the-' ’rbkdabil i ty (i., e,) . likelihood of apparatus being-damagep/by-the movement, of the, mbbile laboratory .without extra special packing ' or' securingf‘ ,2..- In -order .to facilitate' and expedite the completion of the mobile laboratory early compliance with paragraph 1, supra, is desired with the prompt return of the requested lists and comments, to this office,^ . Since both'' JEe" Sturgeon General’.s Office and'the Equipment tab oratory' had long before ■ rqcefive.d copies. of the' last revxs’ed equipment ■ list prepared by Army .Hq.dl’cajL,''pXSipoi, • the inference -in paragraph 1 :of . the above, conimuhi'cation , ' would se.em to be that another equipment- revision was /: in • the.making. ,If so , was the Laboratory to replan its packing • arrange me tits'’ once “morel. ; Was-the. process of ,reqq.i-’' sitioni.ng, to 'begin all -over again? If changes such as these were contemplated, ' it* is difficult, to how-, especially at this- late stagey The Surgeon' General1 s;- Of flee was ; ’Texpediting’1',hrid nfacili,tnti-ngn the completion of the_ project*. . ,. ~ fortunately, Army Medical ,-S ,hoo-l-made- it, clear in its reply to The Surgeon General’s Office that* further postponement of service tests was not desired. ¥hile' a'new • • supply list for the? trailer ‘"laboratory was, forwarded as directed,* it was explicitly recommended, that no eff-ort .be made at this time to require -the Laboratory to conform to; the new list. Instead it was suggested that^if.either units ■or amounts .-now specified-'were not in agreement with.,what'; had already been packed on the- trailer, the discrepancy should' merely be noted in pencil* on' the- new list• It was urged that the laboratory be given a'foad test as soon as possible and. then sent to Army Medical School for a more extended service test.5 ’ • ' ? ■ 'This avoidance, by Arm;/ Medical School, of a ' ; reopening of the equipment controversy cleared the way for a definite termination of development,'activity* Within-ten ' days the Equipment Laboratory..had completed all unfinished' work on the interior of the trailer and had packed, away all remaining items of equipment. The new mobile medical lab oratory'', was at‘last ready to be-tested/. Counting, all delays and’- postponements,' the .finished, product represented an expenditure of time and: off ort: on; the? part. hf. research and development personnel, extending overr a .period, of 27 months. ‘ • ’ ' ' C. Road and field Testing. On 24'Api’ii I94iv Hlie' was given a 60-mile“road test'iy Equipment Laboratory personnel and, on the following day, an additional Slymi-le, dept was given. A formal report of the results of these two tests was then submitted to The Surgeon General’s Office. In brief, the findings were as follows: The complete unit shows good roadability over all types of roads. It exhibits comparatively easy handling, and the power unit can pull the trailer 370 without effort notwithstanding the fact that it is necessary to use low gear on long hills. The equipment and supplies rode well over all types of terrain; no changes in installations are recommended,^ In the body of the report, mention was made of the fact that the height of the trailer (approximately 11 feet) had caused some difficulty (*low.hanging "branches of trees on ..the dirt roads would strike the front and top portions of the .vehicle, and at times fairly large "branches .would strike the windows in the front of the trailer**). On one occasion the driver had taken a wrong turn and had entered a small park with a narrow winding road bordered with trees. Because of the hulk of the vehicle and the number of low- la ranched trees in the rear, it was considered impossible t0t. back .out and the driver was forced to continue through the park instead of returning immediately to the main road, y - . . ’ Evidently these difficulties were considered minor. The Equipment LaboratoryTs summary of its test findings,■ quoted'above, was..highly favorable,- ' v , , .. ’ 'In any event, upon completion Of the* road tests' at Carlisle Barracks, arrangements were immediately initiated to ship'.the ' trailer laboratory to Army Medical School for further testing,. Since no tractor had been assigned, to the ... semi-trailer, there was some delay in obtaining, a vehicle to haul the laboratory to Washington-. This problem was presently solved and actual transfer of the trailer laboratory to Army Medical School was accomplished 2 July 1941,°^ After the laboratory had been carefully checked over by Army'Medical School, action was initiated to ship the semi—trailer unit .to the Second Medical Laboratory, then' located at Lake Charles,. Louisiana., for an extended, service test. On 16 August 1941, The Surgeon General’s Office issued the following test■ instructions to the Second Medical Laboratory: - It is desired that this trailer laboratory be given thorough and complete field tests,, and. a full report submitted to this office on the completion of these tests* It is desired that the' following points be spe- cifically covered in t)oe report* a* 'Roadability of the trailer'-unit. / ... h, . Adequacy .of provisions- for packing and ► carrying»the e quipme nt - wi thout. breakage or damage, * ' ■ - •' ,■ c, Adequacy of the equipment and apparatus to carry out the technical work expected from this unit. d. In your opinion, can a mobile unit of this type be employed in the manner and for the purposes contemplated, viz., Mobile Laboratory facilities for a field army? The report should also include specific recommendations as a basis for future development, along similar or other lines, for Mobile Field Laboratory units*61 By the early part of September, 1941, transfer of the trailer laboratory from Army Medical School in Washington, D. C. to the Second Medical Laboratory at Lake Charles, Louisiana had been effected. The laboratory was extensively tested during Third Army Maneuvers which lasted from 3 September 1941 to 30 September 1941. At the con- clusion of these field trials, a detailed report of findings was prepared by the Second Medical Laboratory and submitted to The Surgeon General*s Office on 16 October 1941# These conclusions and recommendations, supported by nearly a month of careful observation in the field, were in marked, contrast to those contained in the earlier Equipment Laboratory report*. It was concluded first of all by the Second Medical Laboratory that the semi-trailer, as constructed, was not a satisfactory vehicle for an Army laboratory. The trailer, it was pointed out, was too bulky and its-ceiling was too high, making the vehicle topheavy and limiting maneuverability to hard-surfaced roads and parking areas — thereby defeating one of the prime purposes of a mobile field unit. Due to this same topheaviness, moreover, movement of personnel within the trailer set up such a floor motion, even when the trailer was stationary, that it caused considerable interference with microscopic work and ,use of the prescription balance. It was therefore recommended that, in place of the semi—trailer, consideration be given to the house trailer unit of the U. S. Public Health Service or the Century of Progress Unit of the General Electric Corporation. Only' after drastic modification, it was pointed out, would the present trailer laboratory be satisfactory for the purpose intended.62 - — As for the interior fittings of the laboratory, both permanent and semi-permanent, only a few defects or omissions were noted, all of which were remediable# Similarly, while there was some difference of opinion as to the various items of laboratory equipment which had been selected by Army Medical School, and as to the various 372 packing arrangements which nad been adopted by the Equipment Laboratory, only minor changes were suggested. Above all, the Second Medical Laboratory registered its emphatic approval of the introduction of storage cabinets in place of Medical Department chests. Re c omraenda t i ons: D, That whatever the decision made as to what type mobile unit to be furnished the,Army Medical Labora- tories, the equipment and supplies bo not stored in chests or crates, but the ample space in the form of drawers and cabinets be utilized to the fullest extent for their transportation. This cannot be too deeply emphasized, for by actual experience, it took five men a total of ten hours to pack and load the medical supplies of the Stationary Laboratory Section prior to one tactical move during the, recent Third Army Maneuvers, whereas the Laboratory Trailer was ready to move within a few minutes after the order was received,65 IV, Termination of Phase I, A, Project Discontinuance, The test report which had been submitted by the Second Medical Laboratory was studied first by The Surgeon General’s Office and then, 'on 18 November 1941,,was forwarded to the Equipment Laboratory for its Mean- while, the immediate effect of the report had been to suspend all activity on Development Project. E-5. although as yet no definitive action hod been taken to terminate .the project formally,65 The question of resumption of development work on the mobile medical laboratory continued in abeyance until 1 April 1942, On that date,' Table of. Organization. E-234 Medical Laborat-oiy (Army or Gommuni cat ions Zone)' was rewritten and the item ”Laboratory, semi-trailer” deleted. In the new table, Table of Organization and Equipment' 8-611 the organization of the'laboratory Into one stationary and three mobile, sections was continued, but each mobile section was now assigned, a.‘S-g'-ton cargo truck in place .of the semi- trailer unit.66 The second step toward project termination' was taken later in the month of April, In presenting Its annual budget for medical research and development for Fiscal 373'- Years 1943 and 1944, the Equipment Laboratory stated that no funds would he required for Development Project, F-3. unless The Surgeon General desired to have the project A similar lack of interest in continuing the experimentation was evinced hy The Surgeon General’s Office, and on 30 April 1942 the project was formally and officially dropped, B. The 3us-*Type Laboratory, While, as we have seen, Army Medical School and the Equipment Laboratory had a considerable amount of difficulty in reaching an agreement as to the specific items which wore to be installed in the trailer laboratory, they were in com- plete accord on one point, both offices felt that die new bus-type truck, then under development as a multiple ambulance, could be converted into a better medical laboratory vehicle than the semi-trailer. Unfortunately, their desire to attempt such a conversion was never gratified. The interest of Medical Department officers in the bus-type truck as a possible substitute for the semi-trailer first became manifest in July, 1940, At that time the Equipment Laboratory wrote Army Medical School as follows; In regard to your-letter of the 5th, I am enclosing a drawing of the trailer coach-that we have on order, and expect to have delivered in three or four weeks. Please return this drawing as soon as possible as it is the only copy we have. There is only one vehicle on order, but: we expect to experiment with it first as a multiple ambulance, second as a unit to replace the present'semi- trailers of- the mobile surgical hospital, and third as a unit to contain the mobile field laboratory. This unit has many advantages — it is constructed of tubular seamless steel, making it light and very strong and rigid; its engine is built‘in, so that it could not become stranded, as could a semi-trailer if someone took the tractor for another job; it:is low, haying a floor level only 20’inches from the ground. The unit on order has an inside height of .74 inches; this could be made greater on future vehicles, if ’desirable. It was bought■for experimentation • as a multiple ambulance, and wo have thought that later wo. might,experiment with it to . replace the Army Laboratory, if desired,69- Apparently no further steps were taken in the matter until November, 1940, when the first- of the front- 374 drive, bus-type vehicles was delivered to Carlisle Barracks. Shortly.thereafter, on 23 November 1940, The Surgeon General’s Office submitted a written recommendation to The Adjutant General’s Office that as soon as a sufficient number of the new low silhouette bus-type trucks could be procured, several of these be allocated to the Second Medical Laboratory for its regular A few weeks later The Surgeon General’s Office followed up this pro- posal with two more advanced requests: (l) that Table of Organization 8-235, Medical'Laboratory, Army, be revised to provide for the substitution of the bus-type truck for the semi-trailer; (2) that two of these bus-type vehicles be delivered to Carlisle Barracks for installation of medical equipment, and that' after this conversion they bo designated as standard equipment for the Second Medical Laboratory.^ While development of the semi-trailer laboratory was continued" without" interruption during this period, it is evident from’ the data that both the Equipment. Laboratory and Army Medical School were decidely partial to the bus- type truck. In fact, problems relating to the conversion of the latter vehicle to a mobile laboratory were now being discus.sed in some detail. It was-soon learned, however, that the Medical Department’s enthusiasm for, the new type truck was not going te bo given free rein. On 27 January 1941, The Adjutant General’s Office replied to The Surgeon General’s formal recommendations as follows* The recommendations, contained in Paragraph 3, for substitution of.bus-type trucks for semi-trailers ' in the Medical Laboratory (Army), are not favorably considered. .Adoption of the front-drive bus-type . truck will be considered upon completion of the development project for this vehicle,^3 Phrased as it was, the above refusal did. not altogether extinguish the hope that a substitution, of vehicles.might be; effected at some, later date. Consequently, even as late as 26 February 1941, when Army,Medical School was giving its final approval of the trailer laboratory, it appended this important qualifying sentence: ¥o will,.' however, state that we believe it. Messential” that the final selection be a truck rather than a trailer. As subsequent events proved, however, the inter- vention of The Adjutant General1s Office was, on the whole, fortunate. -Field tests, of the bus-type truck desclosed that it was below expectations with regard to cross-country maneuverability, and adoption of the vehicle for. use with the mobile surgical hospital was not carried through,^0 Upon 375 discontinuance . of^that research project, no further attempt was made by the Medical Department 'to 'obtain' authorization to convert the bus-type truck into a mobile laboratory. The entire subject, therefore, turned out to bo simply a dis- traction. As had already been pointed out, a more thorough study of all research possibilities at the start of the project might have eliminated much of this later confusion. C. Contributions of Phase I, Although the research activity which was carried on during this first phase of Development Project. P-3, was underfinanced, suffered from a lack of effective coordination at the top as well as a lack of close liaison between lower- level agencies, and had been launched before a complete investigation of research alternatives had been made -— there were, nonetheless, certain definite accomplishments. In the first place the organisational concept of a truly mobile Army Medical Laboratory was now firmly established. The latest tables of organization, despite the deletion of the semi-trailer, now specified a four-section field unit con- sisting of one base section and three mobile subsections. Compared to the World War I single-section laboratory, the new unit was quite a radical innovation. Secondly, the field test of the trailer laboratory clearly demonstrated the superiority of cabinets over Medical Department chests for the storage and transportation of laboratory supplies and equipment. The Surgeon General*s Office now,- had reliable statistics indicating the precise saving in man-hours by the use of semi-permanent cabinets, and shelving. Finally, although the particular type of vehicle which,had been used'in the ■experimentation did not prove satisfactory, the principle of self-sufficiency which it exemplified had gained genuine acceptance. The Medical Department now had- convincing evidence, based on the Louisiana test maneuvers, that the concept of a mobile ■ labo- ratory, completely equipped as to heating, lighting, and plumbing, • was practicable for-field,usage. - In short, a great deal had been learned during this first development phase. All that remained was to find a sufficiently low-silhouetted and sturdy vehicle in which all of these ideas could bo incorporated. This- manner in which the Medical Department undertook to solve this problem,is the subject of the second and concluding portion of this chapter. 376 V. The Reopening; of Development Project. F-3, A. Interim Developments, From 30 April to 2 June 1943, Development Project, F-3. remained inactive. During these thirteen months, how- ever, steady progress was made by research and development personnel in the design and construction of certain related Medical Department vehicles. As we have seen in the pre- ceding chapter, improvisation in the field together with extensive laboratory experimentation led, in the latter half of 1942, to the development and standardization of the first mobile surgical truck. This unit—consisting of a r special medical Department van body, with appropriate interior fittings, mounted on the chassis of the standard 2-g-ton cargo truck—was a development of truly major importance. It provided the basic engineering pattern on which a whole series of specialized medical vehicles were subsequently constructed. The first of these modifications of the new Truck, Surgical, was the Mobile Dental Laboratory, completed before the close of 1S42 and standardized the following year,76 The second, as we shall see below, was the Army Medical Laboratory, B.* Project Re-Initiation., ' Upon the sucessful' conversion of the surgical truck into a mobile dental laboratory, it was not long before a demand was made for the development, by means of a similar conversion, of an Army Medical Laboratory. On 2 June 1943 it was formally requested by the Ninth Medical Laboratory, stationed at Fort Sam Houston, Texas, that: (l) a special truck be developed for use by the Medical Laboratory, Army: (2) three such trucks be included in the Table of Equipment, Medical Laboratory, Army— one for each mobile section. The Ninth Medical Laboratory stated that, as soon as a pilot was completed, it would be eager to- test the new truck on regular field maneuvers,77 The formal project request, prepared by the Ninth Medical Laboratory,- was a model of thoroughness,. It brought together, for the benefit of those responsible for policy decision, the key facts, past and present, concerning the • mobile medical laboratory. First, the functions of the laboratory, as -set forth in the latest Army Field Manual, were given in detail: a. General. The medical laboratory is a mobile unit designed to provide the Army medical service 377 with facilities that are immediately and con- stantly available for laboratory examinations and investigations. It is organized into one stationary and three mobile laboratory sections. b* Employment.. Location: The .-stationary ' ' section is. .located well- to -the rear of the Army - area where, it will not become involved in-minor movements ..and. where it is readily accessible . The mobile sections are designed to be sent into corps or division areas and .are especial- ly useful in epidemiological investigations; Technical functions,;- Because of the limited capacity and the location of the medical'la bo— ratory, it is not contemplated;that it will engage in routine clinical, examinations - required by the several Army hospitals unitsas’ these hospital;units all include an organic laboratory section for this function.;. Its. principal technical, functions are associated with preventive .medicine such as tho'-cxaml- nation of food and-water and epidemiological ■ Secondly, the present- equipment of each mobile section and the loading and .unloading procedures followed were described briefly. The disadvantages of both the all- purpose cargo truck and the chest-method of packing were particularly stressed. It was then..pointed out that in the 1943 Louisiana Maneuvers the Tenth Medical Laboratory had used an experimental mobile field laboratory truck very' successfully. The truck was a 2-g-ton, 5 x 6,. cargo, on which removable cabinets with work benches-as well as other laboratory equipment Jiad been mounted. On the-positive ■ ‘-; side, the experiment had demonstrated;- .(l) that laboratory operations could be performed satisfactorily in.-the truck; (2) that the use of-cabinets for storage and transportation of equipment was .far .superior--; to the use ■ of ■ chests, On‘ the negative side,,...the standard, issue cargo- truck hhd been -• found to be deficient in.several, respects,' Since th6-truck did not have an enclosed. ;body,a night- work'under blackout conditions had been-extremely difficult, .Moreover, due to' the lack of a heating system, laboratory efficiency -could ■ not be kept at a maximum during cold weather periods. ■■ On the basis -of Its own experience and investigatioh, the Ninth Medical Laboratory then- proceeded, to draw up a tentative list .of -requirements for a new mobile laboratory. These highly specific- recommendations proved 'to be-extremely : valuable for they, were incorporated almost without -exception-'' in the developmental model that was subsequently constructed at Carlisle. It was. recommended first of all,' in' line with’ the findings 'not' ■ a. .That the' truck,. 2-g- ton, 6 x 6,' Laboratory, Medical , .Army .he 'an...adaptat 1 pn of conversion of standard. truck,.. Sir*ton, 6 x 6, Surgical, • .b.: 4’hat., the equipment 'for' installatioii in • the..:truck, he designed and arranged to provide for the following; , . ' ■ - (l) Storage space for the necessary materials for Sanitation and Health . . .. , Lahoratory procedures. .(2) Adequate counter space ‘ and service facilities conveniently arranged for carrying out such procedures. (3) Adequate means for Laboratory Sterilization, Incubation, and Refrigeration, c. The equipment shall he permanently installed in the truck hut capable of easy removal. 381 d. Size and quantity of equipment shall be held to a minimum compatible with the efficient and proper operation of a Laboratory Lhit.?^ Just how equipment could be ’’permanently installed” in a truck and yet be ncapable of easy removal0 was not explained. In view of the demand of Headquarters, Army Service Forces, at the time of project initiation that'all laboratory equipment be readily removable, it is not unlikely that the above verbalism was consciously contrived for the occasion. If it was, it•accomplished its purpose admirably. On 4 October 1943, the above statement of military charac- teristics was approved without modification by the Medical Department Technical Committee,'0 sixteen days later Army Ground Forces added its concurrence,91 and, on 26 October 1943, final approval was given by Headquarters, Army Serivce Forces.^2 VI* Development Phase II - The Laboratory Truck. A* Construction.Stage. By the time all procedural details incident to the re-initiation of Development Project. E-3 had been completed, development work on the new medical laboratory was already under way. Informal authorization to begin these activities immediately had been obtained from Headquarters, Army Service Forces, on 28 June 1943, and by 3 July 1943 the Equipment Laboratory at Carlisle had been notified to commence work on the project, and Lieutenant Colonel Earinacci, of the ilinth Medical Laboratory,, had been author- ized to join with the Laboratories Branch, Preventive Medicine Service, Surgeon General’s Office, in furnishing professional advice on equipping the new The central direction at the policy-making level, which had been so conspicuously lacking in Phase I of this project, was now being efficiently and vigorously exercised. Moreover, as we shall see, this improved system of over-all control was to have a definite effect in bringing about an early and suc- cessful termination of the project. On 7 July 1943, the Medical Department Equipment ' Laboratory forwarded to the Laboratories Branch, Surgeon General's Office, certain basic information regarding the dimensions and utility installations of the surgical van body which was to be used in the conversion, and reques-ted that a list of the equipment desired for the laboratory be furnished as soon as possible. It was further requested that Colonel Earinacci be ordered to Carlisle for a consul- tation regarding cabinets, benches, and other interior fittings.^5 382 In its reply, the Laboratories Branch, instead of submitting a detailed equipment list, merely laid down certain general principles of selection. It was pointed* out that a laboratory of the type proposed would be required to do water bacteriology'and chemistry, diagnostic bacteriology and serology, gross pathology, and a limited amount of clini- cal pathology; these fields being listed in. order of decreas- ing importance. It was, therefore, suggested that, pending the arrival of Colonel Earinacci, for whom travel.orders had already been requested, provision be made for an incubator, water-bath, autoclave, washing facilities for glassware, and bench space for inoculation of media, use of microscopes, and similar work.^6 Orders detailing Colonel Earinacci to Carlisle were dispatched from The Adjutant General’s Office on 18 July 1943, and nine days later he reported to the Equipment Laboratory for temporary duty 'Earinacci, together with members of the Laboratory staff, immediately set about drawing up a list of the heavy equipment to be installed in the truck, together with certain smaller items which were in scarce supply and, on 31 July 1943, this partial list was submitted to The Surgeon General’s Office with the request that these items be requisitioned direct from Washington for delivery to Carlisle.' It was pointed out that the equipment would be available at a much earlier date if this method were followed instead of routing purchase action back through the Equipment Laboratory.98 Once again,.it will be noted, the attempt was.being made to profit from past mistakes. The slow deliveries of key equipment which had so greatly delayed completion of the Semi~*trailei* laboratory.had been dale in..ho small part to the decentralized requisitioning procedures which had then been followed. Such delays, it. was, felt, could be held to a minimum by limiting Carlisle’s procurement responsibility to standard and readily available’ laboratory supplies which could be packed into the cabinet drawers as they arrived. Meanwhile the delivery of heavy or scarce equipment cOuld be expedited through direct procurement action by The Surgeon General’s Office. On 6 August 1943, the Laooratories Branch, Surgeon General’s Office, approved- the.above equipment list, which had been prepared by the Equipment Laboratory, with only a few changes and additions. A one-burner gasoline stove was substituted for the two-burner unit listed, a binocular microscope was recommended instead of the monocular type, and a different type of prescription balance from the one listed was suggested. Additions included two fire extinguishers, two electric lanterns, and one Medical Department chest,99 383 This modified list was thereupon approved by the Plans Division and forwarded for immediate procurement action to the Distribution Division, Surgeon General’s Office. Thus, before the middle of August,*1943, centralized pro- curement of key items was well under way. Meanwhile, a complete list of all other equipment both expendable and- non-expendable, had been prepared by the Equipment Laboratory.2 As soon as approval of these items had been secured from The Surgeon General’s Office, a requisition was entered by the Medical Supply-Office, Carlisle Barracks, on the Binghamton Medical Depot for delivery of all items not later than 21 August 1943,^ The selection and procurement of equipment to be installed or stored in the new laboratory was only one of the major tasks which was carried out during these early months. On 28 July 1943, the day after Colonel Earinacci’s arrival at Carlisle, the Equipment Laboratory requested The Surgeon- General’s Office to arrange for immediate shipment of a 2y~ , ton, 6x6, surgical truck for use in the development of the proposed medical laboratoryOn 30 July 1943 the desired surgical truck was received at Carlisle from the Hew York Ordnance District, and, as the necessary additional materi- als required for construction of a pilot model had already been ordered, the job of conversion was begun at once. The plans which had "been worked out for the con- version of the surgical truck into a mobile medical labor- atory did.not.call for any modification of the chassis of the basic vehicle.. Moreover, in many respects the van body of ■ the surgical truck needed alteration to serve its new .... purpose. The body was of steel and composite construction, with hard pressed structural fiber-?board lining the interior. Flooring consisted, of waterproof plywood covered with battle- ship linoleum; outside panels were.of 22 gagua sheet metal supported on steel framing; and side walls, and end walls wore-all'thoroughly insulated.0 All of these basic structural features, together with-a number" of built-in- items, could be preserved- intact in the new vehicle. However, certain changes in the design and interior construction of the van body of the surgical truck were■ necessary. Per one thing, the amount of outside, light provided by the two side winders of the basic vehicle was insufficient for daytime' laboratory work,- and so one more window was added on each side of the body. Similarly the’ single large ceiling light -which had been designed chiefly for operating'table use, supplemented by two small dome-' lights, was not a satisfactory overhead lighting arrangement for a medical laboratory. So instead, four'alternating current, and two' direct, current dome lights were installed, together with four gooseneck sidewall lamp's to furnish 384 additional light for the worktables* The plumbing was revamped also; faucetsscrub sink, and drainage pipes being moved from the’ extreme left front of the interior to a more accessible position near the center of the front wall.^ The redesign and spacing of the stool cabinet's* drawers, and inserts was, perhaps, the most thorough-going revision of all. In the surgical truck, there had been no necessity for an extensive amount of flat worktable space, but in the new medical laboratory such facilities were essential. Consequently, instead of an irregular series of ceiling-high cabinets, a solid line of relatively low cabinets had to be built into the walls on each side of the center aisle; two long, acid-proof table tops had to be constructed to provide an unbroken working surface; and individual drawer size had to be varied so that, altogether, sufficient storage space would be available for all the many.items of laboratory equipment which had been requisitioned.' Considering the difficulties, both administrative and technical, which these same problems had posed for research and development personnel during the firs.t phase of this project, the progress which was made in the -pre- sent instance was indeed remarkable. By mid-August 1943, tentative specifications for the van body of the new labo- ratory truck had been prepared by the Equipment Laboratory and submitted to The Surgeon Qene.ral’s Office,® Before the close of the same month, fhe actual physical conversion of the surgical truck -body had been completed, construction of the new storage cabinets.was .nearly finished, and two- thirds of all equipment requisitioned had been received. It was anticipated that the remaining portion of the laboratory equipment would be delivered by 15 September 1943,^ The pilot model laboratory was, in fact, so nearly completed 'by this time that plans were made to ship the vehicle to Washington, D. C, within a week for exhibition in the War Department’s public nBack The Attack” show. Actu- ally the new vehicle, less a few minor items-of equipment, was sent to Washington on 6 September 1943, remaining there as a part of the Medical Department’s official display through 28 September* The unit was returned, on 29 September 1943, to -the Equipment Laboratory where further work on the project was temporarily suspended pending receipt of several items of equipment which had still not been delivered. Installation of these items, it was esti- mated, would take only two or three days,-*-® Demonstration of the mobile laboratory at the Army show in Washington gave the Laboratories Branch Of The 385 Surge on' jGen&ral.1 s. Office its first real opportunity to. ' / examine the new unit at first hand.--.The reaction, . judging from the small number of criticisms,‘Was quits favorable. It was merely recommended that: (l) h-‘small pressure,cooker type autoclave.be substituted for the large and rather bulky autoclave which; had. been installed; (2) two adequate, sized knee .holes be provided under the bench tops so that wofk would be possible in a seated'position; (.3) ■consideration be given to air-conditioning the unit if practicable; (4)' a small bacteriologic incubator and a hob air sterilizer be included as permanent equipment; (5) a .different power unit be provided which would operate simultaneously all electrical equipment.il - The manner in which the above recommendations' were made, as well as the phraseology of the, indorsement by which - they were forwarded to the Equipment Laboratory,' indicated that the final decision in these matters, was to be left up to the staff at Carlisle,Making use of this discretionary authority. Laboratory officials, as we shall see .in a,moment, soon gave their approval to two of the above suggestions, but overruled the other three. With all differences of opinion thus exeditiously resolved, the experimental labo- ratory was ready for shipment to Louisiana for field tests, by the close of October, 1943. B, Service Testing Stage. , • On 14 October 1943, the Equipment Laboratory was directed by The Surgeon Generalr s. Of fice , to- transfer the new medical laboratory truck, as soon as. completed, to the Third Array, 'C.amp-Polk, Louisiana, for service ■ te.sfA^--Last- minute .changes were, thereupon expedited' and, in approximately two weeks time, the vehicle- was turned, over - to. the Post Quartermaster, Carlisle Barracks-, for -immediate, shipment.^ A small, 40-quart, autoclave, a special hot•air,sterilizer, a and a bacteriologic incubator' had already been requisitioned, in conformance with the final recommendations of the ' Laboratories Branch/'but'had•not':yet.;been received. These • items were, to be forwarded individually;to the Third Army as soon as, they' / ' ? Meanwhile, the laboratories Branch,, was engaged in preparing an outline of basic instructions for the 'guidance of the officers in charge of the Louisiana field tests. Upon completion this preliminary check list was then expanded by the Plans Division of The Surgeon, General1 s Of flee;, in to .-a formal Test Data Sheet, and, by 1? November: 194.3, ha.d been forwarded for appropriate action to.the Commanding General of'the Third'- Army'.Army .Ground, Forces, through which this correspondence was cleared, thereupon ' 386 directed: (l) that the mobile laboratory be tested in the Louisiana Maneuver Area in accordance with the enclosed test data sheet; (2) that a preliminary report be rendered by 24 December 1943; (3) that a final test report be submitted not later than 24 January 1943, _ ■* While everything had gone quite smoothly up to this pfOint,; a wholly unexpected setback was now encountered which dolayed completion of service tests by more than two-months• This delay, it would appear, was chargeable mainly to rail- road personnel. The experimental mobile laboratory had been shipped t,o Camp Polk, Louisiaha, it will be recalled, in early November0: 'On 29 December 1943, The Surgeon General’s Office was notified by Headquarters, Army Ground Eorces, that' the laboratory truck had not yet been received by the Third Army. A tracer was -initiated immediately■and, on 15 January 1944, the vehicle was finally located by the Transportation Corps. * It was at the Eight Ground Ordnance Pool, L.eesville, Louisiana.^ Transfer of the laboratory truck to the Third Army Maneuver Area was thereupon effected as quickly as possible. However, the three special items of equipment which had been requisitioned by the Equipment laboratory at the request of the Laboratories Branch, Surgeon General’s Office, had not yet arrived, and it was therefore decided to procure at least rough equivalents of these items locally1 Considera- ble difficulty was encountered in locating an incubator and, as a result of this delay, it was not until the close of January, 1944, that service ‘tests were finally begun.^ On 21 February 1944, a preliminary test report, covering the first two weeks-bf.--the-.■maneuver period, was forwarded to. The Surgeon General by the Fourth Army, which had now succeeded the.Third Army as the testing agency. .While the report contained a number of •recommendations, it •whs evident that the'new mobile- laboratory as1 a whole had proven Satisfactory'In the testing thus far completed. The eapy maneuverability' of-’ the- truck,' the ■general adequacy of supplies'' and equipment,-- and the general suitability of interior packing'arrangements were especially noted, Numerous equipment additions were' suggested, but’ these- were for the most part minor. Only one change of a major charac- ter .was proposed: the inclusion, as a part pi non-laboratory equipment, of a 6-man pyramidal tentApproval of this recommendation, it will be appreciated, would result in a substantial modification of the concept of a completely self-contained laboratory vehicle. As we shall see, just such an unexpected revision was destined to be-made. The final field test ;report on the mobile medical laboratory was submitted by- FourthyArmy Headquarters on 17 March 1944." The-detailed" test. findings,'-which will he summari zed briefly .."below* were, grouped under four general headings: (l) Equipment, Glassware, Supplies, Reagents; (2) Apparatus; (3) Adaptability of the Truck as a Laboratory Vehicle; (4)' .Adaptability of Truck Body as a Working Area. As. in the- preliminary report, the general'tone of the comments was highly favorable ... • • t,hrespect to. ,Equipment, glassware, supplies, and reagents-,- the..-testing; agency reported that serviceability was satisfactory in comparison with equipment ordinarily used in field laboratories, and that the manner of packing provided safety in transport as well as ready accessibility for labo- ratory use. !?he original supply list of some 265 items, together with the additional equipment list proposed in the preliminary test report, were approved with only six sug- gested deletions, nine, additions, and two quantity changes. As for the apparatus which had been installed in the laboratory; this was described as generally satisfactory. The two—burner gasoline stove, the water bath, and the electric centrifuge were specifically mentioned as being valuable, and the aluminum cooker was listed as a very useful adjunct to the field autoclave. The hot air sterilizer and the air-jacket incubator which had been provided were found, however, to be-too small for the' uses intended,■ additional generators were suggested'- for the Coleman burners, and a kerosine-operated refrigerator was recommended in place of the electric-refrigerator-which "had been- furnished,' The : earlier request that a t ent' be added' to the - list of non-laboratory, equipment was’here repeated, although the idea of using a pyramidal tent for this purpose had now been discarded.*'• he ■ fth- v a '• ■ _ A tent is.necessary to supplement the truck for (the.collecting and recording'of specimens," autoclaving'and-possible sterilizing of equip- ■ment; For convenience of operation, protection against; inclement weather, and blackout condition, it would be- most suitable to use a surgical operating-tent of the type used in Armored Divisions so that direct attachment to the rear of the truck would be possible,24- As we shall.see, before long the idea of a single-vehicle, self-contained medical laboratory had been expanded into a truck-trailer combination that v/as considerably more elabo- rate than'anything’that had been visualized at the start of Development Project. F-3. ■ As for the adaptability of the 6x6, truck 388 as a field laboratory vehicle, Fourth Army officials were highly enthusiastic. Excellent maneuverability with only, negligible equipment damage, despite, frequent changes of location, made the truck an ideal1 vehicle;for field laboratory use, the testing agency reported.•'The adaptability of the. truck body as a working area was' equally praised.; The size of: the-truck, its.-design', head room,.and.aisle space were all found to be adequate. Two technicians and-one arsis't.anf». it was stated, could be accommodated-without confusion. More- over,, .-interior facilities, with a few minor exceptions, had ...proved to be entirely satisfactory from an operational standpoint, ' / - On 14 April 1944, the above test report was forwarded for study and reply vto the Laboratories Branch, Surgeon General's Offace,2° and three weeks later that' office'presented its ■ detailed The changes In.,-; small laboratory items which had been recommended by Fourth Army officials''were for the most part approved. The idea of adding a surgical operating tent to equipment lists was approved. Disagreement was voiced mainly with respect to proposed changes in heavy equipment and interior' construction. The Laboratories Division concluded its remarks with the following-: , ■■ On the basis of this report.the‘truck is -considered essentially satisfactory. The changes .recommended, are not serious enough to lead to a belief that the idea is , other than sound. It is, therefore'; recommended that these changes, be discussed, and " plans made' to. standardize the truck as soon as agreement can be; reached on- the. details .2? The above letter, together with Copies of the ' preliminary and final test repor t s,;i was forwarded ..within a few days to the Equipment'Laboratory at Carlisle Barracks for its comments and recommendations Then, on 23 May 1944,, a - conference, was held at The Surgeon General’s Office--in Washington with representatives Vqf the •Laboratories Division, the Te chni cal Di viqiong. :ahd the Equipment"' Lab pint dry *.. attending. The mobile medical laboratory, which had been . .; returned by the Fourth Army and was now 6n display at a ". , second Army War Show,- -wad carefully inspected .and agreement . was reached regarding- the. changes which would be made inci- dent to its . On 2.9, May 1944, ,revised specifications, drawings and equipment- lists Covering: the conference suggestions .were prepared by the'Equipment Laboratory and forwarded to The Surgeon General, The second paragraph of the accompanying letter of transmittal indicated the extent to which research and: development person- nel influenced by the recommendations of the testing agency* ' *■ - -• 389 Attention is invited to the fact that the equipment list (Inclosure 2) does not cover the following items, which, it is understood, wall be made part of the Table of Equipment, Tent, Surgical Truck, Operating ea 1 (Complete with poles & pins) Power Unit, PE 75-T • - ea I Trailer, Cargo, 1-ton • V ea 1 In‘short, approval of the additional .supply-items recommended by Fourth Army officers, together with inclusion of-the.'surgical tent., had now forced inclusion of a two- wheel trailer to transport this overflow equipment," The- , mobile, medical laboratory, it may.be observed, had had a remarkably fertile incubation period. Photographs of the ■ completed laboratory, truck, :,as it was presented for final standardization (see Figures 25 and 26), appear on the pages immediately following. VII, Standardization and Procurement, A, Standardization Phase, As early as 30 December 1943, three months before final service test results had reached The Surgeon General's Office, certain key' standardization data had already been assembled by the Plans Division. A formal nomenclature had been prepared for the new item, .and the-following tentative basis of issue, covering Medical Department installations only, had been drawn up: (a) 3 Laboratory Trucks for each Array or Communications Zone Laboratory; (b) 2 Laboratory .Trucks, for each General Laboratory, Using these unit allotments as a yardstick, total Medical Department requirements for ,1944 were: estimated at 60. trucks.31” On 17; February 1'944, in ..answer to Medical Department request, 'Army Air Forces submitted,a preliminary estimate of the number of medical laboratory vehicles it would need during the current year,’ Employing a rather ' complicated basis • of issue, involving ten different classifications of Air Force installations, a total requirement for 45' trucks was arrived at,32 Compared with the estimated needs of the Medical' Department, which would presumably be the principal user of the new. mobile'laboratory, Air'Corps demands appeared to- be somewhat inflated. Significantly, this initial figure of 45 was .pared down substantially by the Medical Department Technical Committee, On 25 1944, Army Ground Forces informed The Surgeon General that it had no need for the ne.w laboratory truck, and with the receipt of this information,33 the preliminary investigation of 390 anticipated requirements' was ended.. Once, final field-test, reports-load deep., received and a conference held; regarding last-minute,modifications:of the laboratory*■ truck, formal act!on-.-vas';initiated within The Surgeon General rs Office• to process the new it eft for standardization. The necessary forms were prepared by the Technical Division during the early part-of June, 1944, and on 6 June the Medical Department Technical Subcommittee met to.consider the question in-detail. Highlights of .this meeting-were s. (l) approval of the addition: to equipment, lists a PS-75 Generator (Signal Corps-item), a Surgical. Operating Tent (Quartermaster item), and a.-1-ton, 3-wheel. ,p.. cargo trailer (Ordnance item); (-2) ..reduct ion 'of Army Air ' Sorce hulk allotment of the. new.• trucks• from ;*45 to 10; (.3.) approval of the 103 trucks as the total quantity requirement for .1944, with..34 additional vehicles scheduled for 1945. On 12 June 1944, Subcommittee recommendations were approved without substantial change by the Medical Department Technical Committee,35 and on 4 July 1944 request for standardization of the mobile medical laboratory receivedIthfe official approval of Headquarters, Army Service Porces.36 B* Procurement Phase. In .view of the. relatively e xpe ditious. manner, in which project, initiation., development and. testing and • processing for, standardization .had-- been carried out in-this second phase of Deye 1 opm.ent: Pro/]eetP-3, it- would appear' that ’a. disproportionate-.amount of;* time was required to :gpt • the 'new. laboratory:--truck,..into- quantity production,; Inr. ... part the.delay.was caused by an.unexpected.reversal of action on the part . of., Army'- Service Porces. _On■ 4 July. 1-944, - as we: have seen.u-*Headquarters., Army. Service Porces had approved the request’of The Surgeon General's Office for standardi- zation of- the. medical laboratory truck. : This-- action had explicitly,.included-.approval of the proposed.-bulk- allotment of. 10 vehicles ..for ■Army.,Air, Porces rMore - than: a month later, ..however, ..a ■ revi si on-of., the. above, basic-, of-issue .was... suddendly .demanded. ,. .... ,r. . . . .... . 5.... *. , , . On 11 August,1944, in a memorandum to the -Director of .Material, Army : Service, Porces r ,the Director of -Supply v ' Army Service Porces, -requested .that the bulk allotment of-, 10 laboratory trucks-.to Army air Porces, previously approved by that headquarters , now bp,.'rescinded for the following ; reasons' . ' , ‘These Modi cal ’ .Department items.... cannot be, 'construed as ..possessing characteristics .-. 391 -peculiar to the Army Air Forces . , . , The above approved basis of.is pre- cludes accurate computations of author- ized allowances for- overseas commands. The above approved basis of issue does' not, provide basic data essential in computing requirements for the Array Supply Program.33 >. •„ It was thereupon recommended that the bulk allotment for Array Air Forces be translated into organizational requirements. If the above were cogent reasons in August, 1944 for establishing an organizational basis of distribution for the Air Corps, it is difficult to perceive why they were not equally cogent in July, 1944, In any event, in view of the excellent coordination that had been maintained by the Medical Department up to this point, the delay was con- spicuous, It was not one, moreover, which could be directly chargeable to The Surgeon General’s Office. The carrying out of the requested revision consumed an additional month’s time. The Army Service Forces’ com- munication was forwarded routinely through channels, and it was not until 31 August 1944 that a translation of bulk allotment into organizational requirements had been made by the Deputy Air Surgeon, Army Air Forces. The amended basis of issue called for the authorization of one each of the medical laboratory trucks, in pertinent Tables of Organization and Equipment, to the .following Air Forces Headquarters; 5th, 8th, 10th, 11th, 12th, 13th, 14th, and 15th.38 The Air Forces ’’translation" vras approved by The Surgeon General's Office.on 6 September and no further objections appear to have been raised by Headquarters, Army Service 'Forces;' -' • vd Arriving at a more satisfactory basis of issue for the,new mobile laboratory was not the only difficulty that beset, research and development personnel during this final period. " Obtaining -a suitable purchase description for the new refrigerator which was to be installed.in the truck took several weeksand the drawing up of final specifications for the truck body and interior were not completed until nearly the'beginning of By this time, with the Allied armies moving rapidly across France, the original allotment of laboratory trucks to the European Theater was deemed excessive. Accordingly, in the Army Service Forces production schedule for the last quarter of 1944, total quantity requirements for the new mobile medical laboratory were reduced from 103 to 83.^ 392 On 28 September 1944, a production order for 83 medical laboratory trucks was placed by Army Medical Purchasing Office in Hew York City.' Chassis and van body were procured through the Ordnance Department, with the Medical Department supervising the installation of interior fittingsExact cost figures are not available, but the estimated unit cost for this quantity production was $5500.-5 On ,18 October 1944, six vehicles were cancelled from the original order, leaving a total of 77 to be manu- factured. By 20 December 1944, 37 of these had been delivered, and within another 30 days the remaining 40 had been received. No further production orders were placed for the medical laboratory .truck, The allocation of the new mobile laboratory-, by theaters of operation, is presented in the table below.^ AUTHORIZATION BY THEATERS OR OPERATION 26 October 1944 Theater No* hy 31 oPe c. 1944 . No. oy 31.Dec. 1945 Pacific Ocean.Area 5 5 North Africa 13 13 India 5 5 South Pacific Base Command 3 3 European Theater 13 19 Southwest' Pacific. Area ' ' 24 24 C, Project Termination. Before the close of September, 1944, the Equipment Laboratory at Carlisle/'having'completed all last-minute revisions of specifications and drawings, recommended to The- Surgeon General that Development Project .• F-3 be dropped from, its list of active projectsTermination of the project was accordingly authorized by The Surgeon General’s Office on 3 October and a few weeks later arrangements were made to dispose of the pilot model labo- ratory truck by shipping it where it would be more urgently needed, ‘ . It had taken exactly 11 years, 5 months, and 20 days to develop, standardize, and procure: a new Army Medical Laboratory. . ■393 , VXIIConclusion,- A* Pbys1cal Evaluation. •' * • - The mobile Army, medical laboratory, in the form in which it was finally standardized, represented the best features of all models, which, had preceded, both regulation and experimental.- - The new laboratory truck, with its Ordnance chassis ahd special Medical Department van body, was at least as sturdy, commodious, and maneuverable as the all-purpose cargo truck which had been in standard use, as a medical laboratory vehicle since World War I.’’ It was vastly superior, on all counts, to any of the trailers or semi- trailers which had been experimented with during the thirties and early forties* In interior construction, the new'van body truck was a radical*departure from the open-body cargo vehicle which, .-until 1944, had been the standard item for rear-zone laboratory units. Within the enclosed body were specially designed, built-in', storage cabinets; complete plumbing, heating, and lighting'facilities; adequate v/ork bench installations and ample aisle space.. Five windows provided additional natural light and ventilation.. In short, all the structural innovations of the 1939 semi-trailer laboratory had been incorporated in the new model, with added improvements. • . v Finally, by the addition of a surgical operating tent and a small 2-wheel trailer to carry this and other overflow equipment, the operational advantages of all earlier laboratory: models'were combined in:a single assembly. The inclusion' of;a 1-ton trailer in the new unit made it possible to transport as much as-had previously been possi- ble with the cargo type of vehicle. The inclusion of a surgical operating tent made possible actual field operation of a portion of the laboratory. .’ Such tasks as specimen- collecting, record-keeping, and, when necessary, sterili- zation of glassware could thus be conducted out of doors, under tentage, while precise and exacting laboratory procedures could be carried out in the interior of the truck. None of the' previous laboratory models had possessed this dual flexibility. B# Administrative Aspects. While the administration of research and development activities during the first phase"of Development Project. F-3 was on a relatively low plane of efficiency, a marked improvement in administrative performance took place during Phase IX•of*.this undertaking. The procedural requirements of Ap 850-25 were hot '-only adhered to more closely during 394 this latter period, hut the time required for such processing action was greatly reduced. Centralized policy control and firm over-all coordination at the top were • substituted•for the loose decentralization and jurisdictional overlapping that had characterized the earlier phase. On-the-spot liaison took the place of consultation by correspondence. Central procurement of key items of equipment was insti- tuted as an ..expediting measure and the purchase of routine items was. facilitated by definitely discouraging last- minute modification of-equipment lists. It is interesting to note that this sudden improvement in project administration coincided, in point of time, with a major reorganization within The Surgeon General’s Office, In March, 1942, the Planning and Training Division, which had previously been charged with the over-all control of medical research and development, was abolished. In its stead the Operations Service was organized, and to one of its divisions, the Plans Division, was given the specific responsibility of developing new medical field equipment. Again, in February, 1944, a further reorganization took place. The Technical Division was established within the Operations Service, and to it was delegated not only the responsibility for the conduct and/or supervision of an expanding amount of medical research and development, but the coordination of all types of research activity, including the writing of specifications and the preparation of Tables of Organization and Equipment,^2 A careful examination of the documents with which this study has "been concerned suggests that these changes in organization, leading to’a greater centralization and . integration of research and development activities, were to a considerable degree responsible for the administrative improvement that was shown during the second phase of this project, C, ■. The Time Factor. . While, as we have seen, the new Army Medical Laboratory was generally conceded to have been an excellent end-product, it had quite obviously been developed too late to be of very extensive service in World War II, Quantity deliveries of the new unit to overseas installations did not begin until December, 1944, Since the war in Europe was over by May of 1945 and the Pacific war ty August of-.that year, it is evident that on-the-spot improvisations had had to suffice for more than three years of the fighting. Yet Development Project. F-3 had been established as early as April, 1933, Why had it taken the Medical 395 Department more than eleven years to produce a satisfactory mobile medical laboratory? It is, cJf cour.se evident. from the discussion which has preceded that the duration "Of Development Project. 3?-3 was definitely protracted by administrative and procedural delays* ■ Numerous instances; of .these types-.of delay have been pointed out in the .course of. this narrative, Not all, of course, were chargeable to the Medical Department, Other agencies had participated in the undertaking, and each bore some measure of responsibility for the total time which had been lost through these causes. The importance of this factor, however, should not he exaggerated. Even considered in the aggregate, the total time lost‘as a result of administrative and procedural'delays was simply a matter of months, while what we are chiefly- concerned with here is an explanation that will encompass years, A more satisfactory explanation, therefore, would seem to he along the following lines. From 1933 to 1939, medical research and development was critically handicapped by a lack of•adequate operating funds. In Fiscal Year 1934, for. example, ho funds'-’whatever were available for the development of medical field' equipment* In 1935 and 1936, only $1,500 .and $2,500, respectively, were appropriated,00 Clearly, no modern military establishment,’however well administered, could have conducted an effective and comprehensive program of medical research and development on such a budget, Furthermore, from January, 1939 to January, 1942, while research activity was increased somewhat, limited funds still narrowed the field of research possibilities to such ■ an extent that only surplus military vehicles could be ear- marked for experimentation. What should have been creative engineering, therefore, was actually little more than dili- gent tinkering. It is true that the administration of this pro- ject could have been improved. It should be emphasized, however; that for nearly-nine of.the.eleven.years_of■its existence Development Project. F-3.was.either completely inactive or seriously hamstrung because of a simple lack of money* ' ■ ; 7 - - ; ' u .. 396 FOOTNOTES TO CHAPTER VI to ArG.O. , fr. S.G.O., 24 Jan. 1939; subject: "Army Medical Laboratory” (M.D.E.L.). Table of Organization 286-W.' Medical Laboratory (Army or- Communications Zone).' 31 Aug. 1921. 'Z See n, 1, above, ■■ %emo*( to IT. Y. Medical Supply Depot, fr, Capt. C. Y\ Morgan, 12 Nov, 1937', Par,- 10 (M.D.E.L.). Department Research Program. Eiscal Year 1941, 3 ■' Apr. 1941, CONFIDENTIAL', p. 33-34 (Rec. Em., S.G.O. 700..2-1). Extracted in clear. * ,, p. 33, , p. 34, of Organization 286-W. Medical Laboratory (Army or Communications Zone)-, 23 Feb,. 1927-. q See n, .5, above* • : , , on Pennsylvania-State Board of Health Mobile Medical Laboratory, Jun ,, 1934 (M.D.S.L.). n, 5, above, IP See n. 1, above. lgIbid. ; • ' . 14 Ibid. •*•■••• 15Ibid.. Ind. to M.D.E.L. , fr, S.G.O., 7 Peb, 1939; basic: see n, 1, above^(M.D.S.L.). to T.S.G., fr. Research Coordination Dr,, Plans Div., S.G.O., 12 Oct, 1943, SECRET; subject: ’’Monthly Status Report on Research and Development Projects for the month of September” (Hist. Div., S.G.O.). Extracted in clear. 49See n, 5, above, 49Supra, p. 358. 397 2(8See n. 5, p, r 51 Infra, gu3381-382. Report for Fiscal Year 1945. Research Coordination Br., Technical Div, (Hist. Div., S.G.b.). 2~3rd Ind. to A.G.O., fr. S.G.O., 27 Jan, 1941; basic: not on file (M.D.E.L.)# ’to A.M.C., fr, M.D.S.L., 2 Feb. 1939; subject: "Mobile Laboratory” (M.D.E.L.). - . * to Holabird QM Depot, fr. M.D.E.L., 25.Apr. 1939; subject: "Installations at Holabird QM Depot in Army Mobile Medical Laboratory Semi-trailer Body” (M.D.E.L’.), 26Ibid, ' ’ . Ind, to Holabird QjM Depot, fr,‘M.D.E.L., 23 May 1939; basic; Itr, to -M.D.E.L,.fr, .Holabird 20 May 1939; subject: "EDT Project 25-9-Semi-tra*iler 2-wheel, 2dt—Medical Laboratory” (M.D.E.L.). 28Ltr. to American Hard Rubber Co., fr, M.D.E.L., 5 Mar, 1939 (M.DiE.L.)* Also see.memo, to M.D.E.L,, fr. .Dept, of Sanitation, M.E.S.S,, 28 Mar,.1940 (M.DiE.L.)./ to MiD.E.L., - fr; American, Hard Rubber Co. , II. Mar. 1940 (Mi D.E, L-,) ,•• ‘ ■ • ’ •-/;./ ' ‘ ' ' V"-. to; MrD.E.L. , 'fr-.-lMonsanto Chemical Co., 14 Mar, 1.940 (M.D.E.L.) . b ■ Office -memo. ,•• "Ebony Finishes/’, undated (M.D.E.L.). 32Ltr. to M.DIE.L.,' fr. B„ ,F. .Goodrich ,.Co., .2 Jul* 1940; subject: "Acid Seal Paint.1945” .(M.D.E.L.). * 33Ltr, to Coleman Lamp & Stove Co., fr, M.D-.E.L., 4. Feb. • 1939; subject:''"Stove” (M.D.E*L,).■, .. Ltr. to American Machine Gas Co., fr, Mib.S.L.,,'4 Feb. 1939; subject: "Stoves” (M.D.E.L.). 34Ltr. to M.D.E.L.,, fr. ,Holabird Depot, 29 Mar. 1940; subject: "Project EDT 25.9, Semi Trailer 2-wheel," 2dt" (M.D.E.L.). C * * y » * . * * • * * > / * # t'Ltrf to 8. G.O. , fr. M.D.E.L.; 3 Sep. 1940;-sub ject: "Army Mobile Laboratory" (M.D.E.L.,). 35Ibid. v , . 398 37Ltr, to A.M.C., fr. M.D.B.L., 9 Jul. 1940 (M.D.B.L.). 38Memo. to Jtf.D.E.L., fr* A.M.C., 5 Aug* 1940 (M.D.B.L.). 39See n, 35, p. 398, 49Ltr, to M.D.B.L, , fr. 5L.G.0, , 23 Aug. 1940; subject: "Ambulance busses and mobile Army medical laboratory" . (A. M.E. & D. Bd.). . ... .. 41See n. 35, p. 398. 42Ibid. ’ *• - A'l Ltr* .to S.G.O, ,'fr, A.M.C* , 18 Sep, 1940; subject,: "A Supply List for Laboratory Trailer Truck" (A.M.R. & D. Bd,). 44lst Ind, to M.D.B.L. , fr* Plans & Training Div., S.G-.O. , 19 Sep. 1940; basic; see n, 43, above (a,M,R,4 D, 3d.), 45Ltr. to M,D,B.L»., f.r. A.M.C. , 25 Sep. 1940 (H.D.E.X,). 46Ltr.. to A.M.C. , frf- M.D.B.L. , 2D Nov. 1.940 (M.D.B.L.), 47Ltr. to M.D.B.L*, fr. A.M.C., 6 Dec. 1940 (M.D.B.L.). 4ft " * *■ • ’ . Ltr.t to S.G-.O., fr, M.D.B.L,, 9 Dec. 1940; subject: "Army Mobile Medical Laboratory", (M.D.B.L*). 492d Ind,. to A.M.C., fr, S.G-.O. ,1.7 Dec. 1940.;, basic: ' see n, 48, above.(M.D.B.L.). , . f 3rd Ind, t,o S.G.O. ,'fr, A.M.C, , 20 Dec,. 1.940; basic:', see n, 48, above (M.D.B.L.). Note especially Ipjd. 1.. 514tL Jna-.-tp M.D.B.L., fr. S.G.O. , 27 Dec 1940; basic: see n, 48, above (M.D.B.L.). 52Ltr, to A.M.C,, fr. M.D.B.L. , 21 Jan, 1941 (MvD.E.L.). .1st Ind..,,to. M.D.jE.L. fr. A.M.C. , ■ 28' Jan. -1941; basis: see n. 52, above (M.D.B.L.). ' . " ‘ • * ' ' *■ Ltr* to S.G.O., fp,.2(i Medical Lab,, Ft. Sam Houston, Tex,, 7 Jan. 1941; subject: "Laboratory Trailer" : (A.M.JU ;& D. Bd*). , . Ind,. to 2d Medical Lab., Ft. Sam Houston,,, Tex.,,• fr. S.G.O., 8 Mar, 1941; basic: see n, 54, above (A.M.S. & D* Bd-,), , : :/ ... 58Ltr. to A.M.C., fr, S.G.O., 3 Apr, 1941; subject: "Equipment for Mobile Laboratory" (M.D.B.L,), ,--. 399 o7lst Ind. to S.G.0. ,, fr, A.M.C,, 15 Apr * 1941; basic: see n. 56,‘p. 399 (M.L.S.L,). CO . Ltr, to S.G-.O. , fr, M.’L.B.L. 25 Apr, 1941; subject: "Road Test Laboratory, Semi-trailer1* (MvD-S.L,), For text of this report, see Appendix E, • 4 4 , * M * r 59Ibid. 3<“*6th Ind, to M.L.S.L., fr, 1324th Service Unit, Office of the QjM, Carlisle Bks,, Pa,, 2 Jul. 1941; basic?*,, l.tr, to S.G-.O,-, fr; M.L.E.L. , '29 Apr, 1941; subject; "Army Mobile Field Laboratory No, 1" (A.H.R, & L. 3d,), to 2d Medical Lab.,• Lake Charles, La,, fr;- S.GVO., 15 Aug,;. 1941; subject: "Mobile Laboratory, Trailer*1 & DU Bd,) . on the Experimental Mobile Laboratory Trailer, Hq,, 2d Medical Lab,, Ft, Sam Houston, Tex,, 16 Oct. 1941 (M.L.E.L.). For text of this report see Appendix F, 63Ibid. 642d Ind, to M.D.B.L,, fr, S.G.O,, 18 Nov, 1941; basic; see. n, 62, above (A.M,R. £ L. 3d,), r . Progress * Reports. M.L.E.L,. covering the period 1 Lec.1941 thru 31 Mar. 1942 (A.M.R. & L,. Bd.)*,', , * “ • * " * » "■ of Qrgahiz'ation~ & Equipment Medical Laboratory. Army,1 Apr. 1942• , .j 37Monthly Progress Report. M.L.S.L.. Apr,, 19421 (A.M.R’. & L, Bd.).. . ... -• ■ 68Ltr, ;to .Cj&,, 'A.S.iS1. , fr. Plans Liv,, $.0,0. , 29 Jun. 1943; subject: "Laboratory, Medical, Mp.bile,• Army - development project on** (A.M.R, ’ & Ef. Bd.) ,"* * ' 8~Ltr, to A.M.C.’, fr, M.L.E.L, , 9 Jul, 1940 (!hD;E,L. ). 70Ltr. to A.0,0,, fr, S.G.O, , 23 Nov, 1940;, subject: ** Improved type of, Ye hi cle s. f or Medi cal department ‘ Spe cial Body • Purposes"' (M. L.S.L. li.- ' ' * . v to T.A.G-. ,. fr.,-S.0.,CL.,-‘30 .1940;, subject: "Transport for 2d'Medical Laboratory (Army) - (M.L.E.L,). ■ to A.M.C,, fr, M.D.S.li.U,- -6' JJn. 1941. (;M,L,B,L,'). If.tr* -to; M.L.E.L,, fr,. A,M,.G,., l&Jan.‘ 1941 (M.L.E.L.). Ltr* to A.M.C., fr, M.L,S,L., 21 Jan, 1941 (M.L.S.L.). 400 783rd" Ind. to S.G-.jO. , fr'. A*G>0., 27 Jan. 1941; "basic: see n. 71, p, 400 (M.D.E.L.). ; . y ■ ’ 7%jtr. to M.D.’E.L.-, .fr. A.M.C► , 26 Fed. 1941 (M.D.E.L.). to Asst. Chf, of Staff, G-4, fr. "S.G-.O., 22 Dec. 1941 (Hist. Div., S.G-.O.). 78See Chapter VII. 77Ltr, to*-S.G-.O., fr, Hq,, 9th Medical Lab'., Ft.' Sam Houston? Tex., 2 Jun, 1943; subject: ,fSpecial Vehicle for Mobile Section* of Medical Laboratory, Army" (A.M.H. & D, ;3d,), 78Excerpt fr. Par. 170, FM 8-10. Medical Service of Field Units. 28 Mar, 1942. Cited in Itr, referred to in n. 77, above, n. 77, above. 80Ibid.' •' ’ * 81Ibid. 88"Memo. to Field Equipment Development. Br,* Plans Div., S.G-.O., fr. Laboratory 3„r,, Preventive Medicine Service, .S.G-,0. , 25 Jun. 1943 (A.M.H. & D. Bd.). 88Memo. to*Chf., Research Coordination Br., -Plans Div., S.G-.O., fr, Chf., Field Equipment Development Br., Plans Div*.r-.:S..G^Q.'25-;‘Jun-* 1943; subject: ."Research Project for the Medical Laboratory, Army"' (A.M.R. & -B. Bd.). 8%fonograph by. .Chf,,. Research Coordination Br., Technical Div., S.G-.O. , History of World* War Ho. Il/fr. l.Jan. 1939 to 30 Jun. 1944. SECRET, Tab. 15 (Hist. Div., S.G.O.). * Extracted In clear, ■; ■ ' ■ * • 85Ltr, to C,‘Cj ,• A.-S.F. (Attention* Chf., Development Br., Requirements Div.).- fr, S.G-.O., 29 Jun. 1943* 1 % subject: "Laboratory,.Medical, Mobile, Army- develop- ment project on" (A.M.R. & D, 3d,). 86lst Indw'to S;G.C., .fr. Hq., , 5 JuT. 1945; basic: see n. 85, above (A.M.R. & D. Bd.). 872d Ind. to C.C., , fr. S.G.O., 6 Jul, 1943; basic: h. 85," above {A.M.R., & D. Bd.), * OD . 3rd *Ind, to S.G-.O.-, fp. Hq,, A.S.F, , 9 Jul. 1943; basic: gee n;v8S, above ‘ ,&tD. ,Bd.) ♦ 401 89 Ltr. to M.D.T.C., fr# Subcommittee on Field Equipment, 22 Sep* 1943; subject; "Truck, 6x6, Laboratory, Medical, Army" (A.M.R., D. Bd.)# 9Q of M.D'.T.C.. Heating No. 10, held 4 Oct, 1943, RESTRICTED' (Hist .* Div., S,.G.0.).; Extracted in clear. • r , ' * « 912d Ind. to C.G., A.S.F., fr. Hq., A.G.F*., 21 Oct. 1943; basic; see n. 89, above (A.M.R. & D. Bd*). Ind. to S.G.O., fr* Hq., A.S.F., 26 Oct* 1943; basic: see n. 89, above (A.M.R. & D. 3d.). . • 98 See notation on memo.,:to< Chf*, Research Coordination Br., Plans Div,, S.G-.O., fr. Chf., Field Equipment'Br*,. Plans Div., 25 Jun. 1943; subject: "Research Project for Revision of the Medical laboratory, Army" (A.M.R. & D. Bd,). to M.D.E.L. , fr. S.G.O. , 3 Jul.."1943; subject: "Laboratory, Medical, Mobile"; with incls. (A.M.R.-& D. Bd,). to S.G-.O., fr, M.D.E.L*, 7 Jul. 1943; subject: "Mobile Medical Laboratory" (M.D.E.L*). f 9Plst.Iijd, to M.D.-E.L. , fr. S.G.O., 17 Jul. 1943; basic: see n* 95, above (M.D.E.L*). .Narrative Report. M.D.E.L... 1 - 31 JuU 1943 ■ (A.M.R, & D. Bd.)i ’ 98Ltr. to S.G-.O., fr. M.D.E.L., 31 Jul. 1943; subject: "Equipment for Mobile.Medical Laboratory" (M.D.E.L.). 99Memo, to Chf., Operations Service, S.G.O. , fr.# Laboratory Br., Preventive Medicine'Service,. S.G.O., 6 Aug. 1943; subject: "Equipment for Mobile Medicine Laboratory, Project F-2.01" (A,M.RV &-D*..B,d.t}• • •1 : ; • ■ * ■ * ■ ' 1st Memo. Ind. to Distribution Div., S.G.O., fr. Plans .Div,, S.G.O., -7 Aug, 1943; bade.: see n# 99, above (A.M.R. & D. Bd.). , f Narrative Report.. M.D.E.L. . 1- 31 Jul, 1943 (A.M.R,' & "d.* Bd,).. * • MD 36-004-21-44 to CO, Binghamton Medical Depot, fr. Medical Supply Office,, Carlisle Bks., Pa,, 6 Aug. 1943 (M.D.E.L.). to S.G.O. , -,fr. M.D.E.L., 28 Jul, 1943; subject: "Mobile Medical-Laboratory" (M.D.E.L*) 402 S* Army Tentative Specification AAS-981, Body, Surgical Tan, 2-yTon Armored -Force, 14 Jul.,1943< • • .* M.D.E.L. Photo Ho* 5-309-; •’■Also see Monthly Narrative, Report. M.D.E.L.. 1-31 Aug. 1943 (M.D.E.L.). v - i . * 4 ' * * ■ ®M,B.E.L. Tentative Specification No. 53-B-, Van Body 2^—Ton, Medical Corps / M"-!' (Laboratory Truck), 7 Aug. 1943 (Supply Service, S.G.0.). Narrative Report. M.D.E.L. ,1-31 Aug. 1943 . (A.M.E. & D. Bd.). .. * * * Narrative Report; *M.D.E.L. , d *30 . Sep. 1943 ; (A.M.eV & D. Bd.). : * ■ • to Operations Div.,, S.G.0., fr. Laboratories Br., Prevent j.ve Medicine Seryice/S. G.0, v 5 Oct-. 1943.; subject: ’’Experimental Mobile Laboratory Truck” (Bee. Em., S.G-.O, 451,2-1 Carlisle Bks-.-N). See also 1st Ind, to M.D.E.L, , fr, S-G.O,, 9 'Oct. 1943; basic: see n. 11, above (Bee,-Em., S,G.O. 451.2-1 Carlisle Bks.-N). ' *' * * • ■ . 3Ltr, to M,D,B,L., fr. . S.G-.O. , 14 Oct. 1943; subject: Transfer of Truck, $ony 6x6,--Laboratory ,..Mpdipal, Army” (A.M. T. & D. 3d.). * * • • ■ » , Ind,' to S.GlO. , , fr.‘ M..D.E.L. , 2 Nov. *1943; basic: see n. 13, above (A.M.E, & D. Bd.). 5Monthiy Narrative Report. M.D.E.L., 1 -• 30- Nov,. 1943 ; & p. Bd.}. -*-®Memo, to Plans Div. / Operations Service/- fr. Laboratories ; Div.,, Preventive Medicine Service, 11 Nov, 1943: subject: ’’Truck, 2Jton, 6x6,. Laboratory, Medical, Army” (A.M.E. & D. Bd.). .*■■■■ ’ : . * * ’ » .4 f , to, O.G*,;Third-Army,, fr. S.G.O. , 17 Nov. 1943; subject: ’’Truck' 2-J fo'hv' -6x6:, Laboratory, Medical, Army”. Ind, 1, Test Data Shaet.■*(A..M.R, & D. .Bd-), t?See. 17, aboye,’ ' Ind. to C.G., Third Army,‘El,' Sam-houston,*Texas, fr. ‘ Hqy, A.G-.E. 29 Nov.-1943;. basic: s'ee n, 17, above (A.M.E., & D,t Bd.)-. • ’ ‘ ‘ ' *' • 403 for Record, 30 Dec* 1943, initialed by Lt, Col. • John 3, Klopp, Dir. , Technical. Div,, S.G.O. Subject: "Shipment of Laboratory truck" (A.M.R, ’& D. Bd»). 21 *; . Preliminary Test Report. Truck, 2j Ton. Laboratory. Medical.- Army, for the period.30 Jan* to 12 Feb, 1944, inclusive; Incl, 3 of 4th Ind.. to C.G,, Fourth Army, fr. Fourth Army, D.r Hq*, 15 Peb., 1944; basic: see n, 17, p. (A.M.R. & D, Bd,) • 22Ibid, Test Report. Truck. 2h Ton. 6x6. Laboratory. Medical. Army. 17 Mar. 1944; Incl. 5 of 6th Ind. to C.G,, Hq,., ■ Army, Ft. Sam Houston,. Texas, fr. Dir, Kq., Louisiana Maneuver Area, 18 Mar. 1944: basic: see n. 17, p. . (A.M.R. & D. Bd,). For complete text of this' report see Appendix S. 24Ibid.. p. 5. Sheet to Chf., Laboratories Div,, fr. Dir., Technical Div,, 14 Apr, 1944; subject: "Final Test Report, Truck, 2-g-Ton, 6x6 Laboratory,'. Medical-, Army" (A.M.R.. & D. Bd,). . 2oMemo, to Technical piy.,,. fr. Laboratories Div.-, ■ 9' May . 1944 (M,D.F.L.),. ■' ; . .. . . - • 2?Ibid. ■ ■ • 28Ltr, to- M.D.B-.L* ,;fr.; S.G.O. ,. 11 May 1944;. subject: .’’Truck, Ton, 6x6,4 Laboratory,. Medical., Army" (A.M.R. & ' D. Bd.). Narrative Report, M.D.B.L.,.1 - 31 May 1944 (A.M.R, & D, Bd.)• to S.G-.O., fr, M.D.B.'L. , 29 May 1944; subject: "Truck, 2-|--ton, 6x6, Medical.Laboratory" (A.M.R. & D. 3d,), to Distribution Requirements Div., S.G.O., fr. Plans Div., S.G.O., 30 Dec. 1943; .subject: "Surgical Truck, Laboratory, Army or CZ" (A.M.R. & D. Bd,). 325th Ind. .to S.G.O., fr,,Hq„, A.A.F.; 17-Feb, 1944; basic: Itr. to The Surgeon, Kq,, A.A.F. School .of Applied Tactics,, Orlando, Fla., fr, Hq., A.A.F,, 13 Sep, 1944; subject: "Mobile Trailer Laboratory Unit" (A.M.R. & D. Bd,). 2d Ind, to C.G., A.J3..F. , .fr, Hq, A..G..F. , 25 liar.- 1944; 404 basic: Itr....to S.G.O,., fr, Hq. 4th Army, 21 Feb, 1944; subject: ’’Preliminary Test Report,'Truck 2-| Ton, Laboratory, Medical, Armyn (A.M.H. & D. Bd-,)>- 34Ltr, to M,D,T,C,, fr, Medical Dept* Technical Subcommittee, 6 Jun. 1944, CONFIDENTIAL; subject: ”MedicaI Department Technical Subcommittee Report on: Truck, Ton, 6x6, , Laboratory, Medical” (A.M.E. & D. Bd.), Extracted in clear,., ■ g°Min« of M«D.T.C. Moating held 12 Jun, 1944, RESTRICTED THist, Div,, S.G.O.). Extracted in* clear, Ind, to S.G-.O. , fr. Hq,, A.S.F., 4 Jull 1944; basic: Itr, to C.G,, A.S.F. , fr. S.G.O. , 21 Jun. 1944'; subject: ’’Truck, 2-J- Ton, 6x6, Laboratory, Medical” (A.M.E. & D. Bd.). 27Ibid, . : to Dir, of Materiel, A.S.F., fr. Dir. of Supply, Hq., A.S.F. , 11 Aug. 1944, CONFIDENTIAL; subject: ’’Basic of Issue for Truck, Ton, 6x6, Dental Operating and Truck, Ton* 6x6, Laboratory, Medical” (Rec, Em., S.G.O. 451,2), Extracted in clear. 4 [ 70 2d Memo, Ind, to C.G., A.S.F., fr. Deputy Air Surgeon, Hq., A.A.F., 31 Aug, 1944; basic: see n, 38, abovfe (Rec, Em., * S.G.O, 451,2.)• Extracted in clear, . .. , • ’ ’ 9 4 - Ind. to C.G,, A.S.F., fr, Chf., Operations Service, S.G.O,, 6 Sep. 1944, CONFIDENTIAL; basic: see n*. 38 above (Rec,- EmS.G.O. 451,2), Extracted in clear, to Development Br,, S.G.O., fr. Chf,, Supply Coordination Br,, S.G.O., ,23. Sep, 1944; subject: . ’’Item 9948300-, Refrigerator,’ Mechanical, 2 Cubic liO Volt, 60 Cycle” (A.M.R. & D. 3d.).‘ ' ‘ to'Development Br, S.G, Q.,fr. Chf., Supply Coordination-Br,., S*G.O,-, 30. Aug, 1944";* subject:/ ”Item 9958720 - Truck, 2j Ton, 6x6, Laboratory, Medical - Specification”. (A.M.E.., & D.* Bd.)-., 4^tr,‘to .C.^,r. A.S.F. ,, frV .S.G.O., 8 Sep. 1944', : • CONFIDENTIAL;. Truck, 2\ Ton, 6x6, Labora-t'ory, Medical” (A.M.E, & D. Bd,), Extracted in clear. 44lst Ind. to Hist. Div,, S.G.O,, fr, A.M.P.'O, N.Y.C., 31 Oct.- 1945; basic: Itr to A.M.P.O., fr, Histroical Div., S.G.O., 22 Oct. 1945 (Hist. Div., S.G.O.). 45See n. 34, above. 405 46See n. 44, p, 405, 4?Ltr, to C.G., P.O.A; C.G., NATOUSA; C.G. , CBI; C?G. , So. Pac, Base Comd,; C.G,, ETO; C.G,, , fr, Chf,, Supply Service, S.G.O, , all dated 26 Oct, 1944, q CONFIDENTIAL; subject; "Medical Department Trucks" (Eec, Em., S.G.O. 451,2.), Extracted in clear. Narrative Report. M.D.E.L.,1-30 Sep, 1944 (A.M.E. & D. Bd.)• ±'J 4%emo, to Dir., M.D.E.L., fr. Chf., Operations Service, S.G.O., 3 Oct, 1944; subject: "Development Projects - Termination of" (A.M.T, & D. Bd,). to Chf,, Supply Service, S.G.O., fr. Dir., Technical Div., S.G.O., 28 Oct, 1944; subject; "Mobile Units - Disposal of" (A.M.E. & D. Bd.), 51 Annual Eeport. Service of Supply, for Eiscal Year ending 30 Jun, 1942. pp, 56-57 (Hist. Div., S.G.O.), by Chf., Eesearch Coordination Br., Technical Div., S.G.O., History of World War No. II. fr. 1 Jan. 1939 to 50 Jun. 1944. SS'CEST. (Hist Div.. S.G.O.). Extracted in clear, Medical Bulletin. No, 32, Jul., 1935, p. 75. 406 • :• CHAPTER VII , THE"MOBILE DENTAL LABCRATCRY I. Introduction., A, The World War I Dental Laboratory. In World War I dental prosthetic service was furnished to forward elements of the American Expeditionary Forces by what were described as "portable dental ‘laboratories, The integral equipment of each of these laboratories consisted of one Medical Department chest, weighing slightly more than 200 pounds when fully packed, in which was contained all the items deemed essential for the manufacture and repair of bridges and dentures. This chest, too heavy to be hand Carried, was in itself something of a field problem as no specific transpor- tation was then provided for divisional dental units. In mov- ing from one area to another, the officer in charge of the labo- rato:ry was obliged to plead for cargo space in whatever unpre- empted vehicle he could locate. The results of this awkward transportation arrangement, which was typical of divisional dental operating as well as den- tal laboratory units, were not altogether .happy, as is indicated in the following passage from the Annual Report of The Surgeon General for Fiscal Year 1919. The transportation of dental equipment and. supplies has ever been a source of irritation to division commanders, transportation officers and division surgeons, . ♦ . Much loss of equipment and Consequent loss of dental service in several divisions has resulted thereby. The First Divi- sion, moving into combat area in May, 191B, was forced to abandon their entire dental equipment through lack of transportation facilities. , , • At that time it required the entire resources of our Medical Supply Depot No,'3 to resupply emer- gency equipment for this division after its arriv- al in the new area, -• Lack of assigned transportation, however, was not the only weakness of the portable dental laboratory. No table of organization had been established for the unit and, as a conse- quence, it possessed no permanently assigned personnel. Although typically the laboratory staff consisted of one dental officer and one enlisted dental mechanic, the amount of time that could be devoted to the making of dental replacements, as well as the quality of the personnel assigned to these tasks, depended upon the military situation and the total number of dental officers and technicians assigned to a given command. Inasmuch as there was a shortage of over 300 dental officers even at the time of the signing of the armistice, it is evident that dental laboratory service, especially in the division area, was subject to consider- able fluctuation throughout the war.3 Since no separate tentage had been provided, the labo- ratory had to. be housed with other units. Usually it was located with one of the: division field hospitals.4- This arrangement, desirable perhaps from a personnel standpoint, nevertheless had its drawbacks. Chiefly, it limited the mobility of the portable laboratory, transforming it into .a virtually serai-fixed instal- lation. Troops in adjacent areas could not be served on the spot, thereby necessitating, for those soldiers requiring prosthetic service, separation from their respective units while they travelled to; the nearest field hospital. The individual soldier was thus likely to be, unavailable for purely military duties for a matter of days rather than hours,. Obviously, where the units concerned were scheduled to move back into' combat within a short time, such separations required immediate replacements. Under these conditions it would not be surprising if the individual need for bridges or dentures did not always, receive the promptest attention,’ • Finally, there was the question .of,;the adequacy of the prosthetic -equipment which had been provided for the laboratory. Actual combat usage’had disclosed deficiencies in all types of dental equipment and, with *the -conclusion of the war, steps were taken by the Medical Department to re-examine all of these items with a view toward developing more satisfactory units.for future use. In order to take advantage of the vast‘fund of experience gained during, this campaign a board of three experienced dental officers was selected for consideration of modifying dental equipment and supplies to meet actual field conditions. The report of this board has been forv/arded to the medical equipment board, .Their recommendations will greatly modify dental equipment and reduce to a minimum the size and number of containers for the articles deemed necessary,5" These words had a confident ring. As prophecy, however, they were not altogether accurate. B. The Modified Portable 'dental Laboratory* Although the board'of dental officers appointed by; War Department - orders in October, 1919, did revise existing dental supply tables and although in 1921 three new field dental units (Individual, Dispensary, and Hospital Company) were developed and it was apparently nearly ten years before the portable dental laboratory under- went basic modification. By that-time the earlier aim of the Dental Division to reduce the weight and bulk of all field items and to reduce the number of packing containers had evi- dently passed into discard. In comparison with the World War I model, the new dental laboratory was heavier, virtually as. bulky, and required two containers instead of. one,^ Developed by the Medical Department. Equipment Labo- ratory in the early thirties, the new portable, dental labo- ratory unit'was contained in two standard size,, reinforced chests (Medical Department Chest #6l, and Medical Department Chest #62), These chests were provided with special inserts, for the packing of prosthetic equipment and supplies,. While individually each of the two chests, when fully packed, was somewhat lighter than the single laboratory container used during the first world war, gross weight of the rcomplete unit was in excess of that of the earlier model. As for..-equipment, with the exception of one hand lathe all'dental supplies and machinery were standard Class 5 items, Concededly,; in terms of the amount and variety of equipment provided, the new unit was an improvement over the World War I assembly, :• ...<*■ Upon approval by the Medical Department Technical Board, the new laboratory chests, together with their, res pec** tive equipment lists, were officially appended to .the 'Tables of Basic Allov/ance for the Medical Battalion, the -Medical Regiment, and the Evacuation Hospital. It was visualized .apparently that upon the return of a division to its rest area, selected battalion and regimental dental personnel would then take over and operate a: dental laboratory service. Prosthetic service at evacuation hospitals, on the other hand, ?/as evidently for the benefit of those units, in the division area which were too small to have their own attached dental personnel. While in some respects it had been a definite step forward to have the new laboratory unit included in standard supply, tables, thus remedying one of the major defects of World War I' practice, the wisdom of assigning responsibility for dental prosthetic service to divisional medical units.was open to considerable question, For one thing, these heavy, laboratory chests would seldom, if ever, be. opened in actual combat zones, for the'circumstances of.combat.would rarely,- permit this service to function. In all probability, when a given medical unit went into action its dental laboratory equipment would simply be left behind at the division dump in its rest area. Moreover, where battle lines were fluid, it would often be difficult to relocate, claim, and obtain this equipment for prompt use when the unit had withdrawn to come new bivouac point. There was, however, a further and even more serious weakness.in "the arrangement. Even assuming'the return of the division to its.original rest area, or the prompt receipt of its prosthetic, equipment'from a previous rest area, it was highly dubious if division dental personnel, just returned from active duty in the combat zone,.Y/ould still possess sufficient physical energy and zeal to set up arid maintain an effective field laboratory service. Rather it would seem reasonable to presume that dental officers and technicians would require just as adequate rest periods as other: officers and .men of. a division. Emphatic criticism of this double duty .aspect of field prosthetic service was made, it will be noted,, by the Dental Division of The Surgeon General’s Office at the- .outset of World War II. . - As for the equipment of the new laboratory, though it did represent a decided advance over World War I facili- ties, numerous deficiencies were noted as the years passed. Instead of an electric lathe the laboratory had been supplied with.a substitute standard hand lathe. , This enforced dependence -upon manual power for the polishing of dental replacements was a serious handicap involving considerable loss of time, 'It was estimated.that oh a busy day the full time of two enlisted men and several others, operating.in delays, would be required to provide the necessary power. As. a further complication, there was no stable element in the entire .assembly to which the hand’lathe could be attached. Other laboratory supply iteihs were also subsequently found to:.be unsatisfactory. The alcohol and kerosene burners which had been furnished had no protection against drafts and thus functioned at lowered efficiency a good portion of the time. The special type blowpipe provided could not be used effectively with the existing facilities. The casting machine was not equipped with a stable mounting and for that reason could not function in-the field. the quantity of supplies Yms discovered to be insufficient for performance of the services contemplated. As we shall see in a moment, by 1941 all of the above criticisms, along with several others, were being levelled against the Modified Portable Dental Laboratory. The Medical Department had improved on the World War I laboratory. The improvement, hov/ever, had not gone far enough. 410 II* Initiation of Development Project* F-2, A. Proposal of the Project* An unsuccessful attempt to obtain research funds for the development of a more modern type of field dental laboratory was made by the Dental Division of The Surgeon General’s Office in May, 1939.9 On 11 September 19A1* how- ever,1 the same request was reintroduced—this time with happier results. In this second petition to The Surgeon General, the Director of the Dental Division began by restating the primary aims of the field dental laboratory service. The merits of the old portable laboratory were then carefully weighed in the light of these objectives. Needless to say, by the time this examination had been concluded, an impressive case had been presented against the then standard field dental laboratory,10 To begin with, it was pointed out that approxi- mately one-half of one per cent of division personnel, when leaving the combat zone, required dental service involving the use of laboratory facilities. Unless, therefore, such services were available at the rest area or town in which a division was bivouacked, from 75 to 100 officers and enlisted men would have to be detached from their units for an indefinite period of time. To prevent this waste of manpower, field' dental laboratories, capable of moving quickly to any designated bivouac point and establishing station without delay, were essential. Such flexibility of movement, however, presupposed a high degree of opera- tional self-sufficiency. Measured by those standards, the old portable laboratory was sadly■deficient in several respects, . In the first place, its .stock of equipment was so inadequate-that-the laboratory could no longer meet ordinary demands for prosthetic service. Yet if this defect were, remedied, inclusion of the .laboratory in corps and division organization tables Would not be practicable, the quantity of prosthetic supplies and equipment necessary in. the light of modern developments in dental service and- present day Army requirements would constitute far too great a burden for forward units to transport. ■ . ' ■. . In the second place, packing,arrangements were unsatisfactory, -Medical Department chests or other types of separate locker boxes, or containers,, while entirely adequate for the temporary reception of instruments or supplies, could be'only too readily removed from the transporting Vehicle, This: was especially true- where, as in the present case, the operating unit did not possess its own integral transportation. It was also pointed out that in moving the laboratory: from-one station to.another considerable loss of time ¥/as involved" “in packing and unpack- ing equipmentstored .in.-laboratory chests.* . Finally, attention was called to.the present lack of permanently assigned personnel, .No specially..trained, staff, assigned' to ; to perform prosthetic construction alone, had been provided, , Instead, each laboratory was forced to depend upon regular divisional dental; personnel for ,its day-to-day operation, , The inefficiency of this arrangement, as well as the unfairness of its double duty aspects,.both from the standpoint of the dental officers and-technicians and their soldier patients, was commented upon,at some length. The possible alternatives to the present, portable- laboratory, the Dental Division continued, were mainly three in number. First, there was the fixed type; of dental labo- ratory installation located in a forward sector of the Army zone in the vicinity of the rest areas. The disadvantages of this alternative were clearly overriding. Corps and division personnel would be required to leave their units in order to obtain necessary prosthetic attention. Moreover, the demands of other units stationed in the Army zone for this type of service would invariably mean that the needs of the field force could not be adequately met. There remained the alternative, of developing some type of mobile unit, so .staffed and equipped that,: it could operate independently of.all other units for considerable periods of time. In. this category there were. two.possibili- ties: a two-vehicle trailer laboratory or a single-yehicle motorized laboratory. The former, it was pointed out, possessed certain serious disadvantages. For one thing, the trailer type of conveyance with its separate power truck unit was much less maneuverable in the traffic congestion of a Theater of Operations than a single, self-contained vehicle. Even more important, however, was the unavoidable danger ?/hich lay in the fact that the power unit was so readily detachable from Its trailer. In short, other authority in the Theater could easily appropriate the prime mover for its own use, and, once this had been done, the trailer laboratory was left completely immobilized. In the opinion of the Dental Division, therefore, * future field dental laboratories should be installed, in power- contained motorized vehicles.. The appropriation of such specialized units.for,,other purposes would be much less likely, and yet all of the advantages of the trailer type laboratory would be preserved.- .Dental supplies could be stored within. ■ the body of the vehicle and prosthetic equipment requiring a stable mounting could be properly bolted into place upon permanent bases, thereby greatly increasing operational efficiency and materially reducing the amount of.time custom- arily consumed in packing and unpacking,* With the enclosed interior of the truck affording ample protection, against inclement'weather and draft currents, casting,-- soldering,? and vulcanizing procedures could now be efficiently conducted at any time, whereas out in the open, under tentage,, or in open trucks such operations were often difficult in, the extreme, if not impossible*' . * •/.• -•V ' Having stated its case.for the development of a new mobile laboratory along the lines suggested, the ,Dental Divi-‘ sion concluded its memorandum to The Surgeon General, with the following concrete recommendations: .. " It is recommended that a new motorized field dental laboratory be developed, similar to the" field medical laboratory. It is further recommended that a dental laboratory section be added to the Medical Service (Army) as a part of the medical labo- ratory unit. The dental laboratory section to consist of four motorized field dental labora- tories; also that provision be made in the Tables of Organization, Medical, for a mobile field dental laboratory•and the necessary person nel therefor, same to be dtermined by a board of officers to consider this, plan* In line with its second recommendation, the Dental Division appended to its report, as Annex No. 1, a suggested last of essential laboratory equipment and a tentative person- nel table. B. Processink the Proposal. In the above project proposal the Dental Division had not explicitly stated that the new laboratory should be pro- vided with cabinets and shelving, instead of laboratory chests, for the storage" of all loose equipment and supplies. It had, however, recommended that the Army medical laboratory, which was equipped with storage cabinets, be taken as a model, And it had emphatically stated 'that the use of chests or any other type of separate packing, containers" for storage' or transporting purposes had been found,to be.highly unsatisfactory and-justifiable only on the grounds of temporary expediency. It might Also"be.observed,.parenthetically/ that : during this same merith/-September,. 19/1 > the. superiority; of the cabinet over the'chest method of packing was beipg vividly ■ demonstrated in the Louisiana field tests of the.mobile medi- v cal laboratory,3-3 , However, in forwarding the recommendations of the Dental Division through channels, one of the officers of the Plans and Training ■ Division, while approving initiation of the project, inserted a request that the old Dental Laboratory Chests #6l and #62-be retained.Favorable-action on this proviso might ?/ell have set-back .development work materially, for it was not until October, 194-2, with the, standardization of the Surgical Truck, that a formal precedent-existed'for the substitution of cabinets for chests in mobile medical units. Moreover, without the additional storage space which cabinets and shelving would provide, it is difficult to see how the limited facilities of the old portable dental laboratory could have been properly expanded, as, the Dental Division had strongly advocated, by the inclusion of a substantially more complete and modern line of prosthetic equipment and supplies, [ ■ ■■- Fortunately for the future course of the project, the above recommendation for retention of the laboratory chests as standard packing equipment was over-ruled by the Chief of the Plans and Training Division, The latter, in a memorandum, dated 17 September 194-1 and addressed to the Executive Officer of The Surgeon General’s Office, expressed himself unequivocally on the matter* It is believed that the dental equipment in Chests #6.1 and #62 is of questionable value to field units in that for a large part,of the time in a.theater it constitutes just so much excess baggage to be carried around with the unit. Furthermore ,its value is in many instances curtailed due to inadequate facilities (shelter, etc.) for setting up the" equipment -and suitable-, for its proper ■ . It is believed, .however,'if the Chests #6l • and #62 are eliminated, a. readjustment Of dental personnel is indicated. The personnel now avail- able to use these chests in the unit should be • reduced if and when the chests are no longer issued and the functions'and work contemplated are furnished by this mobile army dental •'labora- tory*16 The above memorandum appears to have ended,the con- troversy. All reference.to the chests was omitted from the tentative outline of military characteristics for the new labo- ratory, prepared by the Medical Department Technical Subcom- mittee on 12 November and this action1 was subsequently sustained by higher authority, ■ A year later, on 3 November 194-2, Medical Department Chests #61 and #62 were formally ;- deleted from the Tables of Basic Alloy/ance of all medical regiments and medical battalions, h ' With this1 problem settled, no further disagreements arose to delay the formal' processing of the project proposal. The Successive steps which were next taken, moreover, were in complete conformance ?;ith the procedural requirements of AR 850-25. On 17 November 194-1, the Medical Department Tech- nical Committee approved without modification the report of its Subcommittee, which included the following recommendations a. That a research project be established to develop a Mobile Dental Laboratory, b. That the following military characteristics for the subject project to be approved, 1. Dental Laboratory to be permanently installed in a motor vehicle adopted as standard by the Army, 2. This unit to be as -small as possible, consistent ?;ith adequate space and necessary equipment and working Space, 3. The equipment apparatus installed to .'.; be held to the absolute minimum fOr A the proper and appropriate function - of such a unit, all equipment to be' permanently installed,^ It will be noted that paragraph "b.l," ‘above stated that the new laboratory v;as to be installed in a motor vehicle "adopted as standard by the Array." This provision had,; and was to continue to have, a rather interesting history. During the late summer of 1911, the Dental Division had undertaken to dis- cover for itself a vehicle which would be suitable for conver- sion into a mobile dental laboratory. First, blueprints of a model designed by the Ritter Dental Manufacturing Company of’ Rochester, New York, were examined. These were, ho?;ever, considered too elaborate.^ Inquiry was then made of the Office of the Chief of Ordnance regarding the type of chassis and body currently being used for Ordnance Technical Trucks,Ordnance replied on 29 August 1911 that its technical trucks were ljr~3 ton, l&U models, consisting of a bus-type body manufactured by Wayne Works Incorporated, and a standard Quartermaster chassis -manufactured by General Motors Corporation. Specifications and photographs of the vehicle were inclosed. The cost of the' truck, it was stated, was approximately $2,200; •••••■' v ■ ■ • The Dental Division Was favorably impressed;';. 1 especially since there was already some evidence that these Vehicles could be used for field dental laboratories. On file in The Surgeon'General1s Office were photographs-, taken in. 1939, which showed similar machine shop trucks- in which shapers, drill presses, and arbor presses had been provisionally instal- While this unit had never been standardized, visually it seemed quite promising. Accordingly, in its formal report to 'The Surgeon General requesting project initiation, frequent reference was made by the Dental Division to the ‘suitability of the Ordnance Shop truck as a dental laboratory vehicle.^4 : While these actions on the part of the Dental Divi- sion were, in a sense, something, of an invasion of purely research and development territory, no serious complications resulted. The Chief of the Plans and Operations Division in forwarding the recommendations of the Dental Division, sug- gested a considerably more general statement of vehicle speci- and in the final formulation of military charac- teristics by the Medical Department Technical Subcommittee, 6 this provision was so liberally phrased that research and development personnel found no difficulty in substituting a completely different type of Ordnance truck, both chassis and body, when the occasion arose* Returning now to the administrative processing of Development Project9 F-24. on IB November 194-1, initiation data was forwarded by The Surgeon Generali Office to The Adjutant General, with the following requests: (l) that the Medical Department be authorized to establish a formal project to develop a mobile dental laboratory; (2) that the proposed military characteristics be approved; (3) that -$3,000 be allocated from current research funds to the Medical Department Equipment Laboratory, Carlisle Barracks, Pennsylvania, for carrying on the necessary development work,^ On 27 November 194-1, • approval of the above requests was granted by The Adjutant General.2B The Equipment Labora- tory was promptly notified of this action and by December 194-1, preliminary development activity was well under way.^9 III* Development Phase. A, Construction of the. Laborator' Because of. the extensive investigation and experimen- tation which had already been, conducted by Equipment laboratory personnel in connection with the Mobile Surgical Hospital, the Army Medical Laboratory,, and the Armored Force Surgical Truck, and because of the data which had been collected by the Dental Division regarding Ordnance Technical Trucks, there was little need in the present instance- for any elaborate study of research possibilities. Bus-type, trailerand semi-trailer laboratories had already been carefully examined, service tested, and found impracticable for overseas use,- Thus the choice of a suitable dental laboratory vehicle had been automatically narrowed to: (l) the ton, AxA, Ordnance Technical Truck, recommended 416 by the Dental Division, and (2) the ton, 6x6, cargo truck, with special van body, which had been used in the development of a surgical truck for the Armored Forces. While the pilot model of the new surgical truck had not yet been completed, it is evident .that the, Equipment Labo- ratory was already thinking Seriously of using some modifica- tion of this vehicle instead of the OrdnanceaTechnical Truck, for the mobile dental laboratory project. On B December 194-1* Lieutenant Colonel Neal A. Harper, a dental .corps officer . stationed at Carlisle Barracks, wrote as follows to the.Chief of the Dental Division in Washington, regarding a recent con- ference he had had with the staff at the Equipment Laboratory, With regard to the mobile field dental , laboratories, I have had conversations with Colonel Dabney and his engineer, Mr, Taylor. Both of these gentlemen are anxious that I withhold any plans until the arrival of a mobile surgical unit expected in about a week.30 The definite selection, so far as the Equipment Laboratory was concerned, of the 2^-ton, 6x6, van body truck as the vehicle to be used in the current experimentation appears to have been made within a month after the above date, for in the early part of January consultation was held with members of the dental staff of the Medical Field Service School and with the Post Dental Surgeon at Carlisle Barracks regarding the design and arrangement of interior equipment to be installed in this van body truck,31 A tentative blueprint, based upon the interior dimensions of the multiple purpose van body, was then prepared and on 13 January 194-2 .was submitted to the Post Dental Surgeon, who thereupon forwarded the design to the Chief of the Dental Division, Office of The Surgeon General for comment,3^ If, at this point, the Dental Division had any reservations regarding the suitability of the vehicle selected, it does not'appear to have made that fact known. As far as can be ascertained from the data at hand, no correspondence passed between the Dental Division dnd the Equipment laboratory from the middle of January to. the middle of'March, .194-2. Finally, on IB March 1942, complete drawings and specifications, of the new mobile dental unit were forwarded', by the -Equipment Labora- tory to The SurgeonGeneral with- the request -that negotiations be- opened as soon as possible for the purchase of a pilot model.33 • ■ 'This latter request apparently- injected the proper note of urgency into the proceedings. On 20..April 1912, the Dental Division returned the preliminary plans data with instructions that the Equipment Laboratory make certain minor changes. No reference was made to the 4xU technical truck which,, that office had previously recommended, 34- Drawings and specifications were quickly revised by the Laboratory to meet the objections stated, and three days later were resub- mitted for final approval.35 During the months of May, June, and July, no further action was taken by the Equipment Laboratory on Development Project. While there is some indication that an effort was made by The Surgeon General’s Office in the latter part of April, 194-2, to have a pilot model dental laboratory custom built by the Holabird Quartermaster Depot,37 no such vehicle was produced. It was not, in fact, until August, 194-2, that a suitable experimental model was obtained and the necessary conversion work initiated. This three-month delay in beginning actual develop- ment work v/ould seem to be attributable largely to two factors, neither of which reflected upon either the technical or admin- istrative efficiency of Medical Department personnel. The first factor was that civilian as well as military facilities for vehicle production wrere being taxed to the utmost with war orders. As we have already seen,in Chapter V, the- possibility of, placing'a single-unit experimental order at this particular time was virtually out of the question. Because of this production’bottleneck, the second factor—the "A” priority of the Armored Force surgical truck project—assumed an almost overriding importance. ;The efforts of the Equipment Laboratory and The'Surgeon General’s Office simply had to be concentrated on, the procurement pf a pilot model surgical truck, for which there was a demand of the most urgent nature. Even with this concerted-,pressure, it should be observed, it vms not until -18 'July *1942 that this experimental truck was delivered to Carlisle Barracks, Since cabinets had1 already .been installed in'the surgical, truck at the factory, all that remained to be done on this project was- to pack in the necessary equipment,which was all on hand, and ship the vehicle to Fbrt Knox,'Kentucky for an accelerated service test. Inasmuch as, in view of the urgency of the matter, only a brief field test was contemplated, an early return of the surgical truck to Carlisle Barracks was expectedNeedless .to say, the possibilities which this situation'opened up for Development Project. F-24.. now hopeless- ly stalled for lack of an experimental vehicle, were: not lost on research and development personnel, ..; On 3 August 194-2> the. Director of the Medical Depart- ment Equipment laboratory, wrote as folloYrs to The Surgeon General’s Offices 2, The Equipment Laboratory has on hand the pilot model, of the Mobile Surgical Truck of which . twenty-four,(24) additional units are under pro- curement for.the armored force. The chassis and ■ body of this,truck is identical with the vehicle intended, for use as a-. Mobile Dental Laboratory, 3, By installing the necessary cabinets and -.interior equipment as indicated on Equipment Laboratory Specification No, 60 (Interior Equip- ment for Medical Department Dental Laboratory, Mobile), this Surgical Truck can be converted to. a pilot model Mobile Dental Laboratory. ‘This, work can be done in the Equipment Laboratory shops. Funds for procurement of materials are, available under Project F-24, Mobile Dental Laboratory, • 4, Recommendations%' Unless the pilot model Surgical Truck now at the Equipment Labo- ... ratory is to be consigned to a.field organifca- tion for use as a Surgical Truck, authority is ; requested to convert it into a pilot model ,. Mobile Dental Laboratory,39 .. This requested authority was granted by The. Surgeon' ' General’s Office on 5 August 1942.40 As the surgical truck had not yet been field tested, it was still necessary.to wait several weeks before beginning the job of -actual conversion, but by the end of August the pilot model had been returned from Fort Knox, Kentucky, and dismantling operations were soon begun. Conversion of the truck to a mobile dental labo- ratory was not, however, hn altogether simple matter. An extra window had to be cut on each side of the truck, and a suitably sized window assembly, complete with blackout curtains, installed in the rear of the body. .The following pieces of equipment had to be removed from the interior of the truck; all cabinets, (including sink cabinet)> fire extinguisher, 5-gallon water tank,, center operating lighty and parcel racks (to be reinstated later). Complete rewiring to suit the new lighting arrangements was necessaryi wheel- housings had to be cut down in front and rear in order to accommodate the new chair storage compartments* Piping between the 50-gallon and 5-gallon tanks, and to the sink faucets, > had also to be changed to conform to' the new drawings,41 Before conversion work could get fully under way, the additional window assemblies which were needed for the . laboratory had to be obtained. These were ordered at an . early date from Krieger Steel Sections, Incorporated, Long - . Island City, New York, a, firm already busily:engaged in war work, Apparently this relatively small order did not receive a great deal of attention, for it wab.December before 419 the window assemblies were finally This was but one instance of a type of delay which deferred completion of the pilot model dental laboratory until February, 1943. So far as the task of physical conversion was concerned, accord- ing to Equipment Laboratory estimates, all shop work on the vehicle could have been finished before the close of September,4# The remaining months were,.therefore,- spent largely in marking time—waiting.for the arrival of interior equipment and supplies that had been requisitioned as ear-ly as July and August of 1942. The procurement difficulties of Development Project. F-24—and these were the only serious stumbling, blocks encountered in the construction stage--can be traced back to the spring of 194-2. On 23 April 1942, the day. when the. Equip- ment Laboratory had resubmitted- its revised drawings and specifications of the. proposed laboratory vehicle, it explic- itly requested that the Dental Division of The Surgeon-General’s Office requisition at the earliest possible moment all supplies and equipment to, be, installed in the truck and have these'5 items shipped direct to the Equipment Laboratory at Carlisle,45 This request for central procurement had been made because.the Medi- cal Department Equipment Laboratory, a Class 4 Installation, had in the past experienced extremely serious delays in obtain- ing requisitioned equipment for its. experimental models. As we have seen in' Chapter VI, decentralized procurement had become one of the most time-consuming aspects of the research and development process,.' .-:- It was soon obvious, however, that the mere transfer of procurement responsibility from a Glass 4 installation:to headquarters of the technical service concerned was no guaran- ' tee in itself that a conspiculously more efficient.job would be done. Despite the Equipment Laboratory's urgent, request; for action, it was nearly three months before a detailed equip- ment list had been prepared by the Dental Division and> submit- " ted for clearance purposes to the Finance arid Supply Division of The Surgeon .General’s It was not, moreover, until 28 July 1942 that-the purchase order for’-this material (Surgeon General’s Office #91508) had formally entered supply channels,4-Y As might, have been anticipated, the. processing of this requisition by the medical depots was painfully slow. After months of visiting, telegrams.were sent by the Equipment Laboratory both to .the Savannah, Georgia and the Binghamton,- New York supply depots, in an attempt to expedite delivery of the equipment items.still unreceived* The answers were almost identical; ’’Shipment, will be made as soon as stock becomes * V 1 The new window assemblies for the laboratory truck were finally delivered by Krieger Steel Sections, Incorporated, in the early part of December,' 1942. Conversion work was then resumed and, by 29 December, 1942, body construction had been 420 completed and. all equipment on hand had been ins tailed, 4-9 The transformation .of the surgical truck into■ a mobile dental laboratory was now almost an accomplished;fact. The interior equipment of the surgical truck had.been torn out, wheel housings had been cut down, additional window . openings had been made,and the new Krieger frames mounted into position. The laboratory had been completely rewired, plumbing connections altered, and water heating and air ■circulating units: installed. Specially designed storage cabinets had been moved in and their table top coverings fitted into place. The sink cabinet, the parcel rack, and the '50-gallon water tank had been reinstalled in their new positions against the forward wall, bracket clamps and shields had been inserted for the flexible side wall lamps, and over- head lights',"widely spaced, had been fastened into position on the ceiling'of the truck,50 ■With the ■ exception", of a casting machine and lathe, which had not yet arrived, the dental laboratory was now completed. Early in January, 194-3, a representative of the Dental Division, Office' of The Surgeon General, visited Car- lisle Barracks and'inspected the new pilot model. He was advised at that time by Equipment Laboratory personnel that the above items had-not been received,.: and. was. requested to aid in expediting their delivery,51 • It was.p however, another thirty days before'the needed equipment items■were obtained. After that, completion of the•laboratory was.only/a matter of hours, and, bn'8 February 1943, The Surgeon General'was •• formally notified that the pilot model mobile' dental labora- tory was ready for shipment,52 ; ■ ■• . B. Testing Phase. The pilot model mobile dental laboratory was driven to Washington, D.C, in the early part of February, 1943,: end was formally" presented to the Medical Department by the Gold and Platinum Metals in Dentistry at a short ceremony held at The Surgeon General's Office,53 This manufacturers associ- ation had donated some, eight thousand dollars; for the dental laboratory, program. 54- Unfortunately this generous gift, which had been placed in escrow with the Treasury Department in November, 194-2,55 had not been available in time to materially expedite the project. This public spirited action by the'Gold and Platinum Metals in Dentistry, however, pointed the way to a new'type of industrial-military cooperation. Timely donations of money or, within the- limits•of priority regulations, needed supplies, equipment, or rolling stock, could greatly accelerate the process of wartime research and development. Certainly much precious time could have been saved in the subject instance if such outside collaboration had been available from the start. After a preliminary inspection, the dental labora- tory unit was returned to Carlisle Barracks and, on 12 February 194-3, The Surgeon General’s Office requested Army Ground Forces to make arrangements for a service test of the new vehicle at the earliest practicable date,56 This urgent proposal, unfortunately, was not translated into action for nearly four weeks. By 6 March 194-3, the basic communication had just reached Army War College which advised that the Dental Surgeon, Second Army, was familiar with the laboratory in question and would accordingly be requested to select the particular Second Army unit to conduct the test.57 On 16>March 194-3, Headquarters, Second Army, Memphis, Tennessee, replied that the-First Convalescent Hospital,.; ■ scheduled to arrive at the Tennessee maneuver area on 21 April 194-3, would be designated as the testing agency for the new laboratory.5$ By 3 April 194-3, this information was on its way from The Surgeon General’s Office to the Medical Depart- ment-Equipment Laboratory,59 Qn B April 194-3—two months to the day Since the completion of the dental laboratory— the pilot model was shipped to Camp Forest, Tennessee, for service teSti60 Another month elapsed and then actual field testing was finally begun. From 16.May to 19 June, 194-3, the: pilot model mobile dental laboratory was given intensive operational tests throughout the Tennessee Maneuver: Area by. the First Conval- escent'Hospital, Differing types of troopi units were served for periods ranging'from three to ten;days; changes of. location were' frequent, and- the tests' included-' operations' under blackout conditions. During this four week.period,.laboratory personnel completed thirty-five full dentures, one hundred and fourteen partial dentures, and thirteen repair cases. Immediately upon completion of the service tests, a detailed report of findings was prepared by the testing agency. This was forv/arded to The Surgeon, Second Army, on 22 June 19-43.61 The field test report submitted by the First Conval- escent Hospital was unique in one respect. It included, along with the usual list of recommended changes, a detailed enumer- ation of the positive features of the new dental laboratory. The 2|--ton, 6x6, van body truck was praised, as an extremely satisfactory laboratory vehicle for field use.,: The heating, ■ plumbing, and ventilating units with which the laboratory had been equipped were- stated to have performed efficiently during the tests| ceiling and side Wall -lamps were described as well placed and adequate for proper illumination-;' the dual, power system was regarded as very satisfactory. As for supply stor- age space, the testing agency reported that the eighteen bench drawers were well placed and of suitable size, that the three- shelved closet beneath the sink was quite adequate, for larger supplies, and that the filing cabinets located in the rear of the laboratory were entirely adequate for records, gowns,' and small supplies. Miscellaneous items such as> the. dental engine,-acetylene tanks, plaster bins, sirikyi-'work benches, : and curtained windows were likewise favorably noted,62 ' • The‘changes recommended by the testing agency were, without exception,/ of a minor character. The pilot model mobile dental laboratory could, it was:-conceded, function very satis- factorily as originally equipped, but there were not enough expendable items included to permit operation for more than a few days without replenishing the stock. Accordingly it was recommended: :(l) -that no items be deleted from present pack- ing lists $ (2) that certain items be added to present lists; (3) that the quantities specified for certain expendable and nonexpendable--supplies on present packing lists, be .revised upward. A' consolidated list of equipment and supplies, incorporating all the above changes, was attached to the report as Inclosure. No. :yj& As for changes in the design or construction of the interior of the laboratory, the following were suggested; (l) the addition of two shallow drawers and two shelves for special storage purposes; (2) the addition of a-rear wall exhaus't fan for blackout operations; (3) slight reduction in width of work benches to provide a more adequate aisle space; (l) removal of water level gauge, now directly over outer edge of sink, to a position on right wall to prevent persons using sink from striking their heads on the gauge; (5) insertion of an elbow on the terminal end of the sink drain pipe so that it would no longer drain directly on the muffler The report of the First Convalescent Hospital, highly favorable even in view of its recommendations for changes, was'enthusiastically seconded by the Dental Surgeon, Second Array, who added the following commendations This pilot model of the laboratory is excel- lent in design and, with exceptions enumerated in basic letter, has all the facilities needed for the efficient operation in a maneuver area or Theater of Operations. It is believed that the changes recommended in basic letter will increase operational efficiency of the,laboratory when operating during inclement weather or under black- out conditions. This unit equipment is. the most practical Mobile Dental Laboratory ever observed, in operation by the Second Army Dental Surgeon, It has been a great asset to the dental service of Second Array in furnishing necessary dental laboratory service to the personnel in the maneuver, area. - This service has.eliminated the , necessity of ’returning patients tottheir home station for reconstruction of dentures, thus’ preventing loss of valuable time from field training. , . .63 It was accordingly 'recommended; (l) that the Mobile Dental Laboratory be adopted-, standardized, and procured'for uSe in Theaters of Operation where fixed dental installations v/ere not available5 and (2) that the pilot model ?/hich had.Just been tested be continued‘in use in maneuver and training areas in the Zone of the Interior for rendering field dental laboratory service.66 ' , . This latter’ recommendation was obligingly narrowed- by Headquarters, Second Army to the following; 2, Due to the large number of Second Army personnel in the Tennessee. Maneuver Area requir- ing dental prosthesis, who would otherwise lose1 valuable, training by forced absence from the :V' Maneuver Area, it is recommended that the Second Army be authorized to retain the•Mobile Dental laboratory .during the entire Maneuver period’, for the continuance of this service.67* ' ; ... Thus fareverything was progressing smoothly. The First Convalescent hospital has rendered its .test report ; promptly and had made clear its over-all approval of the Labo- ratory, The report had been forwarded up through channels as far as Headquarters of the Second Army in less than a week’s time, and had been favorably indorsed by the two echelons immediately above the testing agency. Manifestly, Judging from the correspondence thus far (and especially -in view of the proposed retention of the pilot model laboratory by Second Army) it was the opinion of those who had seen the laboratory in operation that the suggested modifications could be readily effected simply(by appropriate changes in specifica- tions and the preparation of a new equipment list. This vie?/ was not, however, shared by Army War College v/hich, as representative of Army Ground Forces, v/as the next office to receive the test report and its allied indorsements. Replying on 11 July 194-3, two v/eeks after Headquarters, Second Army, had made its observations, Army War College conditioned its approval of the new dental laboratory upon the carrying out of the follov/ingj 2, Due to the large number of changes recommended for modification of the Mobile Dental • Laboratory, it is believed that this unit should be field tested under the supervision of the same testing officer, after modifications are completed. 3. This Headquarters approves the modifi- cation and inclosures thereto and requests that the equipment, when modified, be service tested ..in the maneuver area for a period of not less . than one month before the equipment is adopted and standardized,^ Had the changes recommended by the.testing agency- been of such a nature that the operational:soundness1 of the new laboratory, would hot have been clearly established until an actual physical modification of the vehicle'had been made, the above proposal would have had an evident justification. As it was, however,-the request seemed impractical. The dental laboratory project had already been so critically delayed, that it would be well into 19A4 before the first factory models arrived overseas. To postpone standardization of the laboratory for several months more—for the sole purpose of observing the operational effect of a 5-inch narrowing of work benches, the addition of a rear wall exhaust fan, or the inclusion of more complete equipment and supplies for which there was already ample storage space—scarcely seemed to be a desirable course of action at this late stage. Consequently, Array Ground Forces* proposal was permitted to die of inattention. On 15 July 1943, Headquarters, Army Service Forces, in forwarding the.foregoing test report and indorsements to The Surgeon General, merely stated that the modifications recommended in basic letter and first indorsement were approved. No reference was made to the third indorsement submitted by Army War College,69 Taking its cue, The Surgeon General’s Office wrote the Equipment Laboratory, on 27 July 1943, to submit revised specifications and drawings covering the changes suggested by the First Convalescent Hospital, The Laboratory was informed that the pilot model would remain with the Second Array for further service during maneuvers.7® On the same date the Plans Division of The Surgeon General’s Office forwarded copies of the test report and inclosureS; to the Dental Division, and requested that' in line with.the trecommendations contained therein a new consolidated equipment.list be prepared in time for submission to the Medical Department'.Technical Com- mittee at its next meeting’* By 9 August 1943, all revisions o£ .specifications, drawings, and equipment list had been, The; mobile dental laboratory ?;as now ready for standardization. Interior and exterior yiej/s of the-new-'laboratory (see Figs, 27 and 2B) are shown bn the pages immediately; ' following, •. . 425 IV Standardization and Procurement, A. Standardization Proceedings. • In processing the hew mobile dental laboratory for standardization, excellent coordination was maintained within The Surgeon General's Office between that office and Army Ground Forces. On 14. August 194-3, the Director of the Dental Division was notified that standardization of the mobile dental laboratory was on the agenda-for the next meeting of the Medical Department Technical Subcommittee and that, accordingly, the attendance of a representative of.his Division was desired. At the same time chassis'and van body whereas 37 Medical Depot Companies would- be requiredythe~latter ‘number to be increased to 43 before:the close; of..thevyear.t -In terms of immediate requirements for 'the: new;:mobile laboratory,.- there- fore, only 4 (l laboratory vehicle -per. Medical Department Service Organization) were authorized-for Communications Zone operation, whereas 74 (2.laboratory vehicles-per'Medical Depot Company) were authorized for use- in Combat Zones * While the foregoing discussions were being carried forward by the Dental Division in an attempt to establish a more realistic requirements figure for the mobile dental laboratory an equally determined effort was being made by other Divisions of The Surgeon General’s-. •Office to get at least a minimum number of the new units into the field as quickly as possible. On 19 October 1943—less than a month after request for standardization of the new laboratory had been approved by higher authority—The Surgeon General’s Office requested permission of the Commanding General, Army Service Forces, to divert 19 trucks from the 1943 require- ments for the Truck, Surgical, so that these vehicles could be converted immediately into dental laboratory units,89 429 This'authority was granted within a week,90 but the necessity of preparing .a fairly detailed plain covering the mechanics of the conversion work to be undertaken delayed matters considerably** It was not in fact until 24 November. 1943, when a conference was held in New York City betweeh representatives of the Equipment Laboratory and' the Army Medical Purchasing Office, that all conversion details were finally settled.91 Inasmuch as requisitioning procedures consumed another two weeks* time, it v/as not until'7 December 1943 that a formal purchase order for the 19 dental laboratory trucks had cleared Army Medical Purchasing Office.92 Deliveries on this initial order were widely spaced. While eleven of the dental laboratory vehicles were delivered on 3 March 1944, the remaining eight did not reach medical depots until 25 March 1945, over a year later. Meanwhile, however, orders were placed for the direct construction of additional dental laboratory trucks (no conversion involved). By 31 October 1945, of the grand total of 107 vehicles which had been ordered by the Medical Department, all had been completed by the factory and shipped to designated supply depots in the Zone of the Interior *93 ■. Actual overseas shipment of the Mobile Dental Laboratory was somewhat slow in getting started. In the South Pacific, for example, the first two units to be received- one. at' Guadalcanal and a second at Esprit de Santos in the New Hebrides--did not arrive until 31 October 1944* The laboratory truck at Esprit de Santos, the first to go into operation in this area, was placed in service in the early part of November 1944. This, it may be observed, was virtually 12 months after standardization of the truck had been accomplished.94 An idea of the distribution of the mobile dental laboratory among the various Theaters of Operation can be gained from the following table,95 Truck, 2-y-Ton, 6x6, Laboratory, Dental (Item No. 9958.700) •; ■ Vehicles Authorized by Theater of Operation 31 Dec. 1944 Pacific Ocean Area 5 North African Theater (USA) 2 ; . China-Burma-India .: ■ ;■ * 4 South Pacific Base Command .... . 4 European Theater of Operations 30 Southwest Pacific Area :: 15 . TOTAL ■ ■ 6o ■ . 430 it will be noted that 50 per cent of the vehicles authorized for 1944 were. .scheduled to go to the European Theater, 25 per cent were•earmarked for the Southwest Pacific Area, with the remaining 25 per cent widely scattered among all other active theaters.. •; This general distribution pattern was maintained'.without significant■change in the estimates prepared tor 1945.^ C/' Pro j ect ■ Termination. Standardization of,the dental laboratory having been completed on 23 September 1943,- in its progress report .for: October the Medical Department Equipment .Laboratory requested that Development Project, -F-24 be dropped from the active" list,94 ! Since there was no further experimental work to be accomplished and since procurement action was now being initiated, authority to terminate the project was granted"by The Surgeon General’s Office on 14,November 1943.9^ V, _ Conclusion. A. Physical Evaluation. Aside from the addition to unit' equipment, in 194-5,. of a 1-ton Ordnance trailer to provide extra cargo space for the more bulky equipment items, such as portable power units,99 no major change'was'made in the mobile dental laboratory following its standardization in July, 1943. As for the trailer addition, the same change, it will be recalled, had been made in the case of the Army Medical Laboratory.-*- Turning now to a comparison of the mobile, dental laboratory -with the 1-chest unit of World War I and the 2-chest portable laboratory of the thirties, the superiority of the new model on almost every.count was evident at a glance* The new laboratory.was vastly better equipped, both quantitatively and qualitatively. It possessed its own integral-transportation, and hence could be moved readily from one location to another. Self-sufficient, from both a' professional and operational.Vstandpoint, the laboratory was ;able';to function with"'efficiency at any'hour of the day or nighty in the most inclement ..weather, and under .conditions of complete'’blackout, ■ • ’ . ' ’ • • -. Because of these many advantages the new mobile dental laboratory was, 'from a tactical viewpoint, an almost revolutionary improvement over everything that had gone before. As ¥/as pointed out in the December, 1943 issue of 431 The Bulletin of the U. S. Army Medical Department: . , .This laboratory will permit the making of,new prosthetic appliances (dentures) or the repair of such in any of the forward areas of combat. Troops needing new dentures, the result of extractions or repairs, are at present evacuated to some fixed installation in the rear where laboratory facilities are available. The new mobile laboratory will eliminate the necessity for such evacuation and thereby contribute immeasurably to the war effort,^ .The acid test, of course, was the reaction of using agencies. In the.case of the mobile dental laboratory, the ’’field reaction” appears thus far to have been uniformly ■favorable. As we have already seen, the First Convalescent Hospital, after subjecting the laboratory to constant and rigorous testing over an extended maneuver period,' was greatly ■ impressed with the unit’s over-all efficiency% and this evaluation was substantiated by the Dental Surgeon of the Second Army and by Headquarters, Second Excellent reports have since been received from the Southwest Pacific and other overseas installations,4- Tli' The mobile dental laboratory, it would appear from the evidence at hand, has been an outstanding-success and has more than, fulfilled the expectations of those officers who. in 1939. and 1.941 so strongly urged its development. ;• B,• Administrative Aspects, In many respects the administrative performance of Medical Department personnel during the course of Development Project, F-2A was a distinct improvement over previous efforts—especially those described in the preceding chapter. For one thing, a balanced and well . relationship was maintained throughout' the life of the project between the Dental Division of The Surgeon General’s Office and,the Medical Department'Equipment laboratory. Aside, from one three-month delay which occurred at the out- set (submission of an initial equipment list by the Dental , Division), there were none of the difficulties which had so •repeatedly deadlocked the Equipment Laboratory and Army- Medical.,School .during the development of the Army medical laboratory. There were no prolonged controversies over minute details of interior truck design, no unexpected unilateral revisions of equipment lists, and no laSt-minute requests for the remodelling of cabinets and work benches i , . already permanently In short, instead of a spirit 432 of antagonism, a definite spirit of cooperation—certainly an essential; ingredient in any successful administrative relationship—constantly prevailed between the Dental Division and the Equipment Laboratory, ' " . The processing activities carried on by the Plans Division, the Subcommittee of the Medical Department Tech- nical Committee, and the Medical Department Technical Com- mittee itself, were likewise efficiently handled for the most part,. From the time project initiatioh was first requested bjr the Dental Division to final authorization by the Adjutant General, only months elapsed.- Less than a month was required to process the completed dental labora- tory for standardization. This 34-month total for these two major procedural actions was virtually a record minimum. It should be noted, moreover, that complete‘conformance with the provisions of AR 850-25 was maintained in both instances. There was one administrative activity, however, in which a definite breakdovra had occurred. This was the . procurement of materiel and supplies essential for experi- mentation, As we have seen, all substantive research and .development activity was held to a stand-by basis for over •twelve months because of: (l) a three-month delay in obtaining a suitable experimental vehiclej followed by (2) a‘nine-month delay in the delivery of heeded equipment and supplies. The basic causes of this excessive slowness in procurement are not, to assess, A deliber- ate attempt had been made’to-avoid--the‘requititioning dif- flCiqlties ,encountered,in previous projects by adopting a centralized, instead of a decentralized, purchasing system. Clearly this reform, by,itself,'had/hot/beeh'enough to solve the problem, ...". /.// * /, ' " ‘ Though, they at .best offer only a partial explana- tion of these serious procurement delays, three facts emerge from the data at hand.as particularly relevant. First, there was a definite, scarcity of dental prosthetic supplies and equipment .in the various, medical depots. Second, these research .and development/purchase orders had been accorded no special priority ratings. . Third, though its procurement position was stronger than that' of the Equipment Laboratory, The-. Surgeon .General’s Office, for reasons not apparent from the /data, had failed to exploit to the full its role as expediter. The evidence does not indicate that a systematic attempt ?/as made to follow up requisitions closely, to canvass additional medical depots when stocks in nearby depots were found to be exhausted, or to ascertain the reasons for unexplained slow deliveries. Such telegraphic follow-ups as were made, judging from all filed project data, were made by Equipment Laboratory personnel at Car- lisle Barracks, . . ..... A final word should be said regarding inter-Service coordination. Army Ground Forces’ delay in replying to The Surgeon General’s request for designation of a field testing agency has already been commented upon in this study. In contrast, the highly expeditious performance of the Second Army, and in particular•the First Convalescent Hospital, is deserving of special mention. Only a' minimum amount’ of time elapsed' between the arrival, of the pilot model mobile dental laboratory at the Tennessee Maneuver Area and the subjection to-official service tests.,,On the third day following com- pile t ion of these tests, a complete report of findings was prepared by the First Convalescent Hospital. Within a Yjeek this document had been read, carefully, commented upon, and forwarded, first by the Dental Surgeon, Second Army, and then by Headquarters, Second Army. A more intensive study of the post-developmental procurement aspects of this project would have to be made before a satisfactory explanation could be ventured for the delays vdiich -occurred between the time vehicle orders were first placed with the Ordnance Department and final delivery overseas of the completed laboratory assemblies, . -Stiffice it to say that approximately twelve months elapsed between standardization of the mobile dental laboratory and quantity shipment of the item to active theaters, ■. ■ C, .The Time Element. Considered purely from the' standpoint of its battle utility during World War II, the mobile> dental laboratory -saw at least as much actual service overseas as the mobile medical laboratory. In some instances, it appears to have seen more. The Array medical laboratory was not shipped to overseas theaters until the first quarter of 1945, whereas, as *we have seen, the dental laboratory truck was in use in certain areas of the South Pacific as early as November, In short, considering that the subject project had been initiated at a much later date than the medical laboratory project, the showing in the present instance was not unimpressive. It should be pointed out, in closing, that such-"' delays as occurred during the course of Development project, occurred mainly in the fields of procurement: pre- and post-developmental,. Personnel charged with the substantive aspects of research and development had acquitted themselves exceptionally Well, the.speed with which the pilot model surgical truck, once it was available, had been converted,; ’ "M into a dental- laboratory truck, and the speed with which cabinets, window frames, power facilities, equipment and supplies had been installed, once they had been delivered 434 to the Equipment Laboratory, was little short of phenomenal. Less than 60 man-days of work appears to have been necessary for the completion of all of these activities. In com- parison to previous projects this record v/as outstanding. 435 FOOTNOTES TO CHAPTER VII Report of The Surgeon General. U.S. Army, 1919, Vol• II, p. 1303. 2Ibid. 3Ibid., p. 1301. . p. 1303. 5 Ibid,, pp. 1303-1304. 6 Annual Report of The Surgeon General. U.S. Army. 1920, p. 303. 7 Annual Report of The Surgeon General. U.S. Army. 1921, p. 122, 8 Memo, to T.S.G., fr. Dental Div., S.G.O., 11 Sep, 1941* subject: ’’Field Dental Laboratory” (M.D.E.L.). The dis- cussion of this laboratory in the pages ¥i/hich follow is based largely upon the above memorandum. 9Ibid. 10_, . , Ibid. 11 Ibid. 12 Ibid., Annex No. 1. 13 Supra. p, 373. to Dir., Plans and Training Div,, S.G.O., fr. Capt, Page, Plans and Training Div,, 1$ Sep. 1941 (Dental Div., S.G.O,), 13Supra, p. 325. 16 Memo, to Exec. Officer, S.G.C., fr, Ghf,, Plans and Training Div., 17 Sep. 1941 (Dental Div,, S.G.O,). 436 17 Ltr..to fr. Medical Dept, Technical Subcommittee, 23 Aug, 194-11 subject: ■ "Laboratory, ■Dental,. Mobilen O' (A.M.R. & D. Bd.). 18 ' ’ ‘; • ’ ‘' • • • ' v.fj . History of The Army Dental Corps: Equipment 'and Supply. ■ 1941-1942-1943. prepared by Dental Div., S.G.O,,' draft copy, p; 15 (Hist, Div,, S.G.O,), 19 " • ; Min, of M.D.T.C., Meeting No, 3-, 17 Nov, 1941, pp. 9-10 (Hist, Div., S.G.O.). For'text 'of-military characteristics see: Itr. to M.D.T.C., fr. Medical Dept, Technical Sub-Committee,.23 Aug. 19435 ■ subject: ’’Laboratory, Dental, Mobile” (A.M.R, &”D. Bd,). 20 ’ . Blueprint #26303, Mobile Dental- Laboratory3 prepared by Ritter Dental Mfg,, Co., Inc,, Rochester, N,Y. (Dental Div,, S.G.O.). For Dental Division comment on above', see draft copy of memo, to T.S.G., fr. Dental Div., 20 Aug, 1941, subject* "Field Dental:Laboratories," Annex 3 (Dental Div., S.G.O.), 21 V Memo, notes of Lt. Col. K.H. Metz, 27' Aug, 1941 (Dental Div,, S.G.O,),. .. 22 - f-- ... ., Memo, to Dental Divi.yS,G,0., fr. Office of Chf,.of Ordnance, 29 Aug, 1941| subject: "i-J-ton G.M.Cy: Ordnance.technical Trucks" (Dental Div*,- S ,G,0.)*.; . , ’ ‘ f; ) 23 • \ ‘ ■ ... . 4,14 -.' Ordnance Department Photographs Nos. 37572 and 375*74, "Ordnance . Machine. SHop ’Truck,*". 9 .Jan. .1939.. (Dental Div., S ,G. 0^,)„ 24 ’ r»T See n, 8, p, 436. 25 - See n, 16, p. 436, 26 See n. 17, above. 27 Ltr, to T.A.G., fr. S.G.O,, 18 Nov. 1941| subject: "Research Project - Mobile Dental Laboratory" (A.M.R, & D, Bd.), 28 1st Ind, to S.G.O,, fr. T.A.G., 27 Nov. 194-1| basic: see n. 27, above (A.M.R. & D. Bd.), 437 29 Monthly Progress Report. M.D.E.L.. Dec., 194-1 (A.M.R, & D. Bd,), 30 ' ’ Ltr, to Chf., Dental Div,, S.G.O., fr. Lt, Col. Neal A. Harper, D.C., Carlisle Bks., Pa., 8 Dec, 1941* (Dental Div,, B.G.O.), 31 Ltr. to Hist. Div,, S.G.O., fr. M.D.E.L,, 23 Nov, 1945| s.ub j e ct s •' " Hi'story, Project F-24 - Truck 6x6, T' Xabcratery’Dental," Incl, 1, ,p, 5 (Hist, Div,, S.G.O.), 32 Monthly Progress Report, M.D.E.L., Jan., 194-2 (A.M.R. & D, Bd.), 33 Ltr, to S'.G.O., fr. M.D.E.L., IB Mar# 194-2; subjects "Mobile Dental. Laboratory" (M.D.E.L.), 34- 1st Ind, to M.D.E.L., fr. Dental Div,, S.G.O., 20 Apr. 1942; basics see n. 33, above (M.D.E.L.). 35 • ■ 2d, Ind, to SiG.C,, fr. M.D.E.L,, 23 Apr, basics see n, 33, above (M.D.E.L.). • ‘: • B6 Monthly Progress Report, M.D.E.L.. 1 May - 9 Jun, 1942 •- (A.M.R. & D, Bd,). ’ • Monthly Narrative Resort. M.D.E.L.. 10 Jun. - 9 Jul. 1942 (A.M.R, & D, Bd,). Monthly Narrative Report. M.D.E.L.. 10, Jul.'.- • 9 Aug, 1942, (A.M-.R. & D, Bd, ) • ‘ /' 37 " Monthly Narrative Report. M.D.E.L.. 10 Jun, - 9 Jul, 1942;/. see penciled notation, 29 .Apr, 1942 (A. M.R. ~ & D- Bd,) , 38 . ! - : - •• ' ; ‘ - Sunha. p, 315* /•••. 39 Ltr, to S.G.O., fr. M.D.E.L,, 3 Aug, 1942; subject: "Con-J . struction Pilot Model Dental laboratory" /M.D.E.L*), * 40 1st Ind, to M.D.E.L., fr, S.G.C., 5 Aug, 1942; basics see n, 39, above (M.D.E.L,), 41 . *.'4" Ltr, to1 Hist. Div., S.G.C.,, fr., M.D.E.L,, 23 Nov, 19451 subjects "History, Project F-24 - Truck 2-4-Ton, 6x6, Laboratory Dental," Incl, 1, pp. 6-7 (Hist. Div,,. S.GuC,) 42 • •• . . -- • ■■ *' Ibid.t p. 7. 438 43 . • • - . .. Monthly Narrative Report;-M;DiE.L.. 10 Nov. *9 Dec, 1942 (A.M.R-l &■ D, Bdi), 44 .... . :..D* .Monthly - Narrative•Report. M.D.E.L.. 10 Jul. - 9 Aug, 1942 (AiMiR; & D. Bd.), ■' ■ 45 2d Ind, to S.G.O., fr. M.D.E.L,, 23 Jul, 1942; basic; see • *’n. 33, p. 438 (M.DvE.L.); •' ; / , * •/; • • j • * • I i ; . *•» . • • * 46 • ■ Memo, to Finance & Supply Div., S.G.C., fr. Dental Div., S.G.O., 21 Jul. 1942 (Dental Div,, S.G.C.). . Ev: in . C > Ltr. to Hist, Div., S.G.O., fr. M.D.E.L., 23 Nov, 1945$ sub- ject; "History, Project F-24 - Truck 2-jr-Ton, 6x6, Labora- tory Dental, "-Incl. 1, p, 6' (Hist, Div., S..G.‘0,), - ’ • 4B Ibid.. pp, 7-8. See, also, telegram'No, 4 to Medical Supply Depot, Savannah,' ‘Ga., fr; M.D.E.L., 12 Dec, 1942, "Undelivered Items" (M■ 10 Dec,- 1942 i- ;9 Jan* 1943 (A.M.R. & D. Bd.). 50 x/ Deduced from comparative study of M.D.E.L. Photographs S-266, "Truck, Surgical," and S-39, "Mobile Dental Laboratory" (Hist. Div,, S.G.C.). n. 49, above, * 52 . ... ,, , ... . Monthly Narrative Repott. M.D.E.L., 10 Jan,•- 9 Feb, 1943 (A.M.R, & D. Bd.). ‘ .. v 53 Ltr, to Hist. Div., S.G.O., fr. M.D.E.L., 23 Nov. 1945| subject; "History, Project F-24 - Truck 6x6,*’Labo- ratory Dental," Incl, 1, p. 8 (Hist. Div,, S.G.O.), See also n, 52, above. 54 ' Ltr, to M.D.E.L,, fr, S.G.O., 15 Jan. 1943 (Rec. Rm.1, S;G.C, 451*2-1 Carlisle Bks.-N), Memo, to Chf,, Dental Div., S.’G.C., ft.'Exec.: Office, S.G.O., 20 Nov. 1942 (Dental Div., S.G.O.). 439 56 Ltr, to C.G., A.G.F., fr. S.G.O., 12 Feb, 1943; subjects "Mobile Dental Laboratory" (Rec. Rm., S.G.C. 451.2-1), 57 ■ * ’ , 2d Ind. to C.G., 2d Army, Memphis, Tehn., fr, Hq., A.G.F., 6 Mar. 194-3; basic: see n. 56, above (Rec, Rm., S.G,0. .. 4-51.2-1) " 58 3rd Ind. to C.G., A.G.F., fr. Hq., 2d Army, Memphis, Tenn,, 16 Mar, 1943; basics see n, 56, above (Rec. Rm., S.G.C. ■■■ 451.2-1). 59 6th Ind, to M.D.E.L,, fr. S.G.C., 3 Apr, 194-3; basic: see ; * nV• 56, above' (Rec.*'Rm,,' S.G.p. 4-51.2-1). . . 60 Monthly Narrative Report.-, M.D.E.L.. 1-30 Apr. 194-3 < (A.M.R, & D. Bd.), ■ 61 ’ Ltr, to The Surgeon, 2d Army, Memphis, Term., fr, 1st Convalescent.Hospital, APO 4-02, Nashville, Tenn.,,22 Jun. 1943; subjects "Report on Test of Pilot.Model of. Mobile Dental Laboratory," with 3 incls, (A.pvI.R, & D._ Bd,). For text of this report see Appendix H. 62 „ : : - - * Ibid. ' ■ " _ 63T, .r Ibid. . t ...... . . . .... 64^-: 'r Ibid. ’ • 65 1st Ind. to C.G., 2d Array, fr. Office of Dental Surgeon, Hq., 2d Army, Memphis, Tenn,, 24 Jun. 1943; basics see , n, 6l, .above (A.M.R. & D, Bd*-svx-:*.-1 '.1 66lMd. 67 ' ‘ ’ • 2d.Ind, to G.G., A.G.F., Army War College, fr. Hq., 2d Array, Memphis,.Tenn., 2B Juni 1943; basic: see n, 6l (A.M.R. & D. Bd.), 68 3rd Ind. to C.G., A.S.F., fr. Hq,, A.G.F., Army War College, 11 Jul. 1943; basics see n. 6l, above (A.M.R. & D. Bd,), 69 74th Ind. to S.G.C,, fr., ■ Hq., A.S.F., 15 Jul. 1943; basics see n. 61, above (A.M.R-. & D. Bd,), 70 5th Ind. to M.D.E.L,, fr, S.G.O., 27 Ju. 1943; basic: see n, 6l, p, 440 (A.M.R, & D. Bd.), 71 Memo, to Dental Div., S.G.O,, fr. Plans Div,, S.G.C., 27 Jul, 194-31 subject: "Mobile Dental Laboratory” (A.M.R. & D. Bd.) • * .' . ■ • 72 1st Memo, Ind. to Plans Div,, S.G.O., fr. Dental Div., 30 Jul. 1943; basic; ,see :n, 71, above (A.M.R. &’D. Bd,), ..6th Indv to■ SvG.O., f r., M, D, E, L., 9 Aug• 194-3; basic: see n. 6l, p. 4Ad-'(A'.M.R, & D. Bd.). 73 .'•••• . ‘ /-V ; . ' •• ■- ’ " . .Memo, to.Dir*Dental Div., S.G.O,, fr. Secy., M.D.T.C., 14- Aug, 194-35 subject: "Proposed Action by Subcommittee of Medical Department Technical.Committee oh'Mobile Dental Laboratory" (A.M.R, & D. •Bd,), 74. ... Ltr, to M.D.T.C., fr. Subcommittee on Field Equipment, 23 Aug. 19435 subject: "Laboratory, Dental, Mobile" (A.M.R, .. & D. Bd,). 75 Ibid. .76 Min, of M.D.T.G.. Meeting* No. 9, 6 Sep. 194-3, RESTRICTED (Hist*- Div*., S',6.0.) • Extracted in clear, *L",i 77 ’ ‘! • ,;5 * Ltr. to- C.G., A.S.F., fr. S.G.O,, 10 Sep. 1943). subject:,• "Trupk, 6x6, Laboratory, Dental!!- (A.M.R, & D. Bd.), t 9 rr% - ■* > • j ♦ 2d Ind, to S.G.O,, fr, Hq., A.S.F,,. 23 Sep,'- 1943) basic: see n. 77, above (A.M.R, & D. Bd.). 79 v . * - • - • ’ Memo. to Chf., Supply Service; Dir,, Fiscal Div, j Chf., .. ... Professional Service; Chf., Operations Service; fr*. Flans Div,, S ,'G;0,, 25 Sep. 1943| subject: "Truck, 2!-Ton, 6x6, Laboratory, Dental" (A.M.R. & D. Bd.), , ,w . 80 Table-of Organization 8-571 Auxiliary Surgical-Grout). 13 Jul, 1942; Table of Equipment 8-571. Auxiliary Surgical Group,. 25 Nov. 1942, 81 Memo, to Operations Service, S.G.O., fr. Dir., Dental Div,, S.G.O,, 7 Sep. 1943 (Dental Div,, .p..G.0^).: Ibid, 83 Memo, to Operations Service, S.G..O,, fr* Dir., Dental Div,, S.G.O., 7 Sep, 1943 (Dental Div., S.G.O.), 84 Memo, to Dental Div., S.G.O., fr. Chf,, Operations Service, S.G.O., 11 Sep. 1943 (Dental Div,, S.G.O,), 85 Table of Organization & Equipment 8-500* Medical Department Service Organization. 23 Apr, 1944. 86 Table of Organization & Equipment 8-500* Medical Department Service Organization. IB Jan. 1945. 8V * Table of Organization & Equipment 8-667,. Medical Depot Company. Combat Zone, 17 Mar. 1944. See, also, Change 1, Table of Organization & Equipment 8-667, 11 Aug. 1944% 88 Memo, to Hist. Div., S.G.O,, fr,•Dental -Piy,, S.G.O., 24 Feb, 1944- See Incl. 1, "Dental Division;-Histopy,. 22 January- 1944 - 21 February 1944, incl., p, 1.,-.(‘Hist. Div,, S.G.O.). 89 , 5th Ind, to C.G., A.SfF,, fr, S.G.O., 17,Dec. 1943; see Par. 2; basic; Itr, to Chf., Ordnance Dept/,’ fr. S.G.O, 3 Njoy,. 1943-1 subject; "S.G.Cy requisition PD 1300" (Rec. Rm., S.G.O, 451.2-1)-. .. , .•:• •• ' 4 - ■ 90' « ■ ' . 4 ■- •• - Ibid, Approval cited in,5th%Indorsement, 9! " ■" " ■■■■■-• Ltr, to S.G.O,, fr. M.D.E.L,, 29 Nov, 1943; subject: "Conversion.of Surgical1 Trucks .to Dental Laboratories" (A.M.R. & D. Bd.). • . *' , 92V ' . .. ■ • 1st- to.:hist.'.Piv,, S;G.0#,,}fr. A.M.P.C . ,• 31 Oct. 1945; ' basic; ;;ltr.:,to ’A'.M.P.O;,’ fr. Hist..- Div,, ’S.G.O., 22 Oct. 1945 ,(Hist. Div. , S,G,-C. ), V 93 ■ - Ibid..r- ■ ■, _ 94 ; V j-vy V,'. / Interview with Pearson W. Brown, Lt. Gul,, D.C., Historian, Dental Div,, S.G.O., 19 Feb. *1946. : * 95„ ■ ■ V • • ' statistical“data based on Itrs. to C;G., PGA; C.G., NATOUSA; C.G., SPBCj,. G,G,, ETC; G.G.', SWPA,-frv Chf., Supply Service, S.G.O, (all dated 26 Oct. 1944)I subject: "Medical Depart- ment Trucks,” CONFIDENTIAL (Rec. Rm., S.G.O. 451.2). Extracted in clear, 96Ibid. 97 Monthly Narrative Report, M.D.E.L.. 1-31 Oct. 1943 (A.M.R. & D. Bd.). 98 Ltr. to M.D.E.L., fr. S.G.O., 14 Nov, 194-35 subject; "Dropping of Projects from Monthly Narrative Report" (A.M.R. & D. Bd.), 99 Table of Organization & Equipment B-500. Medical Department Service Organization. IB Jan, 194-5. 1 Supra, p, 390. 2 The Bulletin of the U.S. Army Medical Department. No, 71, Dec., 194-3, p. 13. 3 Supra, pp. 422-424. 4- Interview Ytfith Pearson W, Brown, Lt, Col, D.C., Historian, Dental Div,, S.G.O,, 19 Feb, 1946, See, also, Essential Technical Medical Data. 1944-,1945 (Hist, Div., S.G.C.), 5 See n. 94-, p. 44-2. 4 • . . CHAPTER VIII TRICKy';2|-TQ11, 6' x 6, OPTICAL REPAID. LUXT I. Historical Background; A. Importance of Armyfs Optical Repair Program, Many a man who, during the earlier days of. Selective, Service.,; was convinced that he would never be drafted because of vision defective, enough to require glasses was later undoubtedly surprised to find himself inducted, nevertheless, he was not alone; for, as he unquestionably came to realize, there were hundreds of thousands like-him in the Army of the United States whose visual deficiencies could be corrected only through the wearing of spectacles. Recalling its experience in World War I, the Army had estimated in 1940 that tau percent of all military, personnel would require And although as late as 24 December 1941 it was reported that "Records disclose an astounding correlation in the precentage of military person- nel wearing spectacles during World War I and the present emergency,it was later determined that those requiring glasses during World War II actually numbered 13 percent.'5 Erom this figure alone the importance of the Army's optical repair program should be obvious. But if other evidence.be: yet desired* one could point to the fact that were it-not for. the optical repair facilities which were employed In the European Theater of Operations alone it would at one time have been "necessary to .evacuate approximately' 10,0.00 soldiers per month who have lost , or broken their, spectacles*;■ B, Medical Department’s Estimate of -the Situation. .. When the United States formally entered the' war in December of 3941, anticipation that expeditionary forces would require Ophthalmological service overseas *. o crystalized into prompt action,to provide such service. A comprehensive estimate of the situation was made-, rand an officer in The Surgeon General’s Office submitted on,24! December 1941 a report on what, in his opinion, was- ’’the .-.I ■ most practical and workable .Mobile Optical -Unit to -.facilitate •’ the Medical Department in the maintenance..of visual efficien- cy of Military Personnel in .the Theatre of • Operations.. This report pointed mit that, although the.Base Optical Unit -. that iSj a fixed installation — which the Medical Department had established in Paris, Prance, during World War I -had u,' .; provided excellent service in filling 22,000 prescriptions for spectacles during its four months of operation, the Chief of Ophthalmological Service had recognized even then the advantages of mobility and had recommended that comparable optical units of the future possess -this characteristic,6 Since the Medical Department estimated from Army • experience in the first World War that an’optical unit which could produce 60 pairs, or 120 single lenses, of spectacles daily per type army would be required, further study of the problem as outlined in this report was predicated upon these considerations: (l) type of unit necessary to provide"ade- quate maintenance facilities in a Theater ‘of Operations;. (2) estimated production service required per type Army; arid'"(’3) extreme mobility and self-sufficiency of the optical unif.,^ Two possible types of units were examined, ’ One, _ , world consist of "equipment necessary to. process spectacles.-;.,... from the grinding and surfacing of the lens9,,.s to .the finishing of the spectacles complete.. Such a unit, Mw.ould,.in fact, be an optical factory capable of supplying .spectacles of any prescription, regardless., of correct ion”.;, nevertheless it would require not only large quantities of specialized tools but even tooling machines,--to maintain ..them, -- the. loss or destruction of"which. ‘wp.ul,d be ruinous .to continued oper- ation; a large ppombei; of, skilled personnel; and fiver-.,trucks for transportation.6 /Mobility —la characteristic which ; had been determined as.’ -- .would obviously be. ,. s o great ly impaired In' such * a. .’cumbersome., unit, as. -t o. b,e . : . virtually non-exisfent*, ,Con,se;quently, all thought, of . \, . •: recommending such a large,.- costly, complex, and immobile-. „ r, ■ unit was promptly .discarded, * ’ The second type '.of ,ur/it .considered in' this ..pre- liminary investigation was described, as. wone, in; whlci the .. grinding and surfacing equipment would be, eliminated,"-thereby reducing the equipment and weight, by, £0$” and, one which, would ’’contain machinery and equipment sufficient to .cut* 'slocked ., . semi-finished lenses down to size,' shape them on a diamond cutter, /and/ smooth and bevel the edges preparatory to insertion in the Its stock of lenses, would be .in accordance with a tariff of sizes as determined from the*' experience tables of principal optical suppliers, of.- the . continental United States —* a stock which would, it was believed, supply better than S.9 percent of the demands. With only five men. as operating personnel, this type of unit would have a greater production capacity than the more elaborate one previously described, it was: thought, ’’because, by the elimination of the grinding and surfacing, 80$ of the time element has been circumvented” and because, too, it was ”designed to operate and be transported on one standard ton truck, thereby affording the maximum in mobile efficien- cy, Such a unit* was, very liberally estimated to cost 445 kESTRJCTEo $21,288,59 complete,: .... , Advantages claimed for the streamlined unit ‘in addition ,to-those .already stated or implied were:- :- •’ l\‘“ * * ‘ ; ■ -A.. - - The five men required to operate at a' capaci- ty sufficient; to produce 60 pairs of spectacles in an eight- hour.. day - need be operators having only optical shop experi- ence and not necessarily skilled technicians, * 2, Efficiency would be increased approximately 200 percent because the need for highly specialized machinery, equipment, and skilled optical technicians would have been eliminated, ••■ 3, In emergencies, improvisations could be effected for wearers of special or unusual spectacles until their prescriptions could be supplied from the rear, 4, The unit cost would be reduced 50 percent; yet a stock of 12,000 pairs of lenses, 8,400 frames., 600- pairs of extra temples, and 1,200 spectacle cases would be included in Its* equipment,1^ Having concluded that the smaller, compact unit was the more practical for the purposes desired,- the report recommended that this typo, be adopted and (although six units were: actually authorized almost immediately that "procurement be instigated to provide the establishment of two such Mobile Optical Units*"14 C, The Original Mobile Optical Repair Unit. The mobile optical repair units thus originally recommended for adoption and procurement by the Medical Department•had been developed largely by the optical indus- try —•; in close cooperation, of course', with the Office of The Surgeon General. There is evidence aplenty to show the ■ ; tremendous efforts made by at least three optical suppliers - ‘ namely, the American, the Dausch and Lomb, and the Shuron optical companies •— in this work. They recommended equipment and supplies to be included in the proposed mobile units and drafted tentative blueprints suggesting the most convenient ..location for the various pieces of machinery to be installed in the 6x6, stake-and-platform-type, tarpaulin-covered cargo truck that was to be used as a carrier, furthermore, they assembled and supplied the complete units to .the Medical Department — originally one to each numbered Medical Supply Depot—at a time when critical shortages of optical equipment and supplies presented almost insurmountable difficulties to the sponsors of the project,^ So impressed was the author of The Surgeon General’s History of the Optical Program with the contributions made "by the optical industry, throughout the war that he observed par- ticularly that the American Optical Company and Baufech and Lomb "were at all times c.onscidus of the importance of the Arm^rs Optical Program and never failed. :tq-be ' fully cooper- ative11-; and he stroh^ly’opined that ’’were it not'for these two' companies the' Army’s Optical Program,;-would he a serious :V- •' . II. Project Initiation Notwithstanding the remarkable contributions of indus- try to the development, standardization,; and procurement qf the original unit—Medical Department Item No,"93638, Optical Repair Unit, Mobile, Large—facilities for optical' repair in the field still left much to be desired. ■ . Inadequacies of Original Unit, On 28 October 1942 the .Senior Consultant in *.Ophthalmology, European Theater of Operations,;had declared "in amemorandum to his headquarters: .’’It is ‘anticipated ,,that the- present mobile optical unit will prove, on trial,.ytp,'be unnecessarily .cumbersome, inefficient-, inadequate, an [_ d__/ unsat isf act dryand a month ■ la ter r.he-inf ormed The Surgeon General that, ’’The-method, of supplying; troops ,/ht- least in this theater, with spectacles' is •■chaotic,, the four ’’causes of this impOsS'rhle. .:,ho. .‘believed,: was. ’’The present unnecessarily complicatedAfield;Optical -hjnit which is not enough simplified for field use and contains some; equipment' that ■■isVjcumberS;Ome and unessential for rapid , work”; , and so he re commended-- among - othe r ..things , ” The * abolition of the present, mobile optical'linit, “19 Having reviewed this report of.overseas -difficulties, the Chief of the Optical Branch, Surgeon 'Gohera-l’s , indicated on 24 December-1942 that the''entire question of replacement of equipment and suppliesf for overseas is.presently under active consideration by this off ice, ■- — Review- of the inadequacies of the overseas program continued for several months, during which time it was decided that not abolition of the standard mobile repair unit—as had been recommended by the Senior Consultant in Ophthalmology, European Theatre of Operations—nor even simplification of it would alleviate the chaos in overseas optical supply; instead, a more complex unit was actually to be desired. The nature ox this decision and some of the reasons for it are we:ll stated in the following memorandum from the Chief of the Specialties. Branch (formerly Chief of the Optical Branch) to the Plans Division, Field Equipment Branch: ?" ' •• . ‘ „ 1. This office has .had under consideration the furnishing of all optical repair units,- ■' including mobile units,, with the. minimum equipment necessary to* take care of essential surfacing work in the case of bifocals and prisms, Reports from all theatres of. oper- • ation have evidenced the’ need for such equipment as the units are apparently able to take care of only about 85fo of repairs and -replacements with their present equipment. 2, The Surgeon General, during a recent • inspection trip overseas, recognized the need for''this additional equipment, and has directed that it be provided immediately, ’ 3.- In view of the foregoing, this office is proceeding with the necessary arrangements to augment the equipment in all these units, and to determine the most practical method of providing the additional equipment in the present mobile units. There is no .space available in the latter for additional equipment, but .’it is not felt necessary at ‘this time to revise speci- fications on the’ entire, unit, redesign the layout, etc., but rather .to* simply.- send" along ’• the additional equipment, for use with the unit. As a matter'of fact, a number of these units- are operating as shops with the equipment removed from the truck. 4, This matter will be coordinated':fully with the Plans Division.?-. Hoteworthly mere’ly in passing is the fact that field experience required The Surgeon General to direct inclusion of equipment which,. when the possibilities’ of employing mobile optical fepai’p-units were initially surveyed, had finally been excluded after careful, con* - sideration because, among other reasons-,-its omission was calculated to reduce the weight of.the unit by approximately 60 percent and to increase its operating efficiency by 20 percent . . . Following issuance af .the, original.mobile optical repair units to organizations iif the field, furthermore, the fact that three separate companies had collaborated in its early development and production became as prejudicial as it had previously been helpful. Fart of the chaos in supply was undoubtedly created by the’fact that the mobile optical 448 shop was being ”supplied by three manufactures, each of whom makes a slightly different unit with parts which;are not interchangeable.”23 a consequence of this confusion, the Medical Department frankly admitted by nild-July 1943'. that thE'raethen existed a- ’’situation whereby we are uninformed as to the- type of equipment which is being used in units in the various theaters of operations.,”24 B• Formal Initiation, of Pr o.ject> .On 22 June 1943 a conference was called, whose pre-announcea working basis for this project,"3^ He further explained that, "in view of the limitation of funds, it will•Lbd.necessary to develop this oh:an existing closed body truck such as is now in use, known as the surgical truck."40 . .• v 451 The Medical Department agencies handling this 'development were working rapidly* On the same day that Headquarters, Army Service-Forces', finally approved the project—i_.e_., on 13. July. 1943-lthe Chief of the Specialties Branch answered this request’ by indorsement. He indicated to the Director of the Equipment Laboratory that the original mobile optical repair unit as transported on the standard 2-J-ton truck with tarpaulin cover had been found unsatisfactory, especially in adverse weather; that the Specialties Branch was then studying the availability of space in the surgical truck to accommodate the extra optical equipment and supplies proposed for addition to the unit; that Until this space factor had been with a reasonable degree of accuracy, there seems little use in having equipment forwarded to your station for installation on-'-the surgical truck”; and that-as soon as the problem was resolved, probably very shortly, “this office will communicate with-you .further .in order that this development project may/be. pursued as expeditiously as possible.”41 - The Chief of the Specialties Branch further stated that It is also the intention for purposes of - ■ uniformity to recommend the use of the equipment of each of the optical’manu- factureK;which .seems best suited to our needs compatible'with'.the .space available in . the truck in order to ayoid/.a. repetition of the-present situation whereby we are uninformed .as to the type of' equipment vhuch is being .used■in:the -units in the various theaters of ‘ • - -V By the end of July,. 1943., -.tjne Medical ’Department Equipment Laboratory-,wap' ableto report that Development Project. F-32. Optical Unit,’ Mobile, had been initiated on 3'July. 1943; that- "Preliminary plans have been made in regard to- equipment to be Installed in a van.jbody mounted on a 2-g- Ton, 6x6 truck”5;and.that the surgical truck.which had been received by the Laboratory on 30 July 1943 was to be "converted'into.a pilot model mobile optical unit upon receipt of thee optical equipment which is to be furnished by the Office -bf The Surgeon General,”43 Two weeks later it was estimated ’ that .the project would be completed by January 1944.44'; -■-... ■ * • , * . 4 • . ‘Initiating development-prior to receipt of formal authorization-of the ..project by Headquarters, Army Service Forces, was not the only expedient resorted to during the preliminary developmental stage in an effort.to speed the progress,of Projects F~32. On 31 July 1943, too, the . ."Dirgct.orof the Medical Department Equipment Laboratory * . requested cf The Surgeon General's Office one electric power ;)L\" unit ,;(Itern ilo, 99600) for delivery to his Organization for ' - use in the Mobile Optical Unit, This request was made, he vexplained,:win' order that the'equipment may be available at „an-earlier date than if requisitioned through normal .’channels*”4® Then, on 2 August '1943, the Table of Equipment which had been previously requested was forwarded to the "Director of the. Laboratory with the request that the equipment ‘ " 'be procured from, the companies indicated— The Shuron Optical .’Gbmpahy .and the American -Optical Company—through . ' Modi.call Department supply channels, and that the -cost be charged against, the $12,000 of research' and development funds; authorized for the Finally, on 10 August, . 1943,- the' Specialties Branch requested that the Equipment ■ LaboratoryV-utilizing a high priority to insure prompt delivery, purchase eight lens and eight frame cabinets from Yawman and Erbe Manufacturing Company, The Monthly Narrative Report for August revealed that delivery of both the optical equipment and the cabinets’ was-'expected within 30 to 60 days,^®. B, Rectifying Previous Violations-and Prescribed .'i ■ ■Prb'cedur.es, . ■ , - : While developmental work on Projc'ctF~32 was temporarily suspended pending delivery for the necessary equipment, appropriate agencies within The Surgeon General's Office began rectifying the apparent, though'unexplained violations of the, procedural provisions ~.ctf -AH 850-55 which. - had been committed when the project was .initiated about five vree’ks... before,...' This activity consisted of" formally, processing therprbje6tthrough the Subcommittee and-the Medical ItepartraentTechnical Committee and, of having’those two j committee-s :determine the military characteristics to be pro- posed for'approval by Headquarters, Army Service Forces. The fact that establishment of military charac- teristics, .had- been earlier overlooked appears to have been realized first—-though the evidence is more inferential than palpable—during discussion of the Technical Subcommittee held 2 August 1943, Be that as it may, after the proposed characteristics had been formally coordinated within The Surgeon General's the Technical Subcommittee on 23 August 1943 recommended approval of their statement in the following form! a. The unit should utilize the standard Surgical Truck chassis and body. 453 .• bi The unit should be sufficiently com-., plete in equipment to provide repair, P-and-replacement in essentially all cases, this ; to ipcludo a focus range af lenses as complete • j -as p-racticable- and the minimum essential surfacing .... 'equipment *■... ; c* :The unit should be self-sustaining from -.•the- standpoint of light, heat, and power so that when necessary, complete operations may be per- formed within the unit regardless of adverse . .weather or blackout-conditions * ; ; d« The equipment should be, securely in- . stalled in the truck, but capable of being removed. 51 , . '. On 6. September 1943 the .Medical Department Technical Committee approved the, report of its subcommittee, but .-with,a modlfi-- " cation of the nomenclature to. read: Truck, 2-g-Tpn,. 6x6, Optical Repair "hy ; ■• ■•• • With the request that "the recommendation by the Medical Department Technical Committee for adoption of. military characteristics of subject item be.approved,n'the report of the Subcommittee, the approval of the Subcommittee report with the recommended change of nomenclature,rand the signed concurrences by members of the Medical Department Technical Committee were forwarded to the Commanding General, Army Service Forces, on September 1943*53 After coordinating the. recommendations with Army Ground For ces , Headquarters, Array Service Forces notified The Surgeon General on 7; October 1943 that the . military, characteristics as... pro- posed were approved,and- this information was shortly, relayed to the Chiefs of.the J’ield.-Equipment Development.' Branch and of the Optical Rranch,, Procurement Division.56 Thus wars atonement made, for the sins against the procedural requirements qf AR 850-25 which were committed not -only by The Surgeon .General’s .Office but also by Headquarters,■ Army Service Forces, since 'that office had failed to require a statement of military characteristics when Development Project. F-33 was first approyedV Fortu- nately, however, processing this remedy through the various committees and headquarters caused no .delay in the substan- tive development of the unit. C. Substantive Development. • Records relative to actual ;e h£i nee ring and .con- ... struct ional activities, incidental to the development/of the Truck, 6 x ,6r- Optical Repair Unit are/extrabdi- . narily meager. This fa’ct of itself' is a tribute / however, to the quality of the work that had heen done in developing the basic Truck, 2-g— Ton, 6x6, Surgical, With such a versatile and adaptable■vehicle' 'to Jbcgin ‘with, it is hardly surprising .-that 'although another .on each side of the truck had. to be* added,- ’’The prime .research and construction * difficulty,troubles one as it was, .was nothing more bother- ‘•■U-some than .finding' ”spa,co for housing the multitude of ' Special optical equipment and supplies., in the 2\ ton, 6.x 6 ■■ truck*”57 . .yt . < tv- - •; ; . liven while, military characteristics were being • processed .if or approval and- while .the- delivery of optical ! equipment), and supplies and: steel*cabinets in which to store them was being* awaited, - the. 'Medical’, Department Equipment Laboratory was- doing such..work as it could on Development Project. Tims, although delivery of the steel-cabinets was riot expected before 1 November the-Monthly’ Narrative Report of the Laboratory for September 1943 indicated that i * V ■■ : poriversion of the body of the Surgical Truck which is being used in the- development. - of the pilot .model mobile optical unit is- .now being accomplished. This.includes the addition of. one more window on each side ,’ipf the. body ;ahd the., installation of a new ...electri'cal'arid plumbing'system,.^8 .* ’ : . ;; i As a result of this progress the--.Equipment ,• Laboratory was able\.to send ,.to The Surgeon; General1 s, Office on 23 October. 1943■ Copies, of- ■”Medical: Department Equipment V. ' Laboratory;• -Drawings . Nos.• G-414, Piping;Diagram, 2-J-Ton,. Van ‘■ 'Body Truck; 3)4510, ■ Optical ;Hepair Unit, Mobile; and v Tentative, .Optical Retail*, :Un-itr which s'how.ttentative con- ; ’struction or--Inst-allabi onr artangemferit'. of the interior equipment of .the mobile ■optical'oiriit ,”59 The Laboratory warned,' however, that ’’Modification of the .plans as shown; in 'the'drawings will, ..no doubt,-require changes; inasmuch as many of the- items' of ’ equipment ".to' be installed' will vary in ..•-diinerislohs;,from-'the-estimated dimensions upon which all plans And drawings have been made,lt'^r * ' ■ The Laboratory was not to wait long, nevertheless, before it could determine just how much modification of its tentative drawings would be necessary, for just at this time The Surgeon General was told that ’’Information has been received by this office that aL 1 of the equipment under pro- curement will be shipped from commercial manufactures by 27 October 1943,” and that each manufacturer had been ”requested to make shipments by express in order to expedite delivery.” The Laboratory anticipated,,.furthermore, ’’that the pilot model 455 mobile optical repair unit will be completed ten (10) days after receipt of the equipment, to. be installed in it,"62 .• .. . •; J-ust as had been predicted, on 27 October 1943— three,weeks after Headquarters, Army; Service Forces, had approved the •action establishing military'Characteristics of ;the' unit =arid some 2-r|| months after The Surgeon General's Office had authorized purchase of most■ :of the"equipment on the : open market-!-the optical equipment that'-was being ‘pro- cured;. commercially arrived#63 Meanwhile the-Equipment laboratory had-apparently found inadequate the Medical Department power unit which it had requested thhee’months earlj.ep,. for on 29. it. apked The Surgebn General's Office, to requisition Irpm'the Signal Corps -''‘power unit #PE - ?:&—■ T1,. 2--|? KW, inasmuch as the Medical-Department had no generator suitable for use. with the optical unit*" ; Nevertheless, by the end of October the Equipment Laboratory was able to report that "With the ’exception of J_ the generator and_7* some power V belts for -the motors of the grinding and surfacing machines, all of the equipment which has been under.procurement for the mobile optical unit has been received?; that "Preliminary drawings'and specifications covering mobile optical unit are now being drafted";land!that ."It- is anticipated, that the unit in .question will be com- pleted and ready for road tests on 15 November 1943and : ready for shipment for service .testing if desired." 65;,, The work of .development* rs. recapitulated', in- . fine*, in these cursory words, of an officer -of the- Medical: Department Equipment Laboratory': ‘ ‘ :• ! In November 1943, nearly all of the ' equipment had been received and the prob- lem of putting in all of the equipment was tackled. Every bit of space available was utilized, drains were hidden beneath table tops so as not to put down one bit the avail- able working space. The load to be carried ■ by the truck was considerable and this' weight ; had to be distributed so as not to overload •in any j one spot. The equipment was shuffled and reshuffled placed and there so that the most feasible plan could be obtained, Finally the unit was finished. ; ,-,66 The pilot model of thfe Truck, 2-g-Ton, 6.' x 6, Optical Repair Unit was then ready, for inspection and tests. ' jP* Infection and Tests. „ _ ,.. . Among other matters on-the agenda of the meeting -••of the" Optical AdvlSohy BbarcL .as •announced’ for 16 Novemher- 1943 discus si On-of *the possibility- ■ of .omitting operational test ,of the- new mobile -.o.pttcal’uhjtf..in view of- i'ts 'hritleal need dverseas,-Con's© quently'V. tfe. completed pilot ’tobcloX •’ hayi ng -;,be eh ‘ 1>r :t & Wash i hgt on' for inspection on’ thajrdate, ;HThs ■ general 'designiembodied -in the optical repair'.imit was.: tentatively approved.by"representatives of The Surigeon .General t:s Office and -by the’ ’Opti cal. Advis ory Board,'11, and at the. same 'time “Plans ;were formulated ,- ¥- to have- an, operational, test ;df the; unit in ques-t'ibn conducted at Carlisle Barracks-, Pennsylvania as soon as'practicable And'soy on 18- November, the Medical Department Equipment Laboratory was authorized “to hold limited service., test: for, the mobile optical ’Unit- at Carlisle and adjacent, military • iristallations.f pr production of glasses for period-of not over ten. days **$? •: ■ ■ • ■ ’ , . : Decisions reached during the meeting of the Optical Advisory .Board and a comprehensive guide to be followed' during conduct of the test were elaborately set forth on 27 November 1943 in a four-page letter from the Chief.of:' the Field Equipment Development Branch to the Director of the Medical‘Department Equipment Laboratory, This letter indi- cated that the Optical Advisory Board had accepted the new unit “with considerable enthusiasm11; that inasmuch as “practically the. same equipment was being included that had been previously used in other mobile units, a lengthy field operational test would not be required11;, but that “a limited operational test should he-'made in order that any minor deficiencies might be corrected before final specifications are written,•- ; It was proposed, therefore, that the tests be conducted “over a consecutive period, of .approximately seven days11 beginning 30 November by a Captain A, E, Mangold, Sanitary Corps,.and six enlisted men who had “recently completed the training-course for opticians'at the Medical Supply Services School, St, LouisMissouri,Captain Mangold had apparently been acting -as an adviser on Project, F-3_2 for some time;, but he was cho-s-.en;:to perform the test, among other reasons, for his “actual’ overseas experience,., in the operation of such units, • • r 'A'.v: ‘As outlined in the comprehensive instructions (See Appendix X), the test was to determine the practicability of the completed unit (l) in stationary operation employing "both commercially available electric power and generated current and (2) under simulated mobile field conditions actually involving movement to several locations and the per- 457 formance of pra script ion service;-- More- specif i'cally, studies were to-be made to; determine the productive- capacity-t)f the unit, the number of personnel required to operate with' maximum efficiency, advisability of adding or deleting equipment-, ■ determination of -most.' suitable size of-generator required, adequacy of heating, and-supply-Of hot water, effectiveness of operation under blackout, ’sufficiency of storage space* protection- of windows from bomb-fragments, and proper-placement of equipment ‘ within the unit'.-- ■ J t was, further re commended that' al 1 addi t i onal - supplies found needful be requisitioned from The Surgeon General’s Office ’’for inclusion with this unit so that ’Pilot Model” will then be complete as to equipment and stock for. .the purpose of using as a basis Of procurement on •' quantities required, in accordance with completed tentative 1 specifications.” Further still, The Surgeon General’s Office anticipated, because of limited production facilities availablethat certain concessions relative to departure frop ’’specifications. written on the Pilot Model” would have to be made to manufacturers "to insure expeditious delivery of completed Mobile Optical Units.” ° For that reason The Surgeon General’s Office, explaining that ’’Your cooperation in this connection will aid in elimination of delivery delays of completed units from suppliers on an item which is urgently needed for overseas theaters of operations,” requested that ”at some time during the operational test, or before the final specifications are written;- this office be advised so that arrangements :can be completed with the supplier for one of.their engineers- to make inspection-of such unit.”7^ Apparently anticipating that personal friction might result from detailing an outsider to conduct ’the field tests for the Medical DepartmentiEquipment Laboratdry and obviously desiring to obviate:any -delay that might'be so occasioned;-.The Surgeon General’s Office advised the Director of the laboratory thus:. : .Qapt.ain' Mangold .'has ,' -in view of his v-hroad'.op’.tical: axp.erience as pertains to ■ .operatton• o;f .mobile units overseas, proved . a:ctyery valuable aid bo ;this'• office through ,racojaraiendatlons :made. for .improvement of the overall optical'' .'program,. • :Tt--iS, therefore, requested that' yoUT; OiffiCe give e:very ■ con- sideration .to any' rec omm'ended changes he might make as a result of this -operational ■ 4 ■ test, as it is believed that this will re- sult- ir the-final approved Pilot Model meet- ing alh the requirement's* that will he nec- •i essary under actual .field -operating conditions,77 • • j Reports of the test, together with drawings, specifications,' phonographs, and recommendations, were to he forwarded ;to The Surge on Generalf 9--Office* ' ’ Promptly upon re chip t;hy the Equipment. Laboratory of this letter of Instructions,'the limited-operational test was performed, /-A favorable formal operational test '.report.,/ signed.'hy Captain Mangold' (who indicated that /he had been: ”given compiete-'-cooperatiOn hy the Medical Department ‘ Equipment Laboratory while'testing this unit"' y) , was sent to • The; $urgeon General1 s Of fice . on 8 December 1943,. This report'revealed that in the field'with a.2% KVA gasoline motor being ;used, ’’five minutes-yre-re required to set; up.the optical equipment for operation and 15..minutes were required' to service and start operation off* the generator,” and "that 11 the -unit, operated in a warehouse using electric means, was satisfactory in all A maximum of six men (one driver) was needed to achieve a total daily pro- ductive capacity of 75 jobs, the 2\ KVA generator was judged to. be-. the size most desirable, the heating and the supply of hot:water were deemed to be adequate, and special protection for .-windows was; considered to be unfeasible During blackout, the:report continued, si light trap could be improvised from a?’’.piece of canvas tent ,fly or tarpaulin-drawn from the Quartermaster or Ordnance ‘ . ; Also considered; we.re,. questions relative to.adequacy ; of sto.rage- spa.ee and, t o; supplementing-'orveliminating, dis- tri-butihg' or equipment and.'-supplies-, within the unit. Among othdf mihor..yec6mmehda-t:ions was one.'that me chni-dal •t guards be required f of" hertsdu - of-, the -more, deli cate equipment to protect- It from damage while the 'tfucfcds.- i,h-'transit. And-as,'suggest ad ,.by .The' -Surge on .General1 s Office, 'the' Medical Department Equipment' Laboratory,,lit Whs reported, would be "happy .'to -cooperate with Manufacturersor«• suppliers •,f (Eor complete -.text this' report see Appendix^). ' Within two'weeksafte ft he report of the oper- ational test' had been submitteed, the Equipment Laboratory completed its revision- of drawings and specifications for the Mobile Optical Repair Unit and, on 22 December 1943, forwarded them to The-Surgeon General’s Office,' Additional information about the pilot model and the test to which it had been subjected was included in the letter notifying The Surgeon General’s Office' that the Laboratory’s part in the develop- ment was, in effect, complete. Indicating that construction of the pilot model had been finished on 1 December 1943, for example, the Director of the Medical Department Equipment Laboratory wrote- 459 ■ 3,- Tests: The completed. Pilot Model Mobile- Optical Repair Unit was examined and tested by,this office for the following: • ■ a. Weights*: Front.and rear axle . + loads'•'and. total gross weight.. c b. Roadability and maneuverability • - of, the loaded vehicle. . . . . ■ £. Shipping dimensions. ' ; • -,i d. Adequacy of interior equipment. . £. Generator carrying arrangement• . i 4, Findings: Inspections .and tests 1 reveal the following: a. Front axle load (less driver). 3,700 pounds. Rear axle load (less driver). 12,000 pounds. Total gross weight 16,800 pounds. b. Roadability and maneuverability of ,, •the vehicle was good and all slopes,. roads,. and ■grades were negotiated without difficulty*. ’ U-* There was no shifting or damage of any of the interior equipment on cross-country .travel*. £, Shipping dimensions will be 1603 cui ft• 160 sq. ft, d. The interior equipment.provided for ■ irr-the- inclosed specification and,drawings . •• (drawings are being sent.under separate cover) are adequate as shown on the accompanying Operational ’test repo.rt .and equipment list of Captain Mangold.,, £. Generator, — A carrying arrangement for a 2-1/2 KVA generator is included in the interior fittings of the body, by the use of : • web straps'and floor plates, however., if any larger generator is supplied the. power unit would have to be mounted on a One Ton Cargo Trailer. A generator smaller than 2-l/2 KVA will not supply sifficient power to operate the unit.83 ... .. This>letter from the Equipment Laboratory con- cluded with a recommendation that the Mobile Optical Repair Unit f,be adopted as a standard equipment by the Medical ; Department, U, S, Except for formal termination of the project—ah action which seems never to have been ■effected, this recommendation •concludes, exdept for subsequent changes in specificationsv* -subsequently to be discussed,.'the.; , developmental work' bn Project: R-32,'' :. . .. , • IT. Standardization Phase Subsequent to the suggestion of the Director of the Medical Department Equipment Laboratory, action to initiate * ■ or - * - 5 t - i standardization of the new development occurred.promptly; for on 29 December 1943 the Chief of the-FieldEquipment Development [Branch of -The ' Surge.on GeneralTs”)Office, -‘formally recommended nthat. the Mobile 'Optical Repair Unit be: standardized by .the Medical Department .Technical Committee."®5 Meeting 3 January 1944, then,, the Technical Subcommittee-recommended that the’-unit be standardized ind in conformity with the provisions of AR- 850-25, ■ further pro- posed that the nomenclature :,be "Truck,. 2^Ton; 6x6, Optical Repair Unit;.-that .'.the old Optical.Rep.afr UnVt, Mobile, large (item ,93638) be reclassified as. limited, standard inas- much as the ne# .unit :would replace' it;. " that” respohsibility for purchase and inspection of the’ chassis, of the newly developed truck be assigned tor the’Ordnance Department but that responsibility for the procurement,.purchase, inspection, specifications, storage and issue of bodyfixtures, and stock equipment be charged to the ' Medical . Department; that the basis of issue be one (l) per Medical, Pepot/-Company (t/0 8-661) and one (l) per Optical Repair. Team,-'type 1- (T/O 8—500) ; and, finally, that the maintenance percehtage be approved as follows: • (1) Zone of Interior ' ■— (2) Theater of Operations 1.2 The Subcommittee report further indicated that the unit cost would be ”$20,000 including stock or $14,000 without stock but including fixtures and tools” and that if the recom- mended basis of issue were approved," requirements for 1944 would be 35 (at a cost of $700,000) and for 1945 they would be five (at a cost of $100,000),°® The Medical Department Technical Committee, meeting 21 January 1944, approved the report of the Subcommittee with the following modifications, as indicated in a letter of transmittal to the Commanding General, Army Service Forces: * ) v/ (1) Ordnance Department [toJ be charged with responsibility for purchase, specifi- cations, and inspection of chassis and body* , less installed optical fixtures and .equipment, specifications being subject to Medical Department' requirements^ (2) Medical Department [toJ be charged ‘with responsibility for•requirements, funds, storage, aid issue of entire item including equipment; and purchase, specifications, installation and inspection of optical fixtures and equipment• Headquarters, Army Service Forces, approved; >ith- out question the-re,ccmimendations of the Medical Department Technical Committee-,on 30 January .1944, ’ and all interested' - agencies within The Surgeon General1g Office were promptly notified of this action,®® Consequently, the"Monthly' * • Narrative Report - of -the, Medical, Department Equipment Laboratory for January 1944 indicated formally that Development Project. F-32 - Truckt 6 x 6, Optical- Repair Unit-carrying Priority A-had. been "completed and previously reported”; that the. pilot model was, at 1the request of The Surgeon General*.s Office, being shipped on 2 * February 1944 to the Army Medical Purchasing Office,-New * York City, and that drawings and specifications covering the unit had already been "forwarded to the Army Medical Purchasing Office, on 31 January.1-944, -for procurement purposes,n®y The report concluded, therefore, with a recom- mendation "that this -project be dropped as its standardization has taken place, Thanks in very large measure to the foresight and speed manifested in the prior development of the Truck, 2^—Ton, 6x6 Surgical-as described in Chapter V, development and standardization, of the Truck, 2-|— Ton, 6x6, Optical Repair Unit was likewise remarkably rapid. On 30 June .1943 The Surgeon'General' s. Office had formally requested;Headquarters., Army Service' Forces; to’ • approve initiation of the project; by‘30’Jantiary‘1944—just seven months later—standardized on had' beeh effected and'- steps were ready to be., taken to get the unit under pro- curement, ; .... ■■ ■ ■ ' V, Procurement Phase., , . "" 1 A, ■ Preliminary Planning to Speed Procurement. Several days before, standardization of Stock-No,- 9958900, Truck, 2-g—Ton., 6. x 6,r Optical.,Repair Unit had been approved by Headquarters-, Army. Service Tor ces, The Surgeon- GeneralTs Office was actively engaged in facilitating pro- curement of the new unit,. On 2$.’January 1944, for instance-,- the Supply Planning Division, informed the Plans Division- of the Operations Service that, tentative'" specifications, -- equipment lists, and other-.required' data had.been-"cleared to : the Army Medical Purchasing Office, New York, for the purpose- of placing this item in procurement to'.furnish urgent over- seas requirements."91 At tfte same time it,was' decided" :tha,!tr "Until such time as firm specifications have been writ fen" the pilot model of the Optical Repair Unit should be "made1 available to the Army Medical Purchasing Office for use as a guide in the completion of the first units delivered from the 462 1 supplier,”. It, was accordingly requested that arrangements '■■be made to have the pi lo.t. model transferred far approximately ■ 50 days:from the Medipal Department Equipment Laboratory'to '•the Army %'dicaVPurchasing. Office in-,Hew York, at the end of which time/-itv.wab to.be sent on ”to the Binghamton Medical Depot for the .purpose pf re-stocking -with1 ■ supplies • packing and crating 'for" overseas. Shipment ,”931 • ■. ,.... .. ; ; ’ ;'i';S'tandariization of the new.!;optical repair unit havfrig been approved ..by Army Service Forces-on 30 January 1944, only. one day elapsed before an order for seven each of the new units was .planed, with Army ..Medical Purchasing Office. 4 With -'delivery ‘of the 'pilot model to- the manufacturer, Krieger Steel Sections, Incorporated, on 3 February 1944,production was ready, to’ begin, ........ 7-nr.;! *. • 33. Developmental Difficulties During Procurement, 1., . Improvising to Utilize Unsatisfactory Basic . V / .'.Vehicles. : :: ' ' -■' • ' •- * ‘ Only two serious difficulties related directly to development occurred during the procurement phase and thosp troubles, were rather easily,.resolved‘ with no very cohsequBiitlal Ip.ss of time, . A better-understanding -of -the- first problem may be- gained by Reviewing a- hembrandum-' of 19 January 1944 from The Surgeon. General1 s*--Office to* the Medical Department Equipment Laboratory'—a, memorandum:written at a time'when' the ' Truck, 2-|-Ton, 6x6, Optical Repair.Unit, -Was still in the process of standardization. On the subject of Truck, x '6',' J , Surgicalthis communication pointed out that ’’considerable/ difficulty is being; experienced in -,standArdi z.ljlg additional- truck:s---pai,tibd3a;fiy 'with' ref erenc'e to Ordnance” and that-” This confusion .could Jqc ..eliminate•-..tiha'-'-’Unit.• -as purchased-- from •Ordnance were' the same- fon all .'trucks, .us'Qd 'by the- -Medical• Department,”9® The .Surgeon -GeneralOffice:.requested, there- fore , that a drawing ”be prepared showing - the interior and exterior plans and elevation of a truck which .could be "Iljy furnished from the Ordnance Department and be standard with' all six trucks now standard or being considered” and, very significantly, ’’that dra\\rings be-prepared showing the additions or modifications necessary for .each individual trucks” The Surgeon General’s Office then proposed a meeting of representatives of the Medical Department Equipment''Laboratory, The .Office of The -Chief- of Ordnance, and interested branches in The Surgeon General’s Office to determine a definite policy for furnishing the trucks and bodies partly fitted from Ordnance and the remaining specialized fittings for the Medical Department,”^® 463 ■Revision of applicable .Medical.Department ■ Equipment'Laboratory drawings was accomplished- then, early in 1944- —apparently on' 29 Fqbru ry and 23 March —in an effort to provide the Medical Department with "a -standard ;truck on which to base all future Mobile The . conference proposed for‘coordinating the problems of supplying Ithe various type.s of trucks seems meantime to have, .held on 1- March for on 24 February The Surgeon General’s Office requested the Director of the Laboratory ’’-.that an officer fr'oin th.e: Medical Department Equipment Laboratory proceed to The Office Chief .of Ordnance-,- Detroit, Michigan, on temporary duty, 1' March. 1944, for two (2) days, for the purpose of attending conference on Standardization of Truck, 2- 6.1 6, Medical Department . . , Despite all these efforts to guarantee a supply of appropriate vehicles, the twelve basic bodies being delivered to the manufacturer for conversion into optical repair units—after the first five, which were satisfactory, had been successfully converted—were found, nevertheless, to be grossly deficient in certain fundamental requirements of the optical repair units. Thus tho representative of tho Supply Service, Surgeon General's Office, who was most interested in the development of the optical repair truck pointed out in lucid d tail on 24 June 1944 the dilemma in which, as a result of this mix-up, the Medical Department found itself. He indicated that his office had just learned through the Army Medical Purchasing Office that specifications for the Truck, 2-§--Ton, 6x6, Optical Repair Unit had "been "revised under date of 23 March 1944, in a manner which makes- various changes both in the basic unit and in the installation of optical equipment,"4 Some of the changes resulted :in an unsuitable arrangement of edgers (which tended to make the area around the sink more congested when- the-,unit was in operation); unsatisfactory re-arrangement q£.the vertical . a water tank (which deprived the unit of, 1-8. or- 2Qi inches., of badly needed counter space); and an undesirable reorgani- zation of the sink assembly (which relocated on;-.the -right.;' instead of the left, •. the.,.cab net standing-on the sink. .o. counter) - an innovation which made nny-use of the cabinet by. the spindle operator extremely -i -■ More important,-howeyer, than,, these changes.'which, though ’’definitely undesirable from .the standpoint of-the optical repair unit, ,cap 'perhaps be •accepted, if - the-changes are vital to the efficiency and overfall adaptability of the basic unit” was *”the elimination -of two lens\-cabinets which fitted beneath the sink .counter”—tcabinets,.,which ’’represent 25$ of the lens storage space:. and arqfvital 'to the unit,”® It was suggested, therefore, that 464 -..'permitting' the sink drain to be elbowed either ■tuhthe. xight-Of to the left somewhat as shown rin the original-layout would permit these two :: JLpnar cabinets-' to"- oe- included' provided the ,hMl't--in* cabinet ■ with shelves as shown in the -revised drawing is eliminated in the basic • unit intended'for use as optical repair ■.-.units, -An extra’board would have to be added tO'.the. ’sink counter which has been reduced in :depth;. otherwise', the lens cabine.ts would pro- trude perhaps four or five■inches It is recommended that the Ordnance'Department be ■authorlzed'-to make the’necessary changes.in. the .sink drain,-' ’Sink counter and sink'cabinet as suggested for the optical repair units if such changes do hot lend themselves to the . basic "unit ! ‘'’; ’ - In support of the suggestion that special handling might be accorded the alterations necessary for the optical repair units, it was reported that. equipment assemblies for all 19 of these units :were, purchased early this year after standardi- zation of the unit, hut before the revisions referred to. The two lens cabinets intended to fit. underi the sink in each unit are all on hand, ;andit is understood’ that the contractor hes.-.purchased sink assemblies for these units • in;accordance with the original specifications which means'‘that if we are forced to accept the :i . current. changes, the contractor will revise his r; ..‘quotations' Upwards , and we will pay more for an •; [. unaat is factory-unit deficient' in badly needed • -..cabinet space;-”f' •In .reply,-.'the' Director of the Technical Division on 14 July 1944-xoncurrod with "the- observation that nthe changes, mad& definitely1 limit-’the-phbper operation of the Optical Repair:-.Unit,” ■■but he did- hot • H re commend any change in ■the standard,.Medical Department- vehicle as obtained from the Ordnance-Department-.” — • In-steady he wrote (but without explanation as. to the. discrepancy: in the" number of units required)• ; Reference.-theVtweive'^Ci-additional, vehicles ■ .re^ulredcatthistime ,r:lt is ’ recommended that , the.;, cabinet arid-" Counter 'at the front of the ;/;truck:ho;.fGmov0d'ahd;a:new counter the proper -width- of" the sink -prdperiy 'Ideated and with .•■the -required cahi nets-mounted he low he spb-. s t i tute.d, . Any-: change -:iri ‘ piping t o prope rly ' locate the -sink, and the • hot ...water tank should he,-made. Edgers should be relocated, also, the cabinet standing on the sink counter. In.gen- eral* -this work would have as its.object as close, a duplication of the .original fi,ve' (i) models as is possible, for. .the. maximum use,'of the materials on hand, ’ r", „ i.T.. Contract for the alterations, if the recommendations of the Technical Division were followed, was to ber.placod by the Army Medical Purchasing Office* And-it was stated, finally, that ttThe design of the present'truck with its accompanying specification will be referred back to the Medical Department Equipment Laboratory for change to include this work on any future requirements for Optical Repair Units,”-1--!- The Supply Service, Surgeon General’s Office, thereupon promptly recommended to the Army Medical Purchasing Office that the recommendations of the Technical Division for remodeling of the basic trucks "be carried out as expe- ditiously and economically as possible through separate contract with Krieger by the Army Medical. Purchasing And a day later the Surgeon General’s Office, transmitting to him. copies of the correspondence which has just been reviewed,■explained to the,Director of the Medical Department Equipment Laboratory that Inasmuch as the, seventeen units, which include the:: five, original,models and the twelve being procured at, this timp. will in all probability serve the needs, of the Army for the duration, it is thought,- that the changes recommended will actually, not reflect a great .expenditure of funds and in any event, it is thought that the adoption and use of the standard Medical Truck for this unit is worth the expenses • involved to effect a satisfactory, design for . the Optical Repair Unit,-^ • : ,•:-.Although the Equipment Laboratory was accordingly requested .’ifor. ..any ..future procurement -of this item" to change the drawings, and.specifications in accordance with sug- gestions made in.certain correspondence that was inclosed, The Surge on.General Vs. ,Qff ice did observe that "Since action has already .been taken by. ;tlie AM?0 .to make changes in the twelve trucks, now sunder .construction, this project need not carry an urgent priority •,.’’,14 o-!;, - And;so* by .its immediate decision for prompt, positive action to rectify by special contract the first of the difficulties of procurement that were directly related to development, the Army Medical Department successfully 466 relieved itself of a dilemma, the two alternatives of which were manifest: namely, (l) to accept a substitute that could have been made to serve the purpose of the desired optical repair unit but.. that. would have been,, in operating efficiency, vastly inferior, to it4 or (-2) to abide a. dangerous, not to say vexing, delay while delivery of urgently needed trucks that did possess, the necessary characteristics-was. being awaited. The expedient of converting the trucks' on hand by means of a special contract was action no more-expeditious than rational. ‘ , 2. Acceptance (of Units at Variance with ■ . Specifications. ■ ' ■ - The second of the two serious difficulties of procurement that were related to development seems possibly to have resulted from the same cause as the first—the failure to complete with sufficient promptness adequate and firm specifications for the Optical Repair Unit. -. / ■ Prom the’ beginning’,’ one will- recall,'* the- Medical- Department .proceeded apace with procurement despite the f act that, S-P-eci f i cat ions- f or the unit had not been finally drafted. At first the developmental pilot model-had served- also as a.procurement model and as such became in practice,■- one might say, a. virtual purchase description. Later'the tentative -specificatiqns-formally submitted by the Army Medical Purchasing Office received from The Surgeon General’s Office approval ”as a purchase description only, to be used until such time,as modified suggested specifications' incorpo- rating the basic i4edical Truck are Although the Equipment Laboratory had revised certain of:its- drawings on 16 August 1944 and had proposed on 1 -September1 an amendment to its Tentative Specification Ho. 100-B, The Surgeon- General’s Office took about two months to instruct the' Army Medical Purchasing Office in part as follows; Since there are additional changes to' be-- made in the specification, it is believed that instead of preparing an amendment, based on1-.'-' the inclosed Amendment No* 1 /dated 1 September 1944J from the Medical Department •* Equipment Laboratory, the specification should" be revised* In the opinion of this office- the requirements appearing in the.inclosed amendment should.,be-.added • ... to read as follows . . .-4 . . Prior to installing the. sink cabinet, 's■ work, surface ,• sink and piping, ■ by Drawings D-510 and B-545 •’.the-con- ' - tractor shall remove sink and sink , . .cabinet as set up in the basic truck, Thus it appears that even in late October 1944, nine months after 'the item...had been standardized, the truck housing the Opticdl Repair, Unit was still so susceptible to change—possibly both through design and through-accident— that drafting formally acceptable specifications fob it-was either difficult or-unwise,s§ long'as the Medical Department was undecided as to just what its intent relative to the Optical Repair Unit really was. • " ., It would not be difficult to believe from such manifest evidence that, the confusion in easily have resulted from the absence of firm specifications for the truck, 5x6, Optical Repair Unit; but if is. probably more likely that the real cause of the mix-up to be , discussed directly lay at least partially in another and more personal ..reason, -, . : At the request of the Army Medical Purchasing* Office a representative, of the Medical Department Equipment laboratory had gone to Uew York to e'kkmifie’-a .production model Truck, 2-|-Ton, 6x6, Optical...Repair Unit with particular reference- to'-’certain changes in the truck . interior equipment which were accepted by the Optical Branch.of the Army Medical Purchasing. Office, New York, and which vcrq at 'variance, with the applicable Medical Department.Equipment Laboratory Drawings. A dot a lied report of this, inspection.*, which revealed twenty-odd departures from the technical ’ •• requirements specified. ip the Equipment laboratory drawings; was submitted tp.'.The Surgeon General on 6 January. 1945, The complete-text of this report is presented as K; but its detailed observations may.be more briefly cate- gorized as follows:-..' , . . 1, Relocation of -certain cabinets-, interior •• fittings , and operational equipment ,. the necessity, of which resulted, in s.ome instances; .from, structural changes that were themselves unauthorised by. applicable1 specifications, 2, Structural changes..-in‘certain'interior • fittings, notably blackout shades, various storage cbm- :r partments; locking bars on'-Cabinets,, hot water tank, '-‘h: auxiliary piping connections, and.the sink dr'4'in pipe, 3*- Substitution of structural 'materials and , finish of table top, ’ • • '.•>* ... 4. Installation of additional drawers, storage 468 boxes* -afid■■■■ft block-device for securing:the bowl of the lens -sUrfacer,' "As the Medical -Department:- Equipment Laboratory Drawings applicable ‘ to the Truck, U? on, ' 6 x 6, Optical-'-Repair Unit have been standardized-as'how-drawn," the report concluded, “disposition of this project is requested.*!9 ' I. : ■ •! ‘ ■ ~ v Shortly after this report reached:The Surgeon General's Office the Director of the Technical Division referred it: to the Chief of the Ophthalmology .Branch with the request ”that changes accomplished which are desirable in', the standard itombe indicated in"Order'that standard. drawings may be revised accordingly” and v/lth the. suggestion ”that 'Capt. A.E,Mangold indicate the'desirable, changes on applicable standard drawings and forward same/as - an a ■ : inclosure for This suggestion'accordingly was transmitted by the Chief of Supply Service, Surgeon General*s-*0ffice, to the Army Medical Pruchasing Office on 19' January 1945. ■ ■ uu •- o In reply to this suggestion of The Surgeon General’s Office came a report from the Army -Medical' Purchasing Office dictated by Captain and dated 3 March 1945Although it considered individually each of the discrepancies noted by the•inspector from the Equipment Laboratory, -most -of its Comments justifying' acceptance of these discrepancies were extremely superficial. Pour of them., for example, stated identically that'"This change should-be:made for the'more’efficient operation of optical equipment”; another reasoned that "This change should be made cd' that1 handle- of-SUrfacer is'; in correct-working position”; a' third, that1 "Additions that were-added1 to the \ inter! oh-bf'the "truck -for more efficient -' . operation- ef unit as a- VhoIh:,-”-,:ahd others- were' almost equally as 'Gaptai-n Mangold concluded-his report— the text of which, fo-r eas-'c of1 comparis-ori with -that of the' inspector from the Medical Department Equipment- Laboratory, is presented as Appendix L—with the suggestion that "before the new blueprints of basic ifuck and 'equipment for the mobile optical repair unit be standardized • *--this office /Army Medical Purchasing Office/ have the oppor* tunity of checking .them-,”24 The changes recommended i'n this report of Captain Mangold wore concurred in by the Ophtbalneology Branch of The Surgeon General’s Office and the Medical Department Equipment Laboratory was instructed to revise MDELTS #100~B and drawings on the Optical Repair Unit, to conform with changes of construction of the interior equipment* These changes • 469 conform to drawings delivered to the.M,D2E,L, by-the Krieger Steel Sections Inc,, Long' Island City,.N.Y., at the request of Army Medical'Purchasing Office,^ In accordance with-the instructions* then, the "Medical. Department‘"Equipment'Laboratory patiently ’revised the ■ drawings ■and'-Specif ications," as an officer of■ the Equipment Laboratdry'pMsed it in his historical account of Developmental"Project. E-32. "and forwarded them to the Surgeon General on 4 April 1945," Officer personnel of the Medical Department Equipment Laboratory make no effort to hide their chagrin over the preemption of their function hy Captain Mangold and the contractors outfitting the optical repair units. Thus the officer submitting the narrative of the role played by the Medical-'Department Equipment Laboratory in the ■ development of-the Truck, 6x6, Optical Repair Unit Remarks; __ The reversal of the testing /Captaiii Mangold1 sj opinion is the amazing part of this story. When he tested the'unit at Carlisle everything was perfect even the changes that-he found in the service test were corrected, 'the truck was standardized yet nearly:a-year and-a half later hevwas changing the design to suit his manufacturers'- fancy irregardless [_ sic fj. of; liaison standard’ drawings and specifica- tions* It makes one wonder who was-really handling such things in the Medical Department,?? ' «• ' ~ • . ;*• And the Equipment Laboratory^-as will be seen in a moment when an attempt the project is made, had legitimate cause for complaint. C, Statistical Summary of Procurement, Of all the new optical repair units procured by the■Medical Department, just how many-were affected by this last•revision of specifications is "not *immediately apparent ,-'1 The ■ original order of 1 February 1944 called for seven each of the units, of which two were--de live red on 15 May, two on 31-May,-and the remaining three on 15 June 1944, Obviously then, since "the revisions just discussed had by that time-not oven been suggested, trucks delivered on the original order were-not-‘involved’'in the changes. Be as it may the effect'of this late revision of"specifications'and 470 drawings, nevertheless, by 31 October 1945—two and a half jgofi'tfee after the end of active hostilities on all fronts — orders had been placed ,tpta.l. of 24 units, all of which by that date had been delivered?. Since 13-each of the old Optical Repair Unit, Mobile CStoclc No, 9363S00) had been - furnished during 1942 and 1943, the'A-rifiy:.:Medical Purchasing ; Office procured a grand total of 37 mobile, repair’ units-- both the old and new types*--rd.uring the period of World'-War] II, for which-the Medical department paid,; at. the unit cost of $20,481,01, more 'than-^three-quarter’million dollars.^;.. VI, Evaluation. *' •... . *• ‘ : : A, The Item. * "•' i •• T;Vr When he appreciates the unheralded, importance -of the Army’s program to supply the optical needs of the 18 percent of its personnel who required spectacles during the recent war; when he reflects upon the utter, chaos of the optical supply that existed during the -early..days of the conflict; when he considers how much was. .contributed to that chaos by the variety of equipment and supplies contained in the old mobile optical repair unit despite the most cooper- ative and assiduous efforts of the optical industry and of The Surgeon General’s Office to make the original unit, effective; when he takes due .cognizance of the contribution unquestionably made by the..newly* developed unit in helping to rectify the chaos,’a rectification so efficacious that by the time the European:;campaign ended the - adequacy of; the Medical Department Is optical facilities -was precluding-the necessity of evacuating' in, the European theater at least,, some 10,000 troops each month-^-then the historian ofd,. • .Development Pro j ect .-r F-32.. Truck,’ -3^Ton,.',-6.x 6,Optical ■ Repair Unit finds himself accepting^as completely plausible., the judgment of the author of the-Hist ory of the Opt leal ... Program that nfor all practical purposes, this::unit worked , out splendidly” and that, in the master program ”the equipment used and-the units devised were completely ade- quate to do the job for which'they .had been developed.”^9 Thus it may reasonably be concluded1that- nowwith- ’ standing the high,, cost ($20,481,01 as against $9,000 for the next most costly of all the Medical Department's specialized truck-units, the Truck, 6x6, Dental Operating30), the money, time, and labor spent in developing and procuring the new mobile optical repair units was labor, time, and money well spent. The unit was, among other things, of pecuniary value in that it aided materially in preserving the effective strength of personnel committed to action. Since comparatively few of these units were required, furthermore, the gross cost to the Medical Department was not really prohibitive,3-^-* The unit developed under Project F-32 (see Figures 29 and 30) had several very decided advantages over the old mobile optical repair unit,which had been so-generously, developed by the optical industry and which the new unit was to replace*.': Whereas the Old,was mounted on a truck with stake body"covered by a tarpaulin, the new unit with its custom-builf.'body was completely self-contained andhhad heat, water, and:light—improvements which enabled operations to be performed within the truck under adverse weather or blackout conditions. The equipment of the new unit f,for all practical purposes was identical to the old unit, with the exception that surfacing equipment was added because it was found that a large stock of lenses supplied with the /old/ unit could fill only 90$ to 95$ of all When the optical repair unit was designed, furthermore, it was decided that all equipment, i.e., the surfacing and edging equipment, would be permanently mounted on the benches which were in turn permanently mounted on the floor of the body; later it was found that it would be more ideal to make the equipment removable since occasionally, these units would operate behind the rear lines, and the ideal con- ditions would be to remove the equipment and operate in some building., In making the equipment demountable, then, the Medical Department was complying with the letter of the: expressed wish of Headquarters, Army Service Forces;, nevertheless the spirit of the action was different, for Army Service Forces had. wanted the .equipment made, demountable merely to facilitate shipment, of the item overseas. • ; In other ways the directive of Headquarters-, Army Service. Forces, however——the directive was so at variance, as. we have seen, with another directive on the same subject but relative to a different mobile unit: the directive that -the Truck, 2-|-Ton, 6x6, Optical Repair Unit be designed ,as a knock down type of vehicle—never reached fruition in the finished product« This directive,--indeed—-with not so .much as an acknowledgment or a hon—concurrence appearing in the records—seems, to have • been completely ignored throughout. Nor was it ever , . followed-up-by Headquarters, Army Service Forces, .who may either have been informally, apprised of the untenableness of its position- or have discovered it for itself and may then haverdecided to let - sleeping dogs lie. ,Since the desirefunderlying this directive, too, was principally to facilitatejpacking for overseas shipment, it is probable that neither compliance nor non-compliance.with.it by the- Office of The Surgeon General would affect the operating efficiency of the mobile optical repair unit as finally developed. B* ■. ■Adm.:i>ni's trailion of Project.- _ _. : • • An eyaluation~df,(t.he. administration Of P F-32 falls rather naturally into two-parts,:.,(l) 'the* . c ctedural aspects and (2)’-thedifficulties' renisountered: in(t., engineering and procurementAlthough:the ',pecond- of‘'' * *,..... these di^ihinns overlaps-’slightly with the,, first-, it. is . independent-’ to' justify ‘ a separate discussion, : $?• "''Procedural Aspects, At, -fiijs.t,- one' may. re cal 1, the ini t iati bn . of. Development Project. P-32 was' handled partly partly informally by-The'‘Surgeon General*s Office land", V Headquarters, Army Servide I’orces. Since the. requirenSdht,.... overseas for mobile optical repair-units was-rapidly-„ becoming acute and since long' delays in delivery were logi- cally to be expected as a result of the prevalent shortage of optical equipment and supplies,.any,device to expedite the project.-was greatly to be applauded. In the unconventional procedure that was employed, howevery two very gross infractions of the provisions of AH- -850-26 occurred! (l) no statement, of military characteristics for the proposed vehicle was Offered .and'none was, ..demanded; (2) the re commendation’,-to- initiate ‘the project formally passed through ne.ii&e;r;'t%©K nor. Medical Department Technical Committee. . ■ ■■ i - ' Vithin five weeks, nevertheless. The Surgeon General1s Office descovered Its oversight, promptly and properly processed the statement of military'characteristics through both the Subcommittee and the Medical Department Technical Committee,.and again received the approval of Headquarters, Army'Service Forces, just about three months after that office had .initially approved the project. But with all this formality in' rectifying oversights in pro- cedure, the work of development proceeded without delay. Once the Truck, 2j~Ton, 6x6, Optical Repair Unit had been developed, no delay was. occasioned, either, in its standardization. Only ohe elapsed "between the recommendation and the .approval of the action classifying the newly developed unit a-s-a standard Medical Department item. Thanks to the. plarxriing1 Vhat had earlier permitted development of the Surgical Truck [into, a ha*sic Medical Department all-purpose "body, only seven months elapsed, furthermore, "between formal initiation of the development project and standardization of the developed item. 2, Engineering and Procurement* No evidence has been discovered toexplain why the twelve basic trucks that were unsatisfactory for' conversion as they were into optical repair units should ever have been delivered to the manufacturer* A possible explanation lies in the fact that, concurrent with this delivery, specifications for the basic body were beipg, drafted and that proper coordination of the proposed specifications among the interested agencies may-not have' been accomplished with sufficient care* But whatever the cause of the difficulty, The Surgeon Generalfs Office intervened promptly and therewith effectively solved the. problem by having the desired alterations performed under separate contract* For taking-such decisive action and for taking it so quickly, The Surgeon General!s Office deserves only praise. ■:‘ The second problem of engineering and pro- curement—the controversy, though hardly-an articulate one, between the Medical Department Equipment Laboratory and Captain Mangold—*was more definitely a result of mal-**, administration. In arbitrarily recommending-and.accepting changes in specifications that related to the- •construction and location of certain fittings, and, equipment of; the optical repair unit without so1 much as .coordinating these: changes with. the;,.Med$cal 'Laboratory i Captain Mangold 'Unceremoniously-..preempting the functions of the Equipment Laboratory, Since he,apparently acted upon his own authority, there is little wonder that' officers of the Laboratory were wondering just who within* the- Medical Department was handling the development ♦of-Yield, equipment. The strictures against Captain Mangold, never- theless, appear not completely justified. The Surgeon General, by implication at least, had given him broad responsibility when Captain Mangold, because of his overseas experience, was assigned to conduct at the Medical Department Equipment Laboratory the operational test of the pilot model. Perhaps the absence of subsequent counter- directives was interpreted as giving him carte blanche authority to continue his developmental activities even after the operational test had been completed, the speci- fications and drawings approved, and the truck adopted as standard. Or it is remotely possible, on the other hand, that he was unacquainted with the accepted procedure by which changes in specifications are ordinarily handled—- that is, by careful coordination with the.Equipment Laboratory and with all interested agencies The Surgeon General’s Office, 474 . A. r\ 'I* • f • ' ■ ■ ■ ’ - '* 1 ■ *-S- X .1 • . •:». ;4 ijlaither •dpes'-ithe .historian consider Captain Mangold1s reversal:$f opinion: as nefarious a trick as some would picture it>;:T6nly seven•-days ode will recall;'"had ‘■‘been allowed for t he operati opal test; and e yen i f tha t we re sufficient for doing a thorough jab, the testing;dfficer should still he., accorded rthe,'privilege-after-f*ufther • reflection of changing, his mind as-to the!- most efficient arrangement of interior fittipgs and equipment ,»e von if1 the rearrangement were at variance, with what he had previously deemed satisfactory. If these .ohservations are correct, it then seems that Captain Mangold; is,' to he praised;rather than hlamed for having, the intellectual /hone sty ■' to admit that certain of his original recommendations were erroneous and • to propose his amended opinions as a substitute. Only the manner in which,he effected the proposed.changes—-only his presentation to. the Medical Department•of a fait accompli. appears to an unbiased observer as a grounds for criticism. Since machinery did exist for obtaining legitimately the.results which Captain Mangold desired, no o one can condone^him for having usurped the functions of others* But regardless of the irregularity of hiscactions and notwithstanding the apparent superficiality of his reasons for desiring .the changes that he accepted. The Surgeon Generalrq Office apparently still trusted his experienced judgment-; .for although the patience of personnel at the Medical ..Department Equipment Laboratory may have been taxed to change aL1 their drawings and specifications to bring them into accord with Captain Mangold1s latest recommendations, the recommendations that he made were in the end accepted* 475 • eoothotes to chapter, VIII -of Hr, Stanley V, Rybak, Optical and Artificial Eyes Sec,,■Distribution Div,f Supply Service,.to Hist. .. Div,, S.G-,0. , 28 tec, 1945; subject: "History, of Optical Program," p, 4. (Hist, Div, S., O.O. 400,16-1) • jSereafter referred to as Report. ' . . !'- Memo, to Chf., Finance Dr,, Finance and Supply Div,, fr, Capt, D, A. Peters, 24 Dec, 1941; subject:.- .."Mobile : T: Optical Unit," p, 1, (Optical and Artificial Eyes See., Di-stfdbutibh Div., S.G-.O,). ’ T 1s Report,. ■ p,. 2, , ; # ' c , , ; , .• » , . ’ * * A ..... . , s ; • . % n,‘2, abpye, »• * f . * 6Ibid, _ •. • *’’ ’ • 7 . Ibid,, pp, 1-2. - - ' ’ • r8Ibjfd., p, 2, * 4 - - J ; t, 1 - *•* • * et passim, * • .. ' . „ • • .. r Ibid,;;p,. 3; et passim. * ♦ *-.,; - • * * to Maj, Griffin, fr, .Caprf, -D. A, Peters, 24 Dec, 1941, Supplement A as Incl, 1 (Op'tical and Artificial Eyes Sec,, Distribution Div,, SlG-,0,),. The unit cost of the truck finally standardized was ;.$20.,481,01, ■ (See p. 471, infra. ■ and» footnote 28. Kote 1. p, 484*,.) *•••.. 12c - * * ' ; - » .See n, 2, above, *p-,* • -3,..passim., - ■. r.-t *'a;.-:rc •, .. . ... '* ♦ • •* Maj-T,> Gar&nerf f D, A. Peters, 22 Jan. r 1*942 •(•Optical *and; Artificial. .Eyeb Seo, u Distribution 1)1^',';*:S,G,0*) 1 ■ ‘ \ >;t U A'-' r’ f4 ‘ '■ ■ 14 " * ' •' ■ * ' " .See n, 2, abo.ye, p, 4, ■^5See, for example,- correspondence relating to this project in the files of. the Optical‘and Artificial Eyes Section, Distribution Division, .Supply Service Service, £■>. G, 0. •An interesting sidelight on the characteristic ' cooperation, of indistry in this project is reflected in the fact that the American Optical Company even forwarded to The Surgeon General ’ s„ Off ice, apparently gratuitously, a partial list of "American' Optical Company Personnel who are in military service" and promised that since this was only a partial list, "more will follow later." (Ltr, to CapW Peters., C/O SiG.0. , fr, American Optical Company, 6 Jan. 1942; fie'.-! "Personnel, Motile’ Optical Replacement Unit" (Optica! and Artificial-Byes Sec*, Distribution Div., Supply Service, S.G.O,), » .... It was apparently contemplated, then, that former employees of American Optical Company would be used to man the.mobile optical repair units• b.ajc1 s: Rep o rt,,p. 2; et passim-. • . . 17 . • Memo, to Dir,, Professional-Service-, ‘fr**’Senior-Consultant in Ophthalmology, Office of the Chief Surgeon, ETO, 28 Oct. 1942; subject: "Optical Equipment .and. -Suppliesi" (A.M.R. & D. Bd.) • Ltr, to T.S.G,, fr* Senior Consultant in-Ophthalmology Office of the Chief Surgeon, ETO, 28 Nov.,1942; su'oject: ■ "Summary of suggested plan for the Solution of the * Spectacle8’ problem, for the Military forces as a whoJ.e" (A.M.R. & D. Bd.). 19itia. to Lt, Col. T. 3J, Page fr, Chf., Optical Br., S’.G.0. 24 Dec. 1942 (A.M.R. & D* 3d.). to Plans Div., Field Equipment ;3r., fr,: Chf,, s ■ ■’Specialties Br*, 4 Jun, 1943(A.M.R, & D. Bd,). "Medical Department’s. Estimate'of the-Situation,", pp. 444-446'.. supra* *•* • * t , -av. Ltr. td C.G., A.S.F,-, fr. Research Qoordination^Br., S.G.O,, 30 Jun, 1943; subject: "Optical Unit, Mobile — Development Project on" (A.M.R, & D. Bd,). ,Xnd.. to Dir.., .M.D.E.L., fr. Chf,, Specialties Br,, S.G.O,,- 1-3 Jul 1943;’basic:' ltr, to Dir., Specialties and Supply Planning Div., S.G.O., fr. Dir., - M.D.E.L,, 7 Jnl. 1943; subject: "Optical Unit, Mobile" (A.M.R. D,^Bd*)• of Meeting to be held at*Office of Th$ Sprgeon General at 2,00 P.M., Tuesday, 22 Jan, 1943, to discuss matters pertaining to the Optical-and Orthopedic. Programs", 22. Jun, -1943. (A.M.R. & D, Bd.), ■ ' / ; a + * * / * - — ~ • - . t * ' r • ;-:j Memo* to*Chf,, Research Coordination Br,, Plans ..pi v,, fr, Chf,t Field Equipment and Development Br., Plans .Div,r 25 Jun. 1943; subject: "Research Project -for...the Beyision 6f the Mobile Optical;*Unit*'(AiMjR: %. x;,:r I . V" 27_ • ■ “• * ; #n ' ‘ * Ibid,; et passim, 28 •- . See h, 23, p, 477, 29 - - r ■; ■••••• VV i * -y-.t.-j •. ‘ ’ ?r Is-t ■*F,'S fiv’Dir,’,Requirementjjq*, ,..r R, $• P*» 5 Jul, 1943; basic: see n,* 23, p, 477 (A,M,R, & D, Bd.). , . ..... ... s . ; •. r-.oZ'" to C,G,t A,S#P,, fr , Research Br., Plans Div,, 6 Jul. 1943? basic; see n, 23, p. 477 (A,M, R# & D, Bd,") , , • 1 . . 4 » » • #••• • ; '* ’• .... ... _ ■ « • ■ * * 9 22 3rd Ind* to T.S.G, fr, Chf,, Development Br»., Div.., -Hq.,- io ’Jul; *1943;' .basic; . see n, t23,. p. .477 (A*M,R, & D*:.Bd#‘)'* . . • % % ‘ I 9 - • * *#iw ' “ ' " 33See pp, 326-329. supra.. . •• , r n.• 32, abbvb• ' ’ ' •' ;:o. . 350f. document cited in p, 32,. above, ..yl.th 7th-Ind» :to - T.S*G.. fr* : Chf .V Dcve 1 optobhV• Brv; ~&0‘$UiTcmo nfs' piv,,.Hq,, .; A.S.P., 27 Apr, 1943; basic: Itr, to T,C*,G,, Hq., Armored Force, Ft .. Knox, Ky,* .fr, S.G.O,, 22 M§r*,:r 1-9431; subject S--U«$rdcfc; ’^-^Toh,: 6' x . fA.M.R.x&.iB;: Bdi) • r, .. '■ ... •' I ■ C «' - - * '* * * .... 33Memo. to Field^Equipment*3 hi "/'Plans Div.; Fiscal Div.J Chf, Optical Br,, Supply Planning and Specialties'/Div, ,': £r* . Research Go ordination Br*, ,13'Jul.. 1943; subjectV . ‘ nOptical Unit,r-Mobile - Development Project on1’ (A,M,R, & D. Bd,), ' : 3?Memo, to Field Equipment Development Br,t fr. Research . Coordination Br,, 1 Jul, 1943; subject; "Optical Unit, MobileJ1 (a,M,R, & D, Bd,), 33Memo. to Dir., M.D.S.L,, fr. S.G-.O.j 3 Jul, 1943; subject: ’’Optical Unit, Mobile" (A.M'.R, & D, Bd,) • * ♦ 39Ltr, to Dir,, Specialties and Supply Planning Div,, fr. Din, M*D»E*L,, 7 Jul, 1943; subject?” "Optical Unit.•Mobile"!_et passim., (A,M,R, & D. 'Bd,), 40imi. , The Director, HediCal Department Equipment Laboratory had not yet been notified ~ formally, at least - of the increased allotment of funds, , * . • Ind. to Dir., M,D,B*L,, fr. Chf,, Specialties 3r., S,G-.0,# 13 Jul, 1943; basic: see n, 39, p, 478 (A,M,R, & D, Bd,}, id* • • ' - * ” Narrative Report, M,D.E»L,. 1 - 31 Jul, 1943, p, 20 (A,M,R, & D, BdTT* Progress Report to The Surgeon General on Research... and Development Projects. 13 Aug, 1943, SECRET (Re c.f Rnu, S.G-,0, 451.2). Ex^r^cfed; in. cleat,• •■r ' ■■■■ * ■ 48 Ltr, to T,S,0,, fr, M.D.E.L,, 31 Jul, 1943; subject: "Equipment for Mobile-Optical Unit (E-32), and Surgical*;' * Truck, Operating " (A.ty.R,-& D, Bd,1) , to C.Gr,, Carlisle Bks,, Pa,, fr, Chf,, Specialties Br,, 2 Aug, 1943; subject: "Optical Repair Equipment on Surgical Truck" (A,M,R» & D, Bd,), 47 ” • • ' Ltr* to M.D.E.L,, fr. Specialties’ and Supply Planning ! " Div,, S.G-.O,, 10 Aug, 1943; subject: "Optical Repair Vrilt, Mobile" (A.M.R, & D. Bd.) . Narrative Report. M,D,E,L,. 1-31 Aug, 1943, p, 16 '(a,M,R, & X), Bd,), 49 ; ■ . ; See memo to Chf,, Research'.' Coordination-Br, ,• fr, • Chf :9, ; Specialties Br, f,5; Aug, VX943» subject: . 1‘Revisioh of Optical Repair Unit, M^ile?,;(a;#M,R, ■:&,D,JBdj)* ’ 50 » • • - r ' ’ * * ’ * ’ 1 ' ' ’ *. See ltr, t #Eio.l(J. 5q-yd,pmdnt Development 3r,,-frv ■■ Secy,, M,D,T,C,# 9 Aug, 1943; subject: "Military of Mobile Optical Repaif-Unit’*, with-- ; * Xncl, and 1st’Memo* ;IncU’('A,M,R, D, Bd,)> " v " ; y.-'.li --■■■ - «♦ 'l’ y • * to Subcommit 1;eq; on, .Field Equipment’ to M.D.T.C,, 23 Aug, 1943; subject: "Optical Repair Unit, Mobile" (a.M, R, & D, Bd,)• fr. Secy,, M,D,T,C,, 6 Sep, 1943; subject-: * -"Optica*! Repair Unit, Mobile" (A,.M,&, & D, Bd,), to C.G-., A,S,E,, fr, Chf,, Operations Service*, 6.0,0,,' 13 Sep, 1943; subject: "Truck, 2jr~Ton, 6 x- 6-, Optical Repair Unit" (A,M,R, & D, Bd,), 54lst Ind, to C. 0,, A.SWE,, fr, Hq., A,S.E, , - 22-Sep, 1943; ■ basic? see n, 53 above (A,M,R, & D, Bd,), Ind, to T-S.G-,, fr, Hq,, A,S,F,t 7 Oct, 1943; basic: see n, 53, above (A,M,R, & D. Bd,), • • 479 to Chf,, Field Equipment Development Br.,'and Chf., Optical Br,, Procurement Div., fr. Besearchr Coordination Br,f 12 Oct. 1943; subject: "Truck, 2-g— T#n, 6 x-S, Optical Bepair Unit.” (A.M.B* & D. Bd.). to fr, Capt. G-.T. Kellogg, Asst-*v "M.D.E.L*, 4 Dec* 1945; subject: "Truck, 2-g-, Optical Bepair Unit, Project F-32 and Truck, 6x6, Dental Ope^Hrihg, Project F-37, Histories of," Incl* 1, p. 1 (Hist,-Div,, S.G-,0,). Narrative Beport. M.D.E.L.. 1— 30 Sep, 1943, p, 16 (A.M,B, & D. Bd,) , ~ -• “■ i' ,V:.*■ ■ * ., ' * . *' * “ .to T.S.G-, fr, M*D*E,L«, 23 Oct, 1943;rsUbjefct? "Mobile Optical Bepair Unit" .(a.m1b, &.D, .Bd,), / V- 60t-l,4 a •*•»' • ■ ■ ’ ' • * * -T.' ■ ■•• • ’ • • Ibid* , • * , v; • • : - . ..v, - ■■ ■' -■ i 611 bid.*; et passim* f-'- .V * I 52Xl-K. - '■ ®3litr. to iT.S.dJ, fr. Capt, G.T, Kellogg, Asst., I-fiD.SiL,, 4 Dec* 1945; subject: "Truck, 2jlr, Optical Bepair Unit, Project F—32 and Truck, 2-g-, 6x6, Dental Operating’; “ Project F-37, Histories of," Incl. 1, p. 6, (Hist., Div,, s.0.0*). f*3; •.*■■■ •■ „ ,r HI- «*■“*"’> r" C'- „ ,::e : -'f ’ • ■ Narrative Beport. M.D.E.L.. 1-31 Oct* 1943, p* ; 16; et passim (A*M*B* & D* Bd*) * _ . ir-'-~ ' ’ n* 63, above. ' . .. : * *n ' • • : *•'* •• iV' ■ *. u . •. .s V r '4* ■ • * • * . . ;Vv • k' 4 • • »;■; ’of Optical Advisory Board Meeting,.. 1943, .-'I p* 2t appended_to Itr, to Dir> M,D,E*L.#. fr*, Joh&'B.’ _ KLopp, Asst. /S.G-.O*/, ‘ 18 Nov. 1943; subject: ’ ’Mobile Optical-Unit" . (A*M*R* & D, Bd.) * * • • • .».* •j t ?••••»" ■ Narrative Report. M.P.E.L., 1—30 Nov. 1943, p. 10 (A*M*R. & D. Bd.). . • 69 • . * • ’ ‘ Ltr* to M.D.E.L., fr. S.G-,0,, 18 Nov* 1943; subject: "Mobile Optical Unit” (A.M.B, & D* Bd.)* to T.C.Gr*, 'Carlisle Bks,, Pa., fr, Chf,, Field Equipment Development Br,, S.G.O,, 27 Nov, 1943; subject: "Operational Test of Mobile Optical Repair Unit as Developed at Carlisle Barrafcks" (A,M,B* & D, Bd*)* 480 ; et passim, 72 T,. - • *' • “ • . Ibid. * • * ■ .. f 73iMd, 1 . ' . *; " ’ !' ‘ 74md, ‘ t # • *;. . * • f . r . . * 75I£M*» et passim. ., J ’ - ; ' * ' • ;•••* . ; * ‘ , . * 1 • *..' ** m : ( rin * • % ‘ • • * i , T * ’ *‘,C *' roIbid,. et passim, ‘ •• . ' . 77rbid. . . .. " ' • ?8Monthly Narrative Report. M.D.S.L.. l’-‘30 Uov; 1943; h. 10, (A.M.R. & D, 3d.). . . ‘ 4 to Dir., Supply and Planning Div., S;G,*0*, fr. Aurel E, Mangold, Capt., Sn. C., 8 Dec. 1943; subject: *. wOperational Test of the Mobile Optical Repair Unit developed by the Medical Department Equipment Laboratory” (Optical and Artificial Eyes Sec., Distribution Div., Supply Service, S.G.O.). 80Ibid,; et 'passim 81 Ibid, ‘ I" *. . - . * ■ 4-- * . ‘: ; -*■ * . V: : 83ibid, 4 : •■■■■ .fy- 83Ltr. to T.S.G,, fr. Dir., M.D.E.L., 22 Dec. 1943; sub'jectr; J ’’Mobile Optical Repair Unit” (A.M.R, & D. 3d.), *1 84Ibid, ‘ -• I rn . to Chairman, M.D.T.C., fr. C&f., ’Eield:5^pipraenb-;-- Development 3r., 29 Dec. 1943; subject: ’’Mobile Optical..„:U Repair Unit”\;(A,M.R. & D. Bd.). . . - • . 88Medical Department!Technical ttee 'Report.,on,:... . Truck, 2-|-Ton, 6 x* 6, Optical Repair Unit* tp The >led. Dept. Tech, Comm., 7 Jan. 1944 (A.M.R.-*& D* Bd,-)»* . fV‘ - »• Althpugli/this, report (Par, 2) irfdicate^..I&at'-the t- Subcommittee met oh 3 Janiiapy; 1.943, the date 1943 is ‘ •*■ obviously a typographical errofdfor 1944. to C.G., A.S.P., fr, Chf., Operational Service ,“ ‘S'; (><0. 21 Jan. 1944; subject! •’’Truck, S x 6, Optical Repair Unit” (A.M.R, & D, Bd.). ’ 88Memo, to Chf., Supply Service; Dir., Procurement Liaison Br,, A*M.P,0,; Chf., PieId Equipment Development Br,, 481 Plans Div;; Chf,, ;0igani zation and Equipment *Allowance , Plans Div*1; " Fiscal Div (IN TURN),'fr: Research *■ Coordination- Br*, S.G-.O.,-2* Febl 1944; ♦ subjects wTruck, 6 x ‘6, - Optical Repair Unit; and see, also, memo* to Chf*, Supply- Service; Dir*, Fiscal Div., Chf., Development Br*, * Technical Div*; Dir*, Training Div* (IN TURN), fr* Research Coordination Br,t S.G.O*, 7 Pel. 1944; subject: ”Truckv 2-g—Ton, 6x6, Optical Repair Unit” (A*M.R. & D. 3d,)* Narrative Report. M,D,3*L,t 1-31 Jan* 1944, p, 10 (A*M,R, & D. Bd,), v 90Ibid* •;J-V Memo*, to Plans Div*, Operations Service, ' S.G.O’*,1 -ir*. Supply planning Div*, 26 Jan* 1944; subjects Model 2-gVTon, 6x6, Optical Repair Unit” ■'(mVd*S,Lv)v -• • • ■ • 92 Ibid* • 93 • ■ ■ Ibid.*; and cf* passim. qa • • • .. . . 1st Ind* to Lt. Richard E* Yatep ,•■ S**0*-0vv fr, MaJ. A. Hornbacher, M*A,‘C*, Historian /A,M>P,*0j7 , 31 :0ct.; 1945;-1 ; basic: Itr* to MaJ* Arthur Hornbacher, A.M.P.O,-, -.fr, Richard E*. Yates-,. 1st Lt,, M.A.C., 22 Oct* 1945 (Hist* Div*, 'S*G*0. - • •' 1 _ ; * ;riv • ••- {■ e.-* , ' .vo^ ■■ : ’ .OX .tip vac. r ... V « •-i-.'-J: , * 4 v- * o 9^Ltr*'’to -fr* *Capt* Kelldggi- Asst*,,:li;DyE*X^, 4 Dec. 1945; subject: “Truck,' ’'Optical Repair Unit,- • • Project F-32 and Truck, 2-J-, 6x6, Dontal Operating, Project F-37, Histories of,” Incl* 1, p* 10.-i(Ris;t*v S,G-*0*)* ; . .:'s- .3* ’ t£;DireJ ;M*D.E*L*; „frifJ’ohd '5* ■Klopp, Lt.'Bol* : Asst* */S,0*0*y , 19#Jah'; 1944; subject: ’-' 2-|-Ton 6X6 Surgical”, (A *H*R* & D, Bd*)* • ■■■■■ -v - i ♦ . * • • 97Ibid* , ’• ' . : ‘ , :7:: .•;' • • ' • • • •. • > • ■ * • *y-.; "ibid* . h* 95,: above*' ■ tjo Chf*, Technical Div*. fr* Lt* Col, W* H* Potter,* Asst* /.Supply Service, S,0*0*7, 24 Jun. 1944; subject: ”Specifications for Truck, pf Ton, 6x6 Optical Repair, Item No* 99589” (Rec. Rm*, S*G.O* 451.2-1)* • # 2 ' See n* 95, above. 482 3Ltr, to Dir., M.D.E.L,, fr, Col, R,. G, Prentiss, Jr., . Asst*, /S.G,0.y, 24 Pet, 1944; subject: ”Reques-t f.or ’ Representation at Conference”' ('A,M,R,- & D, 3d.),’ 4See n.' l/'p,; 482,-1 ' : : -i ' : ‘ ■ . c ' ■■•••>, r- * •■■■ ! r • • . ' , itid* • i'(• j‘ f / * •; A •• -;l) , ■* / ... .et- passim,' , /-V 7Ibid, ' *' - - • t •’•?.■■■ k * % * 8Ibid. * ' ' : ' ■' ' 8lst Memo, Ind, to Chf,f Supply Service, S.G.O,, fr. Dir,, Technical Div,, 14 Jul, 1944; basic: see n, 1, -p'J /482. (Rec. Hm,, S.G.O, 451,2-1). ‘y 10Ibid, 4 . 11Ibid, IP Memo, Ind, to C,G„ A.M.P.O., fr. Exec, Office, _ Supply Service, 18 Jul, 1944; basic: see n,. 1, :-£,' 482*, •• (Rec, Em,, S.G.O, 451,2-1). •• * * ' 3Memo, to Dir., M,D,S,1, f.r , Chf,,; Operation Service, S.G.O,, 19 Jul. T944; subjact-: for Truck 2-g—Ton, 6x6, Optical Repair Item No, 99589” (Rec, Rm>-,. S.G,0, 451,2 Carlisle Bks,—N). .,T - - * * ■■'•.v- il” :r • --:- Ibid,; et passM.'*"'* t "i’"' -*-5Memo, to Supply Coordination, Brv, fr.’Chf,, Development Br., 18 Mar, 1944;'subject: ”M,D.T,S, No. 1697, Truck,. 2^—Ton, 6x6, Optical Repair Unit” (A.M.R, ,& D„ *Bd,y, *; . -r - '■ ■ _ . » * • - to C,G., A,‘H»P**0-,., fr.-Chf,, Operations, Service, *’ S,G,0», 24 Oct, 1944; • subject: ”Medical Department Tentative Specification No, 1697-A” (A,M,R, & D, Bd,), 17Ltr, to T.S.G. fr. Dir,, M.D.E.L,, 6 Jan, 1945; subject: ” Inspect ion of Truck, 2-| Ton, 6x6, Optical Repair Unit” (Optical and Artificial Eyes Sec., Distribution Div,, S.G.O,). 18Ibid, A’ • ,r- * * *•-"v.e-> *'r“’t’**..*e.v.-U »•' •’4”*’ 18Ibid,; see Appendix :s’; v“ " • a.4 “ r 1 “' * V',' # v % • ‘ to Chf., Ophthalmology Br,, fr. Dir., Technical Div,, 12 Jan, 1945; subject: ”Truck, Ton, 6x6, 483 Optical. Unit” (Optical and Artificial Eyes Sec*, Distribution Div.S.G-.O,) . f ; ’ * , ■ •- ."1 .i ?.• 21lst Memo. Ind. to C.O., A.M.P.O., fr. Chf., Supply Service, 19 Jan, 1945; basic: '-see n. 20,' p, *483 ‘ 1 (Optical and Artificial Eyes Sec., Distribution Div,, . S * G, 0*}* *8 22Ltr, to /T.S.Gf/, fr. Capt. G, T. Kellogg, Asst*, ’M,D,E,L*f 4 Dec. 1.945;. .subject• ”Truck, 2J-, Optical Repair Unit, Project: .P-32 and. Truck, 2-|, ,6 x 6,’ Dental Operating, Project P-37, Histories of‘IricX, .1, p, 22 (Hist. Div,, s,g,o,). ’ ■ ■ 22Ltr# to S-G.O,, fr, A,M.P.O,, 2 Mar, 1945; subject: ’’Changes in Basic, Ton, 6x6, Med.DeJ>t, Truck” • (M.D.E.L.), ’ s4Ibid, . ; to.. Chf,.,- Supply Coordination 3r., fr. Acting Chf,, Development- Br,,,.5.4 Apr, 1945;.. subject: ’’Truck,’ 2|r-Ton, 6x6, Optical Re.pair Unit” (A,M,R,. ■& D, Bd,), ■ Pfi See n, 22, above. 27Ibid., p, 23, 22lst Ind., to Lt. Richard E, Yates, S.G.O., fr, Maj, A. Hornbacher, Historian /A.M.P.o/, 31 Oct. 1945; basic; Itr, to Major Arthur Hornbacher, A.M.P.O., fr, Lt, Richard E. Yates, 22 Oct, 1945 (Hist, Div,, S.G-,0,), Rote l: The unit cost, as given in ’’Errata Sheet,” Army Service Porces Catalog MED-3 (l Mar, 1944), is only $20,000, The figures given above, furthermore, apparently do not reflect procurement of those optical equipment assemblies (estimated approximate cost, $3500) designated as base shop optical units, ’’comprised of essentially the same equipment and supplies /as contained in the Truck, 5x6, Optical Repair Unit/ but without the carrier,” which could be furnished ”to areas where mobility is not essential.” (Memo, to Distribution and Requirements Div., Units,” - Optical and Artificial Byes Sec,, Distribution Div,, S.G.O,), Hote 2: Although he overestimated the number of units in service, the historian of the optical program furnishes the following information that throws an interesting side- light upon overseas operation of the unit: ”The mobile optical repair units ordinarily operated behind the rear lines, and only in a few exceptional cases were in the forward areas or went forward with the initial invasion forces. Of the approximately fifty mobile units in over- seas theaters, only one was destroyed by German aircraft which raided our rear lines,5 (Rybak!s.Report, p* £6); OQ . .. * • » ' . ° Rybak’s Report, p, 27; et passim* ■ A . . 30See n* 28,. p, 484. ♦ . ■ i . , ■ - - ■ ■ *71 . . . ’ ■ ■' ! * ' * ' * Against a total of 24 orders and deliveries each, of. tjie •; •; 4 optical repai-r units stands a total of, -77 orders and deliveries* each* of the-; Truck, 2^-'Ton,‘: ,6 x 6,; Laboratory,,,; v- Medical - its nearest competitor for low honors numerically, The unit cost of the medical laboratory, however, exclusive of trudk.and tfody,'-‘was ’'only' $824. : (.Se'a‘Si;;j38^-p.* ryp * * • • • • Rybak*s Report, p, 31, In deciding to add surfacing equipment to the facilities of the mobile optical repair units the Surgeon General’s Office v/as really reverting to a possibility proposed*by rejected for what appeared very valid reasons when consideration was first given to the development of a mobile optical repair unit back.in 1941-42. Eor dis- cussion of this rejection, see "Medical Department’s Estimate of the Situation,” pp, 444-446, supra.., - • 33^/t)ak*s Report, pp, 31-32. . 485 CHAPTER IX ■ . THE MOBILE DENTAL OPERATING- UNIT I, Introduction. A. The Dental Ambulance (1917^1919)1^ The problem of supplying professional dental care to smallitrdops units, widely scattered and lacking attached dental ■.personnel, was not unique to World War II. It was encountered by both American and ,French forces in France during the early months of World .War I,-.and soon led to official recognition .of the need for some type of ”mobile dental clinic”; a unit which, when fully, equipped, would be capable of travelling-under its own power.from one outlying station to another, remaining at each post only long enough adequate emergency service for .the command. . A special ”dental ambulance”—a conversion of the standard Red Cross ambulance-r-was. accordingly designed, and plans- were made .to- have a. number of- these, new units pro- duced as quickly as possible,, . Contributions were raised in the United States: for eleven such vehicles and, as soon as constructed,. these Units were shipped to the. ;East coast to await transportation overseas. Unfortunately,, due- to a lack of shipping facilities* the new ambulances remained' for many months at a home port of embarkation. Despite numerous, letters and cables from overseas units.' urging immediate shipment of the dental ambulances to France, the war ended before any of these vehicles had reached our expeditionary forces. Two dental ambulances were, however, pre- sented in Frapce to. the dental service. One, donated by two American dentists., had come originally from the American Red’ Cross hospital at. Mailly. After being thoroughly overhauled and re-equipped, it was finally placed in operation, with a dental officer in charge, on 1 November 1917, and was. designated ”Dental Ambulance No. 1, AEP'.’” Assigned to.a motor division located some distance bask of the line, this vehicle continued to operate during the entire period of hostilities, its station assignment being with.one or another of the several units of the motor transport corps in the vicinity of Mailly. A second dental ambulance was presented to the dental corps by the American Red Cross through its medical director in Paris. This vehicle was delivered about 1 March 1918, and was designated ”Dental Ambulance* No. 2, ASP.” Its station assignment was with the Air Service of the advance section, with headquarters near Colombe la Belle, and its first location at the second-bombardment airdrome. Throughout the entire subsequent period of the war, this vehicle rendered service- -to the several small “detached stations adjacent to Headquarters, Air Service. B, Peacetime Status of the Dentai Ambulance (1919-1941). While, due to the overseas shipping bottleneck, only txirb ■ dental,;ambuPancGs dve;r saw service with the American Expeditionary Forces;7 Ihe ;of' these, units was- evidently impressive • ' In 'the' Annual Report of The- Surgeon General for the year 1919, specific reference-.was made to these vehicles* and'the scope and usefulness of their activi- ties were described in some detail,0 It .was pointed lout, moreover, that the demand for mobile dental operating units by United States troops in-France had been-far in:excess »f the" token number actually supplied, r The need for dental ambulances—mobile dental offices-—has been indicated"-many.-.times during the ' campaign,- , , • The use-of dental ambulances' with outlying commands/ or ■ detachments-within :divisionalitraining areas, in the rear of-Combat sectors, .'or-with Air : h Service would ‘have proven' of great value, . in • inasmuch ■ as these'-mobile .Units . could .proceed :to the various,;,Iocationswith little loss of "time-,- either in actual transport or in the : unpacking and' repacking-of equipment ordinarily-• required of dental officers on- * itinerary service-,3 - ... In view of the above observations, made immediately-after'’the '61 bse bf the"'war‘On the- basis of actual combat experience,-It might-have seemed:-that inclusion of the ■ dental ambulance as a permanent- and1 standard adjunct ;■ of;;;-.. the field dental service would have followed-as:a/matter of ’ course. This, however, was not the case. Although a board ■ of three dental officers was appointed in 1919, to take advantage of the experience gained during the campaign, it does not appear that the development or standardisation of mobile dental operating units was included among the board’s suggested revisions of dental equipment and supplies,4 This initial opportunity lost, it was never thereafter regained. From 1920 to 1941, its funds drastically cur- tailed, the Medical Department was forced to confine its research and development activities in the field of dental operating equipment to improvement of the Medical Department. Chest #60-add periodic revision of its contents,^ The closest approach to a mobile dental service-*-though ’they bore little resemblance to the specially designed dental ambulances of World War I—were the travelling dental units developed in the thirties by the Medical Department to solve the problem of providing ade- quate dental service to the widely scattered work units of the Civilian Conservation Corps. On the recommendation of The Surgeon General the essentials of the new system were given War Department sanction on 3 December 1936* An organization of travelling dental teams was established, each team consisting of a dental reserve officer and two assisting enrollees, all to be transported by truck, with suitable operating equipment, for short periods of dental service at successive work However, inasmuch as these trucks were essentially cargo vehicles rather than self-contained operating units, the World War I concept of a dental ambulance was still far from being revived* II. Initiation of Development Project. P-39, A, Project Proposal No. 1. . Six months after-cur’, entr$; Into'World War II, official action‘was at last taken to .bohsider development of the ty.pe.eof-dental Vehicle which had/been sodtrongly recommended-In 1919*. On- 29 'May 1942, in at communication addressed:to the.Research and Development Division of The Surgeon'Gdneral’s‘Office, the Dental Service requested establishment of-a'-formal research project to produce a genuinely self-contained mobile dental operating unit. As evidence of the existence 3 of a military requirement for the item, it was pointed out that the Air Corps had already requested that three of these new units be suppiled as quickly as possible,? , This additional dental facility was necessary,, it was explained, for -the following reasons: " ■ ■ f a. To- furnish a more adequate dental service to small detachments not entitled to a dental officer by Tables of Organization, especially those-’-doing guard duty and .small Air Corps units in the zone of the Interior, b. This Unit could be used to*advantage in certain Theater of Operation but it is not intended for use in the combat zone. c* Dental treatment could be brought to small detachments thereby minimizing'the time lost from military duties,® Then foXlowed a brief statement of military characteristics for the; proposed item: (l) the unit should he mounted on ;a standardphag'sis; (2) it should provide shelter for the Operator and for the patient undergoing treatment; '(3)' dental equipment and supplies should he installed'in'cabinets which could he easily removed in the event' tdat the truck became unserviceable; (4) storage. cabinets Should he so located as to provide convenient, accessibility to the dental operator of all necessary .. instruments; (5) ‘suitable lighting facilities‘bhquld be/,, provided for night operations; (6) unit equipment’should include facilities for casting and soldering ope rations'.^ The foregoing project proposal .'did not , it will be seen, represent the strongest possible case that could have been made for the development of a mobile dental operating unit, Ho reference was made to the World War I precedent for such a un.it, or to the early official advocacy ..Qf t&Q dental ambulance.as set f orth In-The Annual•Seporb"df^The'burgeon ‘ General for the year 1919, Moreover, while the. immediate usefulness of the proposed-mobile unit as a-Zone of the Interior facility was stressed, the potential, .overseas demand for such an item was accorded only secondary, con- , . • sideration. In view of the fact that in the months to follow the most persistent, demand for dental 'operating .... vehicles was to comb' from the Hofth African Theatef/rabher than from Zone of ‘the ’Interior, installations,. ,and in view "of. ■ the additional' fact’that overseas need was' a crucial factor both in thb'bvaluaitlOh of "project proposals and.,in thef ’ assignment of research pflbrlties—the emphasis selected in the above' ins tane'e 'was ,doubly unf of tun.ate, , ' . The' ultimate 'rejection of this particular project request can, of course, scarcely be attributed to the single fact that tb,* Dental Service had not phrased its formal proposal as:'convincingly as it might, have•• Behind*this was the basic question as'to'whether a'flfin military- requirement for the proposed vehicle did in. fact exist. That question,, as ye shall see, was decided finally in the negative, ;' * . ' * ’ i‘‘ * On 20: May 1942, the Chief of the Research and Development' Division forwarded the Dental Service’s project application to the Medical Department Subcommittee with the following comment; It appears that the military characteristics of the unit have been formulated satisfactorily. 489 It is not thought that any serious.difficulty would be encountered-in designing a unit to .serve the purpose mentioned, but there may be ' vh'..pome question of whether.it would have a * ■' /’..sufficiently wide range of utility.-to justify its. standardization,!^ . With the’above communication, the documentary history of this first attempt at project initiation comes virtually to an end. Suffice it to say that the Dental Service’s request was not As there is no record that the case of the mobile dental operating unit ever reached the Medical Department Technical Committee for discussion,12 the presumption is that rt was allowed to die in.subcommittee. The only written indication of the specific reason's for this final rejection is a pencilled notation placed in the record by the.Chief of the Research . . Coordination Branch, This states that the s.ubject project was disapproved by' the Deputy Surgeon General, on the ground that there was no’ military requirement for -the' item in the Zone of the , . ■ ;• * , . r This decision to forego initiation of Development Project. «,3V39. made ty the Medical Department * in the early summer of 1942, was based upon the facts as they existed.., .atv that time. As ,-time passed, however, these facts were' t'b-change, ' Before the close of 19.42_r -an urgent need for denial operating vehicles was reported by the Twelfth Air ■Ronce'dri’North Africa, and in- the months that ! followed this,.unit0'Stated that demand had grown to' h point where improvisation would'no longer: During 1943 and 1944r. .of'these dental officers-in the North African Theater'began to be approximated in .other active theaters, notably in Italy and in the. South Finally, by. November-, 1944, as a result of . increases in the-number of small detachments and prisoner- of-war camps- in the -United States, even Service Command y;: requirements for mobile dental operating units had: risen . substantially - ■ ' ; Whether, without hindsight, .the Medical Department might possibly have anticipated this subsequent rise in demand for dental operating trucks -.is-' of course, impossible to> determine at this distance from the event. It can only be said in passing that failure to establish a development project in the summer of 1942 led ultimately to a number of difficulties which might otherwise have been avoided. As it happened even the necessary capital would have been available at this earlier date—and from sources outside the Government, In November, ,1942, $18,000 was made available to the Medical Department by the Dental Gold Manufacturers for the express purpose of assemblying four mobile dental operating units at Carlisle Barracks, Pennsylvania,' -However, since the Dental Service’s'request for development of this item had already been disapproved, the above offer was not .favorably considered. Instead, the money was diverted to development-’of a mobile dental labo- ratory* for* which-a formal Medical Department research pro- ject had just been established; • B#,-. ,• •. ;■ $he: Improvised Mobile Dental laboratory . ra ■ < , -r The dmpetun’.-behind this second attempt to secure Medical ..Department approval' of- a dental' operating , truck projeqt yras>supplied by dental personnel,.of the ‘ Twelfth Mr. Por.cestationed: in Northwest Africa;, Impressed with the urgent need,for some type-of self-contained dental operating vehicle which could bring'regular dental service to the many small and widely dispersed Air'’Force units in 1 that: theater, the dental, staff ’at Headquarters, Twelfth 'Air, Porce, wrote in May 1943 to The Surgeon in Washington,: stressing the ’great desirability of having mobile dental, - operating units in North Africans While awaiting official action in the matter, the dental staff, in cooperation with a local Ordnance section, Immediately -began■.experimenting. with, various types* of simple conversions;, •■dnvelvipg -standard Ordnance-vehicles, Finally , after some' weeks of;'Wprk/a .... somewhat crude but practicable mobile operating 'Unit was, deyise.d.hy mounting essential ’ dental ■ equipment oh a Small arms Ordnance repain truck; .. The improvisatiohywas . tried! out by the 560th f Signal Air. Warning Battalion, then located" in.'' Northwest Africa;,and,, after a fairly extensive service test, V . U ■- • -■■■■•.■ * 1 Q •* £ . ,'w • r was; approved ae-^atisfactory*-1 ■ " .'... .. . . ~ • Photographs ■ of . the new unit, together with. descriptive; data,..-were thereupon forwarded by Headquarters, Twelfth-Air Porce, to The Surgeon General's Office, and this action was followed by- a .cablegram to the Ordnance Department in Washington, requesting that an Ordnance Small Arms Repair Truck be demonstrated to The Air Surgeon as a conversion PD ° possibility*65 Neither of these actions, as we' shall see, was sufficient in itself to convince higher authority of the existence of a genuinely, widespread need for dental operating trucks* Thus far, it should be observed, the demand had come entirely from a single source. Accordingly, no action was taken by The Surgeon General’s Office with regard to the first communi- cation, As for the cablegram, while it fared somewhat better, the end-result was the same* The action copy‘of tho cablegram was handled by an Ordnance liaison officer on duty at Headquarters, Army Air Forces, He immediately * notified Air Corps officials that a small arms repair truck 491 would be made available for inspection at' nearby Bolling Tz Field whenever desired. When informed of the background of the proposed mobile dental unit and its previous disapproval by the Medical. Department, he indicated that he would answer the cablegram to, the effect'that •ifthe Office of The Surgeon General would be notified-of the recommendation for consideration of this truck for such;-purpose, if and .when a Mobile Unit was authorized, The promised notification of The Surgeon General*s Office was duly undertaken shortly thereafter by Headquarters, Army Air Forces, A one-page memorandum, summarizing the above cable*request and Ordnance1s intended reply, was prepared and forwarded to the Dental Division of The Surgeon General1s. Office on 30 July 1943, In concluding this resume report-, Army Air Forces Added these lines : It appears from Major Lightner's reoort as well as a detailed personal description from Brdgadier General Eugend G, Eeinartz (M,C,.l, who recently returned from a trip to North Africa .and while' there observed the improvised Mobile/ ‘Dental Ambulance in operation, that this type of truck is very desirable for this purpose* '* ; It is recommended that the projcctiof a ’Mobile Dental Outfit be again-presented for .approval when considered appropriate,22- A1though, thus far, it had signally/failed to accomplish its objective*, the Twelfth Air Force nevertheless continued' its Campaign.- On 10'September 1943, a letter was sent direct to The’Air Surgeon requesting shipment of twenty- four small arms Ordnance repair trucks to the North African Theater for conversion into mobile dental operating units. The mounting and installation of dental facilities would be accomplished, it was explained,' within the theater,^5 Two days later another letter was: sent ‘ to -The Air Surgeon, this time requesting incorporation of the Truck, /Tc[n, Ordnance Maintenance (less Ordnance equipment) into the Tables of Basic Allowance of ten specified Air Corps units. Approval for this'’change ■ was requested at "the ■ earliest practicable ’’ " '■ ' •*: . .... These two written requests, each highly specific and strongly stated, yielded'tangible‘results at last. Forwarded by The Air Surgeon's Office to-the Office of The Surgeon General on 11 October they elicited;a week later the following reply from the latter agency: 2, Attempts to secure a truck as a Mobile Dental Operating Unit have been 492 unsuccessful,- 'i • -•■‘" '3. . It Is believed that ; the. Truck, 2^T6n:,. 6X6 h (,4dt.) Ordnance. Maintenance, • L. .W» .... B, is satisfactory as an improvisation of a . Mobile Dental Operating Unit but heavier than required. •• .. 4. • It is, recommended that special . 1,1, "./’’'. ■ requisition for, twenty-four (24) Small. Arms ! . .. Ordnance Repair Trucks be initiated by the Theater involved.;• ■ - a Although the Table of Basic Allowance recommendation had *• been passed over, a. special -requisition, for additional Ordnance vehicles was- now authorized. - The Twelfth Air Force was-finally getting results. C, : The. Establishment of an Airr Service Command Dcvoiopinent■: Project» ;- • • Members of: the dental, staff -of. dhe- Twelfth Air Force had."been campaigning for six-months.,, by this,; time, to secure re cognition: erf;the.-dents,! .operatingvVehi.cie as necessary basic equipment for Air Force units in overseas theater-si I "With ; the. ./battle i-now-half won (by the .special allocation of twenty-four Ordnance trucks-to the Rorth ,- African-Theater for .conversion into dental operating units* the‘issue was soon-pushed .one logical .step further* On 1 November’ 1943., over-the .signature of Major Lee H. Lighther, Dental.Corps, Office of The Air Surgeon, Headquarters.Twelfth Air Forcct the following new action was initiated:; *... * 1. The*.-need .for a mobile dental unit has been’ quite apparent - in this theater for some time for the air force' organizations. 2. Experimentation has been done with • r the mobile dental unit mounted on a small arms ordnance repair truck,., pic-ture.s of- which are inclosed. 3. This mobile unit constructed with salvaged material has been quite satisfactory and a decided improvement over the present field dental equipment, 4. It is requested that further experimentation be done at the Aero Medical Laboratory and that servcral units be 493 developed for -t-his theater, i.'jjervice test reports could and would he submitted within two-mOnths from the time of receipt of the -mobile.dental Units , f • . . 5# The mobile dental unit pictured in the attached photographs has made it possible ,• for its dental surgeon to perform 50 per cent r- more work than would otherwise have been done* • . . . In short, improvisation alone would no.t continue to suffice. What was desired was a more long- range program looking toward eventual standardization and of a mobile dental operating unit. Since The-Surgeon General’s Office still declined to sponsor the':necessary experimental groundwork, request was now being, made of bhe Air Corps itself to assume this developmental•responsibility. The service testing function was to be delegated \o the .Twelfth Air Force, and thus, at-, no point would the-assistance, of the Medical Department be required,. 4 : t • -.v ■; Forwarded-promptly through channels, the above proposal was not long in.receiving effective implementation. On 1 December 1943, the;Chief of the Ordnance Aircraft Service, Army Air Forces Materiel Command addressed a request to the Commanding GeneralAir Service; Command, that three 6X6, Ordnance maintenance trucks, •less load, be procured for immediate- shipment, to Wright Field, Dayton, Ohio, The vehicles, it was/explained,, were to be used in the development of experimental mobile- dental units. Each truck-was, to contain a complete dental office, fully equipped to render efficient dental service;in the field. The three pilot models, would be completed-, as, rapidly as ■ possible, -service tested,, and then shipped immediately to overseas- commands,^ • • On 2 December 1543, this request was approved by Headquarters, Air-Service Command and was forwarded for action to.the- Commanding General, Army Service Forces, Before the middle, of December, Ordnance, Department had received- instructions.to procure and ship to Wright Field three small• arms repair, trucks as specified,^ D,-. - -Project-Proposal .Ho, 2 (Medical -Department). v/... As might he expected it was not, long "before news of the above activities came to the attention of the ■ '• * rzi Dental Division of -.The Surgeon General’s Office, • Almost that office wont into action* On 18 December 1943r—jus t; .sixteen days:-after approval of the Air, Service Command project—the Dental Division re-introduced its petition (rejected .a year and, a half earlier) for the establishment of a. Medical Department'project to develop a mobile dental operating unit.i- • Viewed as an alternative to continued Air Force activities in;this:-field,.the above project proposal had, of course, much to-recommend" it." There: were a., number of very valid reasons why , if this experimental, work was - now definitely to be"mdertaken,, t&p Medical Department:, rat her than the Air Service Command should assume full control. . In the first place, the proposed .mobile dental operating unit was not an item.of equipment peculiar to Army Air Forces-, but was an item of Service-wide applicability.. It could (and subsequently did) serve all types of small isolated troop units lacking assigned dental personnel— whether those units happened to be elements of the Air Forces, Service Forces, or Ground Forces. Hence, according to the principles of project allocation sot forth in Ar AH 850-25. which delegated to Army Service Forces, the responsibility for development of all items of equipment except those ,!of primary interest to the Army Air the Medical Department rather than the Air Service Command was the proper' development authority in the present instance.. In the second place, the mobile dental oper- ating unit proposed by the Dental Division was designed to fit into a complete and integrated~Medical Department vehicle program, in' which the,.; newly s tanda'pd’i ted ■ surgical truck:;was. , to serve as-' bhbid: r,Shis". latter- vhhielb will be* recailhdv tff a Medical 'Department-Vhn %bo.dy, with appropriate or...fittings,: Counted o-n. the chassis- of a S-g^tohj1 6X6,^^Grdnancq..cargo'truck. The "model selected for experimentation by the Air. Service Command, however, was a 6X6. Ordnance small antis repair truck, the body of which had six windows on each side instead of two as prescribed in Medical Department specifications and was six inches wider and shorter than that of the _ atandard surgical truck.34 Clearly, the adoption of such a vehicle would be a serious obstacle to the attainment of the maximum uniformity of design'and maximum interchange- ability of parts which was now being planned for all mobile medical units. In view of these as well as other consider- ations, it was evident that the Dental Division, from a purely strategic standpoint, had chosen an .extremely opportune time to re-introduce its project proposal. There were now not only, as indicated above, serious dangers in further inaction, on the part of the Medical Department, out there was, in addition, the growing rivalry between the Air Surgeon’s Office and the Office of The’ Surgeon General to te.mpt the latter into positive action* Also, however slight the’demand for dental operating vehicles might have been in May 1942, when the project was first rejected, that demand had now increased appreciably* Finally, there was additional hope in the fact that .the- now Surgeon. General, who had. taken office in June 1943, was felt to be especially sympathetic toward the idea of a more motorized dental sorvice.3^ , Ml-of these justifications of Medical Department, action were., of .course, valid only if this action-was- to he taken as an alternative to, and not a duplication of,-Army Air.Forces experimentation. However— and this.was an extremely serious ommission—no reference whatever was made in the Dental Division's present memo- randum, to the paralled experimentation which was currently about to he set in operation hy the Air Service’ Command. It was simply- pointed out hy the Dental Division that numerous requests for these mobile units had recently been received from Theaters of Operations, and that the need for a service of this character for small detachments and training areas in the Zone of .the Interior had also become quite evident. In view Of" this definite demand, it was recommended that a research project he initiated immediately to produce a vehicle possessing the following military characteristics: ... •, J a. The unit to utilize the standard surgical truck chasis and body. h. -The unit to he equipped and .stocked with standard items from the Medical Supply Catalog except for utilities so that general dental operative procedures can he accomplished to include fillings, extractions, and the taking of impressions. t • ■ . ■: c. The unit to he; self' sustaining from ■the..standpoint of light,- heat, and power. . : - d. The.equipment to he "Securely installed hut - capable of 'being . removed. - :• • • • : „ On 21 December. 1943,- except for recommending an increase in research funds- from $5,000 to $10,COO, the Medical Department Technical Subcommittee approved without change or addition the project request of the Dental Division,Six days later, the report of the Subcommittee was approved without modification by the Medical Department Technical Committee—with a representative of the Air Surgeon’s 496 Office prosuht-’-'aildvopnhu^rihg,,38. By this action of ffts own liaison Officer * Army Air Forces was joining the Medical Department in endorsing whdt was, in.effect, an exact duplication of its own recently launched research under- taking, :',’v • - . On 30 December 1943/ with the approval of The Surgeon General,-all the foregoing documents were forwarded to the Commanding General, Army Service Forces, with the request that the recommendations contained therein he On 6 January 1944, the Development 'Branch of the Hequirements Division, Headquarters, Army Service Forces,—the same office which three weeks before had cleared Air Service Command’s request for authority to pro- cure three Ordnance repair trucks for conversion into pilot model mobile dental operating- vehicles^—approved the Medical Department’s request without comment'. * III* Development Phase., A* She Army Air Forces Controversy. During January, 1944, the issue of Medical Department versus -army Air -Forces experimentation was at last brought out into the open, and for a brief period-it appeared that duplication of research effort might be elimi- nated after all, ” :: . D~'y' *4 .. 4':0rh3Pf 1943, in a commuhicat-ibn ..addressed to The Surgeon General, the Air Surge on. Ds Office stated that it was contemplated that'the’Aero Medical Laboratory at Wright Field would establish fifty mobile dental'-'operating units during the early part of 1944, and that, accordingly, requisitions for. equipment would-be-submitted to The Surgeon General’s' Office from time to time, depending upon the pro- curement of the trucks in which this equipment was to be installed. 'A detailed equipment list was attached to facili- tate future shipments.^ In short, as soon as a satisfactory conversion had been worked out, the Air Service Command’s initial experi- mental order for three small arms Ordnance repair trucks was to be followed by what would, in effect, be a production order for an additional fifty vehicles. This was, of course, an entirely logical proposal. Army Air Forces had been officially authorized to initiate a development project to produce a mobile dental operating unit. Once a pilot model had been constructed, service tested, and approved, the placing of a quantity purchase order adequate to meet Air Force needs WP-S the natural next step in the process* The fact, however, that this ambitious program was running directly counter to the Medical Department’s own intended efforts in this field, was now clearly recognized by the Requirements Division, Army Service Forces, through whose hands the above document next passed* In a first indorsement to the Air Forces Communication, Requirements Division called the attention of The Surgeon General’s Office to the fact that Headquarters, Army Service Forces, had, just two. days earlier, classified the dental operating truck as an experimental Medical Department An explanation, of this apparent duplication was evidently in- order. . With the. issue thus clearly drawn., action was soon forthcoming,' On ,10, January 1944, at a meeting of the Medical Department Technical Subcommittee, the problem of intcr-Scrvice duplication of-research in this particular* field v/as discussed at some length. It was pointed out by representatives of .The Suhgeori’General ’s Office that the' Medical Department had aiheady, initiated a- project aimed at the development of an item identical in purpose to that proposed in this latest Air Force, communication. Apparent- ly not electing to make ah issue of the fact that, strictly speaking, the Air Force, project had antedated that "of the Medical Department by more than.'a -month, the- representative of Headquarters , Army 4-ir Forces was quoted-as stating that the existence *of this.Kedical Department project had not. been known at.the time the communication in question had-been . prepared,-, and that ’’the Army Air Forces-would be agreeable to awaiting development of fer,standard Mobile Dehtal’Unit, This understanding—-that Army Air Forces would drop further consideration of the activity proposed in,its last communication—was forthwith conveyed by The. Surgeon General1 s 'Office, through the Commanding General,' ‘Army . . Service Forcesv to the Commanding General, Army Air' • f . Forces * * -Inasmuch as no record has been found of any; • further, borresp oh this subject either from Army Service Forces '.of-Army Air Forces, it is presumed that.-the. arrangement describe’! above was accepted by all concerned. A careful reading of these proceedings v/ill disclose that actually, little had been accomplished by the 10 January meeting with respect to.the elimination of dual research* The Army Air forces had not- agreed to discontinue full scale experimentation at the Aero Medical ia-boratory with the three Ordnance trucks already on order. It had merely agreed to postpone the requisitioning or outfitting of any additional vehicles pending development of a standard mobile dental unit. It was nowhere stated, moreover, that the "standard Mobile Dental Unit" might not be an Air Force development just as well as a Medical Department development. 498 In short, so far only the danger of a duplication of final production orders had been averted* B# Liaison with Army Air Forces^ Eyeu• though no assurances had been obtained from Army Air 'Porcps that it would discontinue its independent investigation, of mobile dental operating units, the Medical Department nevertheless went ahead with plans to invite the Air Porces to send a representative to Carlisle Barracks for on—the—spot consultation and liaison with Equipment Laboratory officials. In-its letter to the ■ Commanding General, Army Air Porces, reporting the, results... of the' 10 January conference, The Surgeon General1s Office added this final-paragraph: . The Medical Department-development project,' "Truck 2-|-ton 6X6 Dental Operating Unit" will be carried on at the Medical.Department Equipment Laboratory, Carlisle Barracks / Pennsylvania, .Its -supervision will'be- joint by • the Dental Division and the ..PieId Equipment ;' Development Branch, Plans Division of this /*• officet. In addition cooperation by a dental representative of the Office of The Air-Surgeon. ' Headquarters, Army Air Eorces will be' welcomed,46 On 22 January 1944, Army Air Forces replied that ! it would be pleased to detail a representative to Carlisle Barracks for temporary dirty, and requested information as. to when such a trip might be made,4 The Surgeon Generalrs ' Office, concurring with- the above, informed the Equipment Laboratory that a representative of the Aero Medical' , ", Laboratory, who had( done.considerable work with mobile' dental operating units Knight Field,- would attend ’ ", development of the-’Medical Department's' pilot model,46 The necessaiy coordinating action was-take A-in due course ‘-"With! the result that an Axr- Force- liaison office-was- present at * the Equipment Laboratory throughout "the''greater part;: of the construction period,4^ This intcr-Service cooperation, despite the continuance of paralled experimentation, at least paved the way toward a more willing acceptance by Army Air Porces of the Medical final product. C. Construction of the Dental Operating Truck. Inasmuch as the standard surgical truck had been specifically proscribed as the model to be used in the present conversion, and since the conversion work itself would 1)6 governed to, a considerable extent by the structural patterns already established* by the Army medicai; laboratory and mobile dental, laboratory developments, there wap little, need in this situation for a lengthy- prelim!nary inyesti- gation of all possible, research ;aiternativQ&*;^. There was, however,, in the files of The Surgeon General1 $ -Office , , certain-background information with which research and' ( development personnel were familiar, and which, at least' in’ one instance was to prove useful in the. subject project. The Research and Development Division, for example, had requested and received photographs of the 3~ton Dental Lorry being used ."by the Canadian Army* The Director of the Dental Division had obtained a description of two mobile dental units developed in England during the early part of 1943 by United States Eorces—these units consisting of 32-passenger, diesel power motor buses, equipped with dental chairs, dental units, and X-ray facili- ties, and supplied with individual power plants transported via trailer,51 But most important of all, officials both •f The Surgeon General's Office and of the Equipment Laboratory were thoroughly familiar with the Ordnance repair truck conversions which had been performed by the Twelfth Air Eorce in North Africa, Actually, the Medical Department had, itself, participated in that experimentation to the extent of: furnishing The A‘ir Surgeon's Office with a detailed requtpment list for the unit As .we shall see, thiSv previous;- assembly of an equipment list did much to expedite .thb'-selection of dental items to-go into the new •Medical .‘Department truck, ■ ■ nr ■ ■ On 12 January 1944, the Research and Development Division of The Surgeon General’s Office notified the Dire-ctoi* of the Medical Department Equipment Lab-oratory that the1 initiation of a research project for .a mobile dental operating unit had been approved by Headquarters, Army Service Forces, and that $10,0Q0 had been authorized for the development work. In addition, the communication contained an especially clear statement of the division of responsi- bility which was to obtain during the course of the project. The- Dental Division, it was explained, was charged with, the preparation of a complete equipment list, a copy of which would be sent to the Laboratory as -soon as it was finished. The specified equipment,/Would then be requisitioned by the Research.-and Development Division-fOr.direct shipment to Carlisle Barracks,,tRpqu|st;had already'been, made for authority: to purchase; one ton, 6X6,1 surgical truck and, as soon as this vehicle was received qy thp Equipment Laboratory, it was desired that- conversion work-be,-..begun,53 ■ ;He-re .was central pbluey control at; its best. All major duties-had,.been precisely allocated. There was, no 500 residual overlapping of function. Moreover, considering the liaison arrangements with Army Air Forces which had already heon worked out, close inter-Service coordination was assured. Finally, care had been taken to avoid the lengthy delays that had been encountered in previous projects as a result of:de cehtraii z e d • purchasing;procedure s, In. the present instance instead of'delegating.this function to the Equipment-.Laboratoiy/ 'a Glass’ it installation, ail supplies ..and to'^':be;1Cdntraliy by the Research.and .Development division of'ThC Surgeon General’s ’office,- ;'. ■ ■- : ,.‘//‘y v- x *.These-several" measures set tile tone .f or the pro- ject* -Asvwil.l soon become evident," it was no accident that the dental operating truck was completed in the record time of 45 days.,-: r: i ' Haying already thought through the problem, of equipping a mobile dental Operating unit—both in connection with its previous project proposal of May,. 1942.,.,and later in.response, to-The Air Surgeon’s request for.an equipment list which might boused by the•Twelfth Air Force.in its experimental work—the Dental Division hadJ little difficulty in revising these'.earlier lists to meet current requirements. Accordingly, on ,14 January 1944, just eight,,days after ■ ,, approval,of the subject project, a four-page equipment list was forwarded ..by the Dental Division .to the'Director of the Equipment .Laboratory at CarlisleIn the;;accompanying . ; . letter of transmittal, attention was1 called to 'the. .fact that certain, additions-and deletions' suggested by .tiio Laboratory and by the. Air Force; liaison representative ’had. been; made- in preparing.-the’ attached list,'' Except fbrJ the; ppasible;;j sub;stituti on of? •&? Signal '.Corps-generat or for, Medical,; Department'power unit now specified," the re 'being' some question as to whether the latter*unit could’ produce the amount of electricity required., no further revisions of significance were anticipated:,^*1 *; The Director'of'theMedical Department Equipment Laboratory”, apparently having already learned of the dis- cussion regarding the Signal Cohps versus the Medical Department generator, lobt -no-time in expressing a prefer- ence, On 14 January 1944 the same day the above communi- cation was mailed, the Laboratory sent a letter to The Surgeon Generalrs Office requesting that a Signal Corps power unit be.selected for installation in the experimental dental- truck* '.and also that this item be centrally requisitioned in order to save time. :r. : Prompt and energetic action on this proposal was taken the following day, The Surgeon General’s Office addressing a request to the Requirements Divisision, Array 501 Service Forces, that authority to purchase a Signal Corps generator he granted the Medical Department at the earliest date practicable* It was explained that the. item was neefted immediately for experimental.purposes The decided note of urgency v/hich had been injected-into the above.letter produced results. Within.a week a reply had been received from Army Service Forc.es, -approving the purchase request and authorizing direct communication with the Chief Signal Officer in order to expedite procurement,5? Before the close of the month,,the power unit had arrived at Carlisle : Barracks,5® , \ . Authorization for the purchase of an experimental vehicle having by this time been obtained*, on 19. January 1944, the Equipment Laboratory requested the Commanding General, Carlisle Barracks, Pennsvlvania, io requisition one surgical truck from the Army Service Forces Depot at';; Pdchmond, Virginia,39 Five days later, the truck was ■ delivered to the Equipment Laboratory, whereupon construction work was immediately Thus far, only 18 days had elapsed since the date of formal project approval. The first operation was the removal of the pre- installed surgical equipment, cabinets, and other items from the interior of the Upon completion of this task, the actual conversion of the surgical truck into a pilot - ■ model dental' operating unit was initiated*,. Additional- - window assemblies, and; a new electrical' system were,-installed The van body of', the truck was modified to', conform':to the new ■ design. Storage cabinet.s, table tops, and .shelying were•••■ prepared for ready installation. 63 - ,v>:; ’• By 29 January 1944, well in, advance., of completion of the above operations;, all of the dental equipment and supplies which had been requisitioned by the Office of The Surgeon General had, with the exception of a very few items, arrived at the Equipment Laboratory. Arrangements were thereupon made to have representatives of The Surgeon General’s Office.,, the Air Surgeon’s Office,’ and the Medical Field Service School meet at Carlisle Barracks to render final decision in regard to the location of the equipment which was to be permanently installed in t&e truck. It was further anticipated that an officer from the Aero Medical Laboratory, Wright Field, Dayton, Ohio, would arrive shortly to begin a two week tour of temporary duty as liaison adviser to the Equipment Laboratory staff.®3 It was not long ‘before a decision had.been reached, through joint consultation, as to the placement of the perma- nent equipment as well as the general layout of other interior fittings* Actual installation of dental equipment and packing of dental supplies then went forward under the 502 supervision of the Post Dental Surgeon, Carlisle Barracks, and the Director of the Dental Division, Medical Field Service School. A representative of the Aero,Medical Laboratory was present throughout this part of the con- version period. Having *se.t an extremely early target .date for the completion of the project, the.staff of the Equipment Laboratory devoted.a considerable portion,of its:time to this particular activity during the weeks to follow*--Duo partly "to this fact, and .partly to the complete .absence of outside .interference—last-minute equipment lis.t revisions, changes, in interior design, and the like—work on the truck progressed smoothly and rapidly. By 21 February 1944, the mobile unit was finished—just six weeks after formal .establishment of the project, •' Equipment Laboratory officials were highly satis- fied with the new vehicle, so much so in fact that, in a letter to The Surgeon General announcing completion of the truck, it was suggested that a brief field trial of the unit would be all that would be- necessary. It was pointed out that interior truck space was sufficient, that only standard equipment had been used, and that whether additional equipment or less equipment was desired, this would make little difference unless special installation was required. This latter remark referred to certain Air Force recommen- dations which were being forwarded in the same mail. Representatives of the Aero Medical Laboratory, while apparently pleased with the unit,• desired to make a more complete.; use of storage space, by adding laboratory, equipment. ’Their proposed' supplementary ,11st contained, twenty-eight items, in quantities ranging.from one to"four each, all relating primarily to prosthetic -r ..... .* On 27 February 1944,: the-hew unit was driven to- Washington for an on-the-spot■inspection by members of-The Surgeon General’s Office,®'* The reaction,* as will be seen' below,.-.was extremely favorable,- . Moreover, Air Force • • ;jJ re commendations -for the'..inclusion of dental laboratory' ':U'; equipment.; were; overruled,. Equipment lists were, it:was stated, t;P remain intac£--at'least for the time being; Again -I;wdsh’ 16- }compl -you on the 1 yery nice job, -in pmcthcing the.,’.pilot; .model of , the’ Mobile ' Dental.-,,‘Operating Unit * :,■ I. looked it Over and . cbuj,dnIt i. find h thing]. t p •cri.ti ci ze*•' Xn reference to the extra_equipment recommended . by Poster and Appleraan, ./.theiAir'’ Fofce repre- --.I . septatiyes/ pf’ the opinion*1 Vis'should*.'. •"'hot be/included V"? ■*. *'-• -y./Jh ed* ?;:i i " ' . ’ ri General Mills /Director of the Dental Division/ is of the opinion that the uni,t should remain as is and-that ajft&x d 'dental officer has used it he can. ad anything he wants to it,0® Photographs, -specifications, and drawings:■ for the new unit were prepared by the Medical Department -Equipment Laboratory and delivered to The Surgeon General’s Office- on 26 February All thet now remained to be done;was to test the performance of the vehicle under field conditions. D, Service Testing of the Dental Ope rat irig" Truck, From the start' of this project it had been recog- nized that the need for mobile dental, operating units had already become too urgent, to permit an elaborate type of field testing which might extend over a. period of months. The attitude of The Surgeon General’s Office on this, point was reflected in, a letter written by the Director of, the. Dental Division to the Director of the. Medical Department Equipment Laboratory on 14 January 1944, which contained this statement'! > • The ided at present is'tb-standardizd'this unit- without a .-service, test*7' It■;might be a good rf Idea, when- completed, to put’a dentist;1 f-roii:t your 'post-iin./it and let him’operat e there-’fieri a/weSk47Ql4.ci-x * lo *>•.* _-r . ... '-This 4 intact', the- plan. ,that was' subsequently followed; " Upon returli of :the pilot.model dental operating truck from‘Washington to Carlisle. Barracks in March, a four- day field service test of the unit was immediately initiated by personnel of the Station Hospital Dental -Clinic of that post. The comments of this group of officers', itfhich wore forwarded to the Equipment Laboratory upon completion of the test, 7 March 1.944, are quoted here in full,-' We have had the dental operating unit in use hero for four days, and it was operated by different dental Officers each day with very satisfactory results. They report they wore able to care for patients adequately and at a rate equal to their offices in the regular clinic. They suggested only one change, that is, in the operating light which was a little too- diffused. This will be taken care of. The following items of equipment are desired! 1, Forceps of some kind to take hot instruments out of the sterilizer, such as, large 504 dressing or sponge forceps, io.t:a "• 2, Flashlight, • • .' ’• ' 3, Wire .brush to clean burs, Item:.50310. . •; '-’4v., future needles■cur-yed eye Ho, 1, * '-5* Wheel bristle polishing brushes-(now in supply h’-vf- table as old,-.disk, .bristle, .an, issue 'while • In stock)',--: 6, A ball burnisher, probably - Plugger Ladmore double end; Item 54400’ wotild ■ do. V 7, Points., assorted for angle and straight hand pieces,.carborundum, mounted; Items 54540 to • -54830. -f / - -. 8, Brush tooth,ppplishing Item 53020;' an.si shoe** . while in stock, ”v j = Otherwise they had no other comments, Colonel - Harper talked ’to me about it and;s aid he; was also • writing you. One officer suggested sky lights, but. their value, would not be much in comparison to the cost and engineering required,. . .' • We- .are holding the truck now awaiting further • A summary: of the foregoing,-report, together with a copy of the list of suggested additional equipment, was r forwarded immediately by the Equipment Laboratory to The ' . -Surgeon,..Generalfs Office, Four days.-later, on 11 March :;V : 1944,: a revised"equipment, list was prepared by the Dental ' T-Division,, incbtpbra.tfing’most of the-re commendations which - had-been ma.de- by the.-testing officers- at Carlisle Barracks, ' After submission-of these changes .tpvthe newly- organized Technical Division: (formerly Research,and’ Development ■ ': Division) for concurrence, the list- was sent on to the Supply Service for fihal ‘ac-tien, The .dental operating, truck was now ready for standardization,. .. ’ , • ' • ’. Exterior .and interior photographs of the completed mobile dental -operating unit (sbe Figures 31 and 32) are presented in the pages injmediately foilowing, IV, v.Standard!zation and .Procurement, •A# Standardization Phase.? Within a week after construction of the dental operating truck had been completed, members of the Technical Division of The Surgeon General's Office were busily engaged in assemblying the data necessary,, far standardization of the vehicle. By 28 February 1944—before the new unit had even been subjected to field trial—this information, complete except-for a final determination of quantity requirements, was forwarded for action to the Medical Department Technical Committee. Computation of total requirements and replacement rate was obtained a few-days later* .On a proposed basis of issue calling for (a) four mobiletdental operating units per Table of Organization and Equipment 8-500 (Dental Operating Team) and (b) two units per Table of Organization and Equipment 8-611'(Medical Depot Company),requirements for 1944 and 1945 were calculated by the Supply Service at 138 -i and 39 vehicles, In the Technical Division’s original memorandum, an additional bulk allotment of fifty vehicles.had been established for Army Air Eorces* At the request of The Air Surgeon’s Office, this figure was now increased to fifty vehicles for 1944 plus twenty-five for 1945* It was also suggested by The Air Surgeon that distri- bution of the subject item to Air Force units in the various Theaters of Operation be made ”in accordance with their tactical needs”, this allocation to be accomplished at the discretion of the Surgeon of each Air Force, with the coordination of the Air Surgeon*^ With preliminary data now complete, on 3 March 1944 the Subcommittee of the Medical Department Technical Committee met and approved standardization of the new item under the nomenclature, ftTruck, 2-g—Ton, 6X6, Dental, Operating*” It was further recommended that the Ordnance Department he responsible for specifications, purchase, maintenance, and inspection of the truck chassis and body, electric wiring, lights, hot water heater, sink, and plumb- ing* Responsibility for all other supply and maintenance functions affecting the unit should, it was proposed, be assigned to the Medical Department■ On 6 March 1944, '.'the above report was approved by the Medical Department Technical Committee with but one Modification.' It was decided that, instead of a single listing' for both truck and equipment as1, suggested by the Subcommittee, the Medical Department equipment for the dental truck- should be. standardized under a separate item number before.incorporation into the‘prescribed Tables of. Organization and This change was more signifi- cant than might'be ;supposed, ' ' / a In? the case., of the mobile, dental7 laboratory, where a single[rathem.than..a.double listing.'method had been adopted*-[Considerable' inconvenience and confusion was subse- quently:, experienced; Hot only diderequisitioning procedures immediately, become' much more complicated*;'but it was soon discovered .that in depot s'.: where dental -laboratory equipment was assembled, spparateiy from the' truck,... there was no proper 506 QQ means of accounting for it for storage and shipment purposes, Such difficulties had now been avoided by the :above action of the Medical Department Technical Committee, AS',.we have. seen.in the preceding section, on II March 1.-944 ,a final .revised equipment list,, incorporating changes suggested by testing.personnel at Carlisle Barracks, was prepared by .the. Dental Division and submitted to the Supply Service of The Surgeon General’s Office, ' On the following day,, all of the foregoing .stanclardization data was ' forwarded^for apuroval, to the Commanding General, Army Service ForcesAuthority for the’designation of the ” mobile dental operating unit as a, standard article was granted by that office on..16 Inarch.1944,®3 B* Procurement Phase. While it had taken only two and a half months to develop, test, and standardize the. dental operating truck, three additional months were now; consumed, in getting the,item into procurement. The problems encountered'at this state were for the most part minor, or.technical in nature and.their solution was not difficult, but in the'aggregate they repre- sented a rather substantial loss of time;. In several' instances, moreover, it would seem that,Resent,'difficulties' could have been avoided by more careful; ■admlhistr'at'jLdn' during earlier phases of the project, ... . * ' ' ;; ;4 . * :‘7 For example, a week’s delay was' now necessitated / because of an error which had previously been made' in Cost • * ‘ ; computations * While an operating chair, dental operating * unit, and:operating lame appeared in the latest Equipment • l-' List for the subject unit, somehow the cost of those items ' ■ had not been included in the total Equipment List cost, but instead had been included in the estimated cost of the dental This discrepancy was duly called to the attention of the Technical Division by the Catalog Branch of the Supply the error was admitted, and by 28 March 1944, a new breakdown of cost data had been forwarded to * ftfi Supply Service for the indicated recomputation. It was soon appeared that not'only had price statistics been calculated somewhat too hastily during the preceding StandardizationiPhase, but that basis of issue had also been described with some inexactness. The designation ’’Four. (4) per.T/0 and.F 8-600''(Fehlal 'Operating Team)” as one of th§ distribution criteria'; for I the',; mobile dental operating.unit was, the Technipal' plvision discovered upon reflection,; hadly in need of amendment,' In the first place. Table., of -Organization and Equipment"3-500 was the table* for” ' 507 the Medical Department Service Organization rather than for the Dental Operating Team alone as implied above, this latter team being merely one of many components of the parent unit;, In the second place, only one dental operating team—not four—was authorized for each service organization* In order to clarify this particular requirements criterion, therefore, it was requested by The Surgeon General!s Office, on 28 March 1944* that-the above basis of distribution for Truck, Dental, Operating, be changed to read as follows* "One (l) per Dental Operating Team* T/O&D 8-500*,r Inasmuch as it was felt that this would probably have been the interpretation of supply officials even in the absence of a clarifying amendment, it was not believed that the proposed change in wording would produce any change in total requirements for the vehicle*89 On 31 March: 1,944* approval' for this action Was-granted by Headquarters, Army Service. Forces.,90 ' ' . : " During, .the months of April and May, 1944, aside from a few technical:changes in specifications and equipment, little was accomplished on the subject project. On 13 April 1944, The Surgeon ’General1 s Office notified the Equipment* Laboratory that the pilot model dental operating truck was to be sent to Army Medical. Center, Washington, D, C., on: ■ 15 April 1944 for formal presentation to the Medical * ■' Department by the Maryland State’ Dental Laboratory Guild and . the District of Columbia Dental Laboratory Association,-- It , was further requested that the’unit be sent -on XI,May 1944 to Buffalo, New York, for, a similar presentation by the U'Vn.. Dental Society of the: State:- of,..Hew York’, / ; . On 36 April 1944, recommendations for certain• minor and largely formal changes' in specifications were forwarded to The Surgeon" General is Office by the Army Medical Purchasing Office in Hew York City.Upon com- pletion, a week later, of a now set of specifications incorporating^these suggested changes,93 nothing further appears to haire been done by the Technical Division until 24 May 1944. On this date a last-minute substitution was suggested to the Supply Service. It was requested that the Hittch1 Dental Unit be furnished for the dental operating truck instead of the Weber Dental Unit previously specified. It appeared that the latter item, which had been installed in the pilot model, had already begun to show signs of considerable wear, and also that all dental surgeons con- ferred with had recommended that such a change be made. On 17 June 1944, after the above rather considerable dalays, a purchase order for 35 dental operating trucks, at a unit cost of $9,000 (including equipment), was placed by the Army Medical Purchasing One further last .minute change in .specifications- was necessitated shortly 'thereafter..when it was discovered by the Equipment Laboratory at Carlisle, that .the type of paint which had been ''prescribed for the. interior equipment was nlusterless" instead of, the.-.type.,specified for all other mobile* Medical' Department Units, 6 Upon completion of this change., no further.,diff.icultie,s.. incident to the procurement phase; of the' project were encountered. v - CV *; Dj: s t ri~but x on Pha's-e. On 22 September,1944, the following;announcement— .the first of its. kind noted thus far in this series of studies—was sent by The adjutant general to commanders qf all theaters, defense commands, departments, and bases -over- seas; . 1, In order to provide dental treatment for personnel of.units which either have no dental officer assigned or which are not located near hospital installations, there has been developed and standardized Medical Department item #99588-05, truck, 2^*Ton, 6.X6., dental operating, and Medical Department item #99588-10, truck;2-|—ton, 6X6 'dental 'operating, equipment for. ' / , 2, *' .It is antipipated -that 32 of these trucks 1 with dental equipment will be available for issue to Oversea theaters, by 1. October 1944 with additional ones becoming available- monthly. 3, . The personnel required for the operation of the. above equipment is as follows: 1st Lt,- or Capt *Dental Corps 1 .‘ Dental, technician, SSN-855 1 ... Aggregate 2 4. All oversea theaters having requirements: for Medical Department items #99588-05 and #99588- .10 should submit requisitions in normal manner, *. for consideration. If no requirement, exists it is - requested that The .Surgeon General be so -advised, The above communication was an excellent, .example of informative and well-timed.advance,. publicity. Assuming that this ''letter was subsequently given appropriate distribution within each of the.commands concerned, few. overseas units should have bqen unaware' of theexistence -of .-.the- newly j,r I developed dental operating truck.and of its imminent ;-?• availability fpr overseas .us.e, Moreover ■ as.-a result of the direct solicitation of orders for the new vehicle which .was included in the above announcement, supply officials in The Surgeon General’s Office were now in a good position to obtain an extremely accurate picture of total overseas requirements. Unfortunately the expectation that.32 new dental operating;trucks would be available for overseas*shipment by 1 October 1944 proved to be somewhat over-optimistic, October deli varies, on the original factory order .Of 35 ch vehicles, placed in June, 1944, totalled only two'. Fifteen more.trucks wore--delivered in November;, and it was not until the following month that the last*of,the 35. units had reached our medical depots,In terms of combat utility, therefore, the mobile dental operating unit, cannot be said to have seen any very extensive service before the first quarter of 1945, • w . The flow of new dental operating trucks was con- tinued well into 1945, Additional production contracts were placed and periodic deliveries made throughout the first three quarters of that year. As of 31 October 1945, a total of 138 mobile dental operating units had been contracted for all of which had been built and'delivered. ’Compared with a total production, aS of'this'same,date, of ,.37 optical repair trucks *■;'7.7 medical laboratory trucks.*...and 107'dental labo- ratory It .wxllbbe seen thatpthe- jjmportance'of the dental' operation. truck, -from’ the' standpoint-.pf, quantity requirements, ;was considerable. Only--the: surgical oper- ating trucks were, at this' point, in greater demand. An idea of the overseas distribution of the dental operating;truck, as projected in October, 1944, can be gained from the following table-5"T - Truck, 2^-Ton, 6X6, Dental Operating. Theater of Operation * Authorized by. 31 Dec* 1944" Authorized by ‘ 3l' Doc. 1945 Pacific-; Ocean. Area' 5 ’ 5 ‘ Uorth.African TJieater -:e- ; is 20 China~Burma~. India’’ * • 18 -v •• . •;... .18 : • ' So* Pacific Base Command ‘ 4 I European Theater ’■ 33--..- r,,,'. / ' ‘ 33v Southwest Pacific Area 15 •' . . . . ' 15 510 Vj» - The Dental Operating Truck (Army Air Forces), ■■■■ Although aware that the Medical Department had already launched a full-scale development project' to produce a mobile dental operating unit—in fact, hayipg given its formal concurrence to the establishment ..of that project—Army Air Forces nevertheless went-ahead with its own experimentation in this' field. On 11 February. 194:4—just ten days before completion of the pilot model dentalLoperating truck (Medical Department) at Carlisle Barracks,■Pennsylvania— the Engineering Division of'Array AiriFdrces Materiel Command issued a lengthy-report ’describing all the various mobile dental operating' which,had been brought to the attention of the Aor.oiMedical Laboratory at Wright Field, Dayton* Ohio. The report was evidently intended as a pre- liminary survey of the research.field,. indicating the alter- natives that were.,being! considered. As was expected, this was followed somewhat later by a second technical report. . describing the unit which had subsequently been developed by the Aero .Medical-Laboratory The Air Forces,1 February report included a description- and. discussion ~o£ a njmbcr of different experimental. Cental:: operating Units, : Trailer'conversions; !for-example, had been tried but at several Army Air Bases * At. the - Sapid City: Armyn Air'-Base', .Sapid Gi.ty,: South Dakota, an Army Air Forces office- •'tlrrai'X"or. had been fitted' .out as a dental office and had been used successfully-in the field. At the Army Air Base at' Great Falls, Montana, a dental trailer -had'been made up and used to supply-dental service to three satellite fields. Inasmuch as a, touf of those fields: Involved 900 miles of travelling, the trailer innovation had amounted to a considerable saving both in patient-time and expense to the Government, Finally,- the- Third Fighter Command at Drew / Field,Florida,had a two—wheel office trailer, which* had been equipped as a mobile dental unit and had greatly aided'thc dental service of the Command. ... • -.-..vi In commenting upon the above, the Ae.ro Medical Laboratory pointed out that, while trailers appeared to wbAlb'fhirly ,ce satisfactorily in this country; information" received.' from ;;.v- overseas units'indicated a less favorable reaction.'./ There, trailer units had been found to bog down with--too much weight in certain terrain, and, due U» their complete dependence upon tow trucks, often became immobilized at the time of a general movement because of lack of a prime mover. For these reasons, it was recommended that trailers be con- sidered only for use within the continental United States, if at all. The major alternative remaining for overseas units was, therefore, some type of self-contained vehicle, capable of 511 supplying its own motive power. Several models were listed in this category, but it was clear wherte the preference lay* Passing.reference was made to a single-vehicle unit used by the; Hew York State Department of Health '-and 10 - a drawing of a similar dental unit designed for-use ih "Ptierto Rico, .sub-, mitted by the Ransom and Randolph Company10of'’Dayton, Ohio, . But chief emphasis was given to the small arms ordnance repair truck which, as we have already noted-;-"had.been con- verted into a mobile dental operating unit by the. Twelfth Air Force in North Africa, It was stated that' with this mobile equipment dental officers had been able to'complete fifty percent more work than with their conventional non- mobile field equipment. ' ■ ' ; Sv\:. Developing,this latter idea, the Aero Medical Laboratory went on to describe in some detail the truck, ton, 6x6*-1, Ordnance, Maintenance, the basic vehicle upon which the small arms repair truck had been patterned. It was explained that the,subject vehicle came equipped with blackout curtains, complete electric wiring, gasoline burning heating unit, six windows on each’side, and that it drove on all six wheels. Interior dimensions were shown to be ample for the purpose intended. In short, it was clear from the report that future experimentation in this field by the Aero Medical Laboratory would be largely concerned with the latter vehicle. Although the formal report of the -subsequent development by the Aero Medical Laboratory of a now mobile dental oper- ating unit, using the chassis and body of the Ordnance maintenance truck, was not published until 7 October 1944, actual construction work had been completed several months before*. In fact, on 9 July 1944, representatives of The Surgeon General's Office and the Medical Department Equipment Laboratory, together with certain dental officer representatives of the Washington vicinity, visited Wright Field for tige express purpose of inspecting the new Air Force unit*,, By. this date, it may be observed parenthetical- ly, .the. Medical 'Departrite.rtt ’s' model had already been developed, tested, standardized, ahd’placed minder • ,:0nthe day following this'visit - to Wright'Field,, a brief written report of the•inspection trip was prepared by a member.; of the .Technical Division of The Surgeon General’s Office;, , It was pointed out first of all 'that the basic yeblcle used-in the. construction of the Air Force dental. operating, unit was' the 2-|-ton, 6x6, Ordnance' Maintenance Truck, -the body of which was six -inches -wider and oge foot •shorter than, the. standard Medical Department truck. While the above statement was not elaborated, its import was evident. The Medical Department Vehicle Program, in which the dental operating truck represented merely one of a series 512 ox related units,'was based' entirely upon-the 2-|—-ton, 6x6, Ordnance Cargo Truck," . ■Manifestlyany deviations from the structural dimensions"or design of this basic vehicle would only already difficult problems of pro- duction and maintenance, * As for Jbhe other characteristics • of the Air Forces model, the inspecting officer concluded his report with the following general comment; •— ; :v .. The item presents no particular advantage over the one developed by the Medical Department Equipment Laboratory in conjunction with the Dental Division of this office. As we shall see shortly*; this latter statement was not to pass unchallenged. In the early part of January, 1945, a stout defense of the Air Force model was presented by the President of the Army Air Forces Board at Orlando, Florida. In any event, to return now to our narrative, on 7 October 1944, the Aero Medical Laboratory issued its final memorandum report on its dental operating truck project* The report consisted of a carefully written, 27-page document supplemented by 20 photographs. The recommendations arrived at, however, were somewhat general. Ho attempt was made to fores, a comparison between the Air Force model and the now standard'Medical Department uni tv j The plea was simply foh continued procurement •"of “dental operating vehicles, whatever theirtype. It is urgently recommended that mobile dental. operating units be procured for Army Air Forces organizations, both overseas and within continental United States„ Sven if-hostilities should cease in the: near future, a' large army of occupation will need :dental 'attention-,- and any surplus ; equipment of this type will serve a good purpose after the ” ‘ ;y-: • The. Air Force model was not,- however, destined to pass out of the unnoticed, A' large ' illustration of the. unit appeared on the cover ef the-- December* -X£44., issue of ' The Air Surge on Vs Bulletin.' and a full-column article des- cribed the . in. considerable ' A month,- T . later, on 1945, the i-sstie of .the, Air Force, model versus the Medi:cal Jfej)artinent dental 'operating truck was at' last explicitly ‘s'tate'd, ■ -Iii to.the Commanding ’ General e;-,Army Air .Forces, the President of the Army Air Forces Boardv-/Pflando,* ,FiofIda, asserted that the -experimental dental operating unitUdeveloped by the-'-Aero- Medical-Laboratory possessed a number of advahtageous features-: which * we re. hot' offered in the Medical Department model. After discussing eech of these features in some detail, the author of the communication concluded, with the recommendation that they he considered for inclusion in future mobile dental units issued to field organizations-. Because of its potential interest to future students of this particular vehicle,- this communication is quoted here in full.- ” ' "■ . • 1, The Aero'Medical Laboratory of the Air Technical Service Command has developed a mobile dental unit which.is., doscribediin detail in Inclosure 1, A similar mobile dental Derating unit has been developed by the Army Service forces. It is believed that the.unit developed by the Air Technical Service Command-possesses the following advantages* a. BODY. The body of the Aero Medical Laboratory model has six (6) windows on each side as compared to two (2) on each side of the standard model. Theiimportance of this advantage can not he over-stressed. Maximum light and ventilation is apparent to both the dentist and the patient. The fLoor space of each body type is very nearly equal. The standard model is 13 feet X 7 feet (91 sq, ft,), v* The'Aero Medical model is 12 feet-X feet '.S(90 sq, ft,). The rear door of the Aero Medical model is- ten (10) inches larger in each direction (52 in, X 70 ini). The standard model- measures 4'2 inches X 60 inches. The 70 inch height of the door in the Aero Medical ..model gives much greater ease of entrance and exit; a very distinct advantage, A very ..efficient gasoline burning heater f.orvc61d * weather operation, is mounted.on the'inside .. front wall of the body. This item-Comes as standard equipment with this truck, v.' '-••• b. '■ MOUNTING OP. DSUTAL;UNIT • : I- - • •• i~ Th the' Air - Technical Service Corpmand dental" truci;, the dental unit is mounted bn-a level the same as the floor of the truck. This places the dental cuspidor at a proper level for use by the patient and places the entire unit in such a way that it can be used efficiently and comfortably by the dentist. 514 c. "WATER SUPPLY SYSTEM . . An eighty (80) gallon water tank is bolted to the floor under the work bench in the Aero Medical model. The standard model has a fifty (50) gallon water tank mounted high nn the front wall of the body. The tank in the Aero Medical model may be loaded through an; outside garden hose connection, or local water pressure may be used if available. The tank may also be loaded bucket, from a well: or spring by use of a funnel through the work bench’top. The tank in the standard model must be loaded either by hose or bucket through a pipe in the top of the body. Moreover, the placing of the water tank high on the front wall -of the body of the truck tends to make the truck top heavy and to give it undesirable driving characteristics, if the truck is. moved, when the water tank is filled. It is .believed to be. a- distinct advantage; to, enable: the dentist, to travel with a full water.tank* since arriving at other- stations the.,dentist may find the water supply very' limited or not suitable for his use. The hot water tank in the Aero Medical model holds eight’, (8.)’gallons.A The standard model-has a five (6). * gallon -hot water tank, d.'' .EMERGBNCY Z3ATUHSS r- . In the Aero Medical model definite consideration has been given to the possibility of electric power failure, due either to lack of local current supply or breakdown of the 'gener- ator, In ..case of power failure, air pressure may be supplied,through- an- emergency air intake (tire valve), on.-top of the-.;water tank, by" the: use of an ordinary .hand;pumpir A.foot engine'is pro- vided, as well as an alcohol burning sterilizer and two alcohol -lamps. ; ;A-:relief valve (set at 70 pounds) ' is’'fhstalled in a pipe leading from the-top -.of the ..water, tank./-and .extending through the floor . of. the truck* ,, If.-it he' pressure -ever r^eached:-r,70,. p)ounds: (throt^h:failure of -the • compre*ssoi .ifob - much -hekt ; • under the-, hot water coils;) -it will be relieved through, the floor.without damage' to personnel' or equipment. r! 1 lb .ri o i 515 e* STQEAGE SPACE The Aero Medical model;has more storage for both expendable and - no h-’e xpendabl e supplies than the standard model, ‘ By the use of an overhead cabinet on each side, it is estimated that expendable material, sufficient for three (-3) months operation may be carried. , fLAUNDRY EQUIPMENT . 1 - •. In the Aero Medical model, a tank of acetylene supplies gas through a 3-way valve on the work bench for blow-pipe and bunsen burner. This-' may be. used in the repair of .removable dental appliancesas well as fixed bridgework, Also sufficient- laboratory equipment is provided for the repair- of broken partial and full dentures. It is not known to V/hat, if any extent,, labo- ratory equipment Is provided in the standard unit. .... 2, It is'" recommended.- that the advantageous features of the Mobile.,Dental Unit developed by the Aero Medical Laboratory of the Air Technical Service Command be considered for inclusion in mobile dental units which will bb issued to field organizations*^3 - ; The above document has an historical importance ■‘only, for it does not appear that the recommendations which it “ contained ever received practical implementation*- The- ;; communication was forwarded routinely by the Chief of the Supply Division, Air Surgeon’s Office, through the. Dental Division of The Surgeon General’s Office with the notation! ’’This report is forwarded to your Laboratory for infor- mation#”1 On 6 February 1945, the report was accordingly sent to the Laboratory a:t Carlisle Barracks with the- ohe- word indorsement: ’’Forwarded”* The records do not disclose that any further action was taken in the matter* Photographs of the non-standard Air Force model,‘(see Figures 33 and 34) are' presented for. purposes of comparison on the pages, immediately following.* ;, VII# Conclusion,- A* Post-Standardization Changes! : 1. •. . Although the 'Magical Department dental operating truck had been standardized after .-only a four-day field trial, 516 only one complaint of consequence appears to have been subsequently registered against the unit. In February, 1945, the Regional Hospital at Fort Jay, Hew York, reported that in temperatures ranging from zero to -31° Fahrenheit the water pipes of the unit froze and split and the heater coil cracked, attempts' to remedy this condition by installing'larger piping, reducing the; number of elbows and bends, and inserting additional drains, had been unsuccessful. Representatives of the Kriegcr Steel.- Company, manufactures of the truck, had been consulted and wore of the opinion that a-chemical reaction had *a result of extreme low temperatures acting upon certain minerals in the water— and that this, in turn, had produced? a.pipe corrosion which might have impeded the water rKv::-r ':it , *• *’ l* r< , S • .'f 'Z -j • ** T In accordance with verbal instruction from The Surgeon General’s Office, the;.problem described above: was promptly investigated by officials of the liedical...Department Equipment Laboratory.; The theory that : the damage ..was; either traceable to some structural'defect: in the vehicle’s plumbing system or that if was.'caused;- by some special type of pipe corrosion, was rejected at the outset. The fact that the pilot model dental operating truck had been out in the open all winter at Carlisle Barracks in .temperatures down to 10° below zero without suffering ary damage to the water system was felt, to be a. sufficient refutation of both these hypotheses. ... Actually, it was believed, preventive maintenance had been the real cause of the reported diffi- culties. The dental truck, it was pointed' out, was pro- vided with an air compressor designed to-furnish positive air pressure at'all times. If, while this compressor, was running; all valves and faucets were kept open, complete drainage would be obtained unless there was a definite stoppage in_ one of the pipes. The. rupture of pipes,and fittings‘in the above instance was, therefore, in all . Im- probability due either .to failure to. drain the water c. : properly-before storing the'- vehicle where it -would be. ..Vi subjected to- sub-zero temperatures, or if was due to a~ failure-to notice and prevent an accumulation^of sediment in the water line which might clog the -•> .,■.1 •• -i ♦ V • Apparently the Equipment Laboratory’S' analysis was, a sound one for no further complaints of this nature were received. The case did, however, serve to illustrate a need which had not received adequate attention in the past—rt.he• ” • need for detailed operating instructions for each‘new item of equipment. It is suggested a- complete set of operating instructions for each piece of ‘equipment made at the time equipment is developed, and completed,, would forestall such failures- outlined in- basic communication,' At the time of development of this item, -HO-:one was charged with the drafting of operating instructions. 'Medical- Department Equipment Laboratory-has not pre- pared any instructions until the last few pro- jects.18 The above recommendation was we 11-titled,. i.A basic Medical Department van truck, to be used for all future mobile medical unit conversions, had just been designed but no operating instructions had been included along with the specifications. This omission, now brought forcibly to the attention of The Surgeon G-eneralfs Office, was soon to be remedied, Furthermore, as we shall see from the statement of the Technical Division quoted below, the remedy was to be extended to all other related Medical Department vehicles as well. ■ , , Since such operating instructions have not “been furnished v/ith the basic vehicle steps will he taken immediately to have operating instructions prepared for this vehicle and the other five mobile units which use the seme basic truck. These will be forwarded to the Office Chief of Ordnance with appropriate recommendations.^-® The,Equipment LaboratoryTs suggestion had had a far-reaching effect* c-vi-r. •; .. ■The■experience of the Fort Jay Regional Hospital, previously discussed, -stressed the importance of proper drainage in preventing the freezing of the water pipes installed in the dental truck,* Several months later, a suggestion was received from a station hospital at Fort Sheridan-, Illinois, which was to make possible continued operation of the 'dental unit even while the hot water :'i heating coil and. other' exte-rior piping were beings drained. The. alteration proposed would also make possible -the"Saving of the five gallohs -of watetiin thd :h©t water stbragS' tank - during this operation,'^r’1 o-i;-'.,.-;; u : ■ ■ Specifically, it was that cut Off- valves be installed inside the,van body, one oh the pipe- that led to the heater, and the other immediately below the hot water storage tank. By closing “both these valves and" opening "both the hot water faucet.and the drain pet cock on the heater coil, the coil could he entirely drained without cutting off the water at the sink or at the dental operating unit * i :' . This proposal met with the immediate approval of the Equipment Laboratory and, inasmuch as that office, was then in contact with the Chief of Ordnance, Detroit, preparatory to the standardization of the basic,Medical Department van truck* basic drawings were accordingly revised to include the structural improvement mentioned above B* Physical Evaluation. Proceeding now to a general evaluation of.the standard dental operating truck, it would appear that user- reaction as a whole has been highly favorable,,' .Officials in the Dental Division of The Surgeon General .'s' Office praise the and demand has been relatively widespread, with even the United States Coast Guard making a special requi- sition for the vehicle,£ spot check of overseas reactions pA * * further tends to confirm this positive judgment., •, It could scarcely be denied .that the “dental . operating truck was a notable improvement over the awkward r; cargo truck-dental chest system -that had previously, beep • used in itinerant dental- service. TJio 1 n cl os e d dental -. truck made possible the--Carrying out' of dental operations even in the most inclement weather, required no. .extensive- •*, and t ime- c ons.uming ■ pack-i ng • and ’unpacking' ope rati ohs whe n the unit moved from one location to another, and, being duly authorized equipment under official Tables of Organization,. was available,forthe-dental operating team to which it. had; been assigned. In view of all these' adyantagesr ..there is , little wonder the dental staff of the Twelfth Force declared that even their improvised mobile'dental’unit had,-., made it possible for"-dental hurgoons to perform fifty - percent more work formerly,35 --- - - • _ As for a-comparison of the'standard mobile dental operating unit developed by the Medical Department and. the nonstandard model produced; by Army Air Forces, one fact-or. . overshadows all others in Importancek The truck chassis and special van body used for the Medical Department, model. wore the same as those used' in the’ manufacture of the entire series of mobile medical'unit—the surgical truck (Armored Force), the Medical laboratory truck; the dental laboratory truck, the optical repair truck, and the surgical operating truck* The ultimate development and standardization of one basic Medical Department van truck for use1.with all mobile medical units was, therefore, a- comparatively"simple matter. The Air Force model, however, was built around a different Ordnance truck and a different body* Adoption of this latter vehicle by the Medical Department would inevitably have raised formidable production problems and, 519 ■because of-a lack of high interchangeability of parts, almost equally formidable maintenance and supply problems* As for a more detailed comparison of interior design, choice' of equipment, and structural characteristics—~ this is left; to the judgment of the’ individual reader. Army Air Forces contended that its model possessed several features which, could have been incorporated with profit in Medical Department specifications. By its inaction, the Medical Department would seem to have indicated its dis- agreement with this viewpoint. C * Adm i n is t r a t i ve Asp e ct s * Once Development Project. F-39 had been instituted, it administration was excellent--up to.the final pro- curement stage. As a result of a positive police of central- ized direction, a clear distribution of research and development functions had been made at the outset*.. :Bach ; participating office had a specific job to-do and* con- ■ ■ ■ sequently, a direct and personal responsibility- to see that that job was done quickly and well. The results- speak’ for : ' themselves, " ■ • ' • The preparation of equipment lists, which in ‘ previous projects had sometimes taken as long as eighteen months, was accomplished in a matter of days. Procurement of supplies and equipment for the pilot model, which under earlier decentralized procedures had an occasion delayed project completion hy as much as nine months, was here completed under central handling hy The Surgeon General*s Office in less than two weeks. The Equipment Laboratory, working directly with liaison officers instead of having to rely on long range corre- spondence for the coordination of its activities, had in a few short weeks constructed a complete experimental model ready for immediate service test. As for standardization, all the procedural steps required hy All 850-35 were complied with to the letter and yet the total time consumed hy these processing actions, was under three weeks. Although the causes of' the change are not evident from the data-,: a* decided drop ih administrative: speed:and efficiency occurred upon completion of the standardization phase of this project. Pre-procurement activities, involv- ing merely a few last-minute changes. of a ..minor'-or technical nature, dragged out'over a period .of three months,-. Another six months elapsed .before' -all deliveries, had been made: on the first production "order placed in June,,’ 1944, s o that it was not until the: first quarter of 1945' that overseas ship- ment of the new vehicle reached significant-proportions. That these various post-standardization tasks should have taken over nine months to complete was unfortunate in view of the excellent progress that had "been made in the preceding stages of the project. Duplication of research effort on'the ■ part >of .tire Medical Department Equipment Laboratory and the Aero-Medical Laboratory of the Air Service Command has already been commented upon at some length. Suffice it to trhat, apart from the Medical Departmentts successful action in preventing quantity procurement of' the Air Force mddel, there appears to have‘been a general reluctance on the'part of all concerned—The "Surgeon General1 s 0ffi.ee, the Air Service Command, Headquarters, Army Service Forces, anil Headquarters, Army Air Forces—-to make a definite issue;of this'matter of parallel experimentation so that one or the 6t£e#"of.f.tho two identical projects would be eliminated. Before concluding this section;'"’s be made of two new administrative which were' v“ employed during the course of the present project, yFirst, the problem of giving newly standardized medical equipment items adequate advance publicity was solved here by the , issuance to all 'overseas,installations of a letter from The Adjutant General1 s. Office, giving fiill; details' regarding, the new dental operating truck,' including--the estimated -date of its availability. Second, eventsjwhich.pccurred fin this project served to dramatise the need for the regular prepay" ration of a complete.'sot,..o.f. operating instructions, to be issued with cauh newly .'developed ■,item of equipment. The* subsequent formal -'of this policy-with -respect to all related'Medicpi PGijartmbnt ’yCrhicies'was- the direct result of the re cemmendati ons made-' by the Equipment Laboratory in March 1945. D, The Time Element. The Medical Department dental operating truck,was, as we have seen, a highly satisfactory vehicle. Moreover, despite delays in procurement and distribution, this unit had been developed, service tested, standardized, and put into the field in only slightly more than a twelve-month period* Compared with previous projects, where two or more years had been required for a similar type of undertak- ing, the record achieved in the present instance was remarkably good. The fact, therefore, that the new mobile dental operating unit did not reach overseas theaters in quantity until the first quarter of 1945, and consequently saw only a limited amount of actual combat service, must be viev/ed in this perspective. Only tea very limited extent was the delay chargeable to the administration of Development Project. 3T-59, Had production, procurement, and overseas distribution been completed in record time, the unit would still have seen far less than a:-year1 s battle servicev-.- The basic cause of the failure to get a new dental operating vehicle to troops overseas in time to be of maximum use. was .simply the lateness of the decision to-.- establish a full-scale development project- to produce-such an item. Once this decision had been made,- the performance of research and development personnel was at as high a • level of efficiency as at any time during the course of the war, • -•; ■ 522 FOOTNOTES' TO" CHAPTERS IX ; . Medical Department of the United.’.States Army in the World Var. Vol, II, 1928, p. 119, The material-;for this section has been drawn exclusively from the above/.account. 2Annual Report of The Surgeon General. U. S. Army.: Vol. II, 1919, p. 1303,. . 3Ibid. 4Ibid», p, 1302, 3Annual Report of The Surgeon General, U. S. Army. 1919-1940, incl. 3The Army Medical Bulletin. No. 39, Apr., 1937, pp. 74-75. to Research & Development Div., S.G.O., fr. Dental Div., S.G.O., 29 May 1942 (A.M.R. & D, Bd.). 8Ibid. 9Ibid. to Medical Dept. Subcommittee, fr, Ghf., Research & Development Div., S.G*0*, 20 May 1942 (A.M.R. & D. Bd.) to Hist, Div., S.G-.O., fr. Dental Div., S.G-.O,, 27 Jan. 1944, See Incl* 1, "Dental Division History, 1-22 Jan. 1944," pp. 2-3 (Hist. Div., S.G;0,). 12Min. of M.D.T.C.. 1942-1943, incl. (Hist. Div., S.G.O.). T 3 °Pcncillod notation, initialled by Leon H. Warren, Chf., Research Coordination Br., Research & Development Div., undated; (A.M.R* & D. 3d,). to C.G-., A.A.P* (Attention; Air Surgeon), fr, 12th Air Force, APO 550, 12 Sep, 1943; subject: "Mobile Dental Squipment" (Rec. Rm., S.G*0, 451*2-1). to Hist. Div*, S*G*0w, fr. Dental Div., S.G.O., 1 Fob. 1945. See Incl, 1, "Dental Division History, 15 Jan. 1945 - 31 Jan,- 1945," p, 3.(Hist, Div., S.G.O.), Memo, to Hist. Div.-, S.G-.O,, fr. Dental Div., S.G.O., 15 Doc. 1944. See Incl* 1, "Dental Division History, 1 Dec* 1944 - 15 Doc, 1944," p. 5 (Hist, Div., S.G.O.), 523 Memo* t o--Hist.--Div*,• SvG.O*,- fr, Dental *Diw, S.G.O,* 27 Jan. 1944V- Sefe-In cl-. 1,* 0 Dental-Division History, 15 Nov. 1944," p. 6 (Hist. Div., S.Gr.O,*), * ' '*''■• 1?Ibid.P-.■ 2«. . . • • 18 * * Ltr. to The Air Surgeon, Hq,, A.A.F., fr. Hq,, 12th Air Forpc, APO 650, 21 May 1943; subject: "'Mobile Dental Operating Units." This document is cited in itr, to The Air Surgeon, Hq., A.A.F., fr, Hq., 12th Air Force, APO 650.. 10, Sep.,1943; subject: "Mobile Dental Unit Mounted on Small Arms.Ordnance' Repair Truck" (Rec. Rm., S.Gr.O., 451.2-1) . to C.Gr., A.A.F,-(Attention* Air Surgeon), fr, 12th Air Force, APO 650, 12 Sep, 1943; subject: "Mobile Dental Equipment" (Rec, Hm ., S.G-*Ok* 451.2-1). ; to Dental Div., S.G.O,, fr, Hq,, A.A.F,, 30 ,’Jul. 1943 (Dental Div., 3.0.0.). * • . ' *; ' 21 Ibid. . • ‘ • 22Ibid. . .. . ' ; ' ' ;;; to The Air Surgeon, Hq,, A.A.F,, fr, Hq., 12th Air Force, APO 650, 10 Sep, 1943; subject: "Mobile Dental* Unit Mounted on Small Arms Ordnance Repair Truck" (Rec. Rnj., S.G.O., 451.2-1), h. T9, above, 25Ltr. to S.0,0,, fr, Chf,, Supply Div., Air Surgeon’s Office-,; Hq., A.A.F,, 11 Oct, 1943; subject: "2-|-ton, 6x6, Laboratory, Dental" (Rec, *Rm,, S.0,0., 451.2-1). 26lst Ind, to CcOo, A.A.F., AFTAS, fr. Operations Service, 5.0. 19 Oct;e 1943.; basic:. - see n. 25,' above (*Rec, Rm.,* , 451-,2r*L) .. % to Asst,,. Surgeon,' Medical Sec., Hq,, 12t»b Air Force,; APO 650, fr.,- .OffTee of- The Air Surge on,; Hq. , 12 th?'Air ' * ■ ; Force, APO 650, 1 Nov. 1943; subject: "Development of Mobile-. Dental Unit.,"'’ This* document appears* as Part 0, - Appendix I, to Aero Medical’, laboratory Report, 11 Feb, * 1944; subject: "Mobile Dental Operating Units; Serial Number'EN^D-^;8^2&"-XA.H^<&‘D^:Bd>),; '\ . « * » ‘ ' V . ’ * • * * * • , f 4 * \ * 22ltr. to C-,0;, j ;Air -Service' Command, -fr. Ohf,, Ordnance ••• • Aircraft Service ,T A.A.F, 'Materiel Command, 1- Dec,11943';- subject: "Procurement of Trucks, Machine Shop — * ’ ■ ' Experimental"; record summary (A.M.R. & D, 3d,). 1st Ind. to C*G,, A.S.P., fr. C.G,, A.A.P,, Air Service Command, 2 Dec* 1943; basic: see n, 28, p. 524.; record . jStmjmary' (A.M.R, .& D, 3d*)*.' 1:1 l’ '[ — ■ * •* ?■'; j * ;r . • ’ .' A • Ind* to. 'Gh£* |. Ordnance- Dc-pt ., ' $r, Hqi,- ’A,*S,P,, 14 Dec* 1943; basic: see n* 28, p* 524 (a.M.R, & D, Bd,). • - • v with Col* Rex McK. McDowell, D.C., Dental Div*, 19 .Peb, 1946, •» -•••* ‘1* ; r • • - ‘ • * “" * 3?Mema* to Research Coordination Br.v:-Plans Div,, S.G.O,-, , fr. Dir,, Dental Div*, •&.G*,0,l€hDeu. 1943 (AvM.R, & D, Bd#)#. . V • rfl S3AR 850*25 . 30 Jun. 1943, Sec. I, Par. to Dir.., Technical Div»*,• S*,G,O', V f r. Development . . 3r,, Technical Div*, S.G-,0*, 10 Jul.--1944; subject: “Visit to. Wright Pield* Ohio-, on 9 July" 1944“ (A.M.R, & D. Bd.), Also see Memorandum Report Wo.. 1 :':‘DBT(^r49-693-r26. Engineering Div*, A.A.P. Materiel Command, 11 Peb, 1944, p* 46, Ph®t©graph-Wo, 1630 (A.M.R-; & D, 3d*)* rZ y.j "■ -vr *f Interview with Col. Rex, McK, McDowell, D.C;-;--Dental Division, S.G-,0., 19 Peb* 1946, , n* 32, above, '37 • * “ ' • • • *. . ‘ . V.*.„'1 ". Ltr, to"M.D.®,0*, ftf. Medical Dept.-"Technical Subcommittee, :21 Dec, 1943; subject: “Medical Department Technical Subcommittee Report on: Mobile-Dental Operating Outfit” (A.M.R, & D, Bd.), 3®Ltr, to C.G,, A.S.P,, fr. S.G-,0,, 30 Dec, 1943; .subject: 5 “Mobile Dental Operating'Unit ’ See Incl. 2 ‘(A.M.R, & • D. 3d,:). ■ • :■ r : - * to C.G,, A.S.P,, fr, S.G.O., 30 Dec. 1943; subject: “Mobile Dental Operating -Unit,“ 3 Incls, -(A.M.R, & D, Bd,), I 4 ♦ » Ind, to Chf,, Ordnance Dept., fr, Hq,, A.S.P,, 14 Dec, 1943; basic: see n, 28, p, 524 (A,M,R. & D, Bd.), 41 1st Ind, to S.G.O., fr, Hq,, A.S.P,, -6 Jan, 1944; basic: see n, 39, above (A,M,R, & -D, Bd,)-, 42 Ltr, to S.G.O, (Thru: C.G,, A.S.P.), fr. Chf., Supply Div,, Air Surgeon’s Office, Hq., A,A,P., 30 Dec, 1943; CORPIDENTIAL; subject:• “Requirements of Equipment to be Installed on Mobile Dental Units” (Rcc, Rm,, S,G,0,, X-451,8-1). Extracted in clear. 525 43 ' . •• ) *■ .. 1st Ind, to S.G.O,, fr. Development *Br,, ‘Requirements Div., A.S.F,, 6 Jan* 1944, CONEIDENTIAL; basic: see. n. • * 42, p . .525 (.Rec* Em,, S.G.O,, X-451 , 8-1),' *Extradt.ed in clear. , Ind. -to G.G., A.A.E,- (-Thru; C.G,,- A.S.EAv fr* S.G.O., 11 Jan, 1944, CONFIDENTIAL; basic: *se'e n.‘ 42, 'p.*‘525 (Rec. Rm#f S.G.O., X-451 • 9-1), Extracted in clear., ... 4 J * ' ‘ • 0 • • • * AR ’* 1. • • ■Ibid. Note channels indicated. • ‘.1 46Ibid,.. . . ' ::' :; !*.Tl»tr*l; tp. ;S% G., 0-,, fr, Chf., Supply Div,, Air _SufgbQn,s> Office, Hq., A.A.E,, 22-Jan. 1944; subject: "Mobile Dental Units, Medical Department Equipment Laboratory, Carlisle Barracks, Pennsylvania" (A,M,R. & D, Bd.) , ±8lst Ind, to M.D.E.L,, fr, S.G.O,, 25 Jan; 1944;’basic: see n. 47, above (A,M,R, & D, Bd,). 4-9 * Ltr. to Hist, Div., S.G.O,, fr. 4 Dec. 1945; subject: "Truck, 2-|, Optical Repair Unit, Project F-32 and Truck, 2\% 6x6, Dental Operating, Project E-37, Histories of," See Ind, 2, p. 7 (Hist, Div., S.G.O,’), 50 Ltr* td.S.G.O,, ■ fr. Arms & Requirements ‘Bri; Canadian ’ Army Staff, Washington, D.C,, 4 Jan, 1944 (A.M.R., & D. Bd.). . . * " . - to Hist, Div,, S.G.O., fr. Dental BiV.',' S.G.*0'.‘’27 Jan. 1944. See Ind, 1, "Dental Division His.tory., 1 Jan, 1944 'n 22 .Jan,’ 1944’, and," •(•Hist, Div,,• •S;G,’0,‘)4 ' to Dir,, Drntal Div,, S.G.O., fr, Secy,, M.'D.T.C,, 8 Jan, 1944, CONFIDENTIAL; subject: "Requirements of Equipment. to be Jhi>teiled bn Mobile Dental*.UhiTs*"' (A.M.R, & D, Bd,). Extracted in clear, * . * • ■ * to M-,D.’E0L«,, fr. Research & Devoloptoeht* 'Div,,., S\G,0,, 12 Jan. 1944; subject: "Dental Operating- Truck";.‘(A4K.R, & D. Ed.). to: M.D.E.L,fr. Dental Div,,'S.G.O. , With I#cl,N 14 Jan.. 1944; * subject: • • "Dental Operating Truck'" (MwTT, B.L.)• ( A ,, • . :" -a 1 - '• • • ♦ - i . , • y ■ * 5Ltr* to S.G.O,, fr, M.D-iE.iJ*' 14 Jan1944; subje'ct: * "Power Unit for Truck, 6x6, Dental, Operating"' (A.M.R, & D. Bd.). . . . •• *C * 56 " • • « .. . .. . . Ltr* to Requirements Div,, Hq,, A.S.E,,'fr. Supply Service, S.G.O., 15 Jan. 1944; subject: "Unit Powef. Electric.* 526 P&-75-T” (A.M.R. & D. Bd.). 57 , 1st Ind. to S .G-.O,., fr, Requirements* Div. , A.S.P.,.21 Jan# 1944; ‘basic:-’ see, n. 56, p. 526 (AiM.R. &:D.‘Bd.). Report . M.D.E.L.. 1 ~ 31 Jan* 1944, p# 14'(A#M.R. & D. Bd.). , • ***■’* . Ltr* po ■ HjLet#* Div.\ • S;G-,0,, fr. M.D.E.L#, 4 Dec# 1945; ‘.' subject;:, .‘’Truck, 2-g-ton, Optical Repair'Unit, ‘Project P- ‘ 32 and Truck, 2-g-, 6x6, Dental Operating, Project P-37, Histories of”; see Incl# 2, p. 6 (Hist. Div., S.G.O.). Ticket, Richmond A.S.P. Depot to M.D.E.L., 24 Jan. 1944; subject: "Surgical Truck” (M.D.E.L.)# 31See n. 59, above, Incl, 2, p. 7# n, 58, above. 53Ibid. ' . . %, #•: * . , A f ' . T "See n. 59, above, Incl. 2, p. 7. . > ' i' 65Ibid. , • ’ 66Ltr. to S.G.O., fr. M.'D.P.L.',; 21 Peb. 1944 (M.D.E.L.). Monthly Narrative Report.. 1UD.S.L.. 1 - 29 Pet/1944, p# 14 (A.M*R. & D.,Bdw)Vv V , / • • ’ to M.D.E.L#, fr. S;.G.O. Peb.*1944 (m;D..E.- ■ , ; -.I.'. — • :)„■ J __ ,, C; cq VC ' ,y I"-1'- ’" • r ’’’ D Sec .6?,, aboveV vr.f--' 5 ♦ • • * • ’• ’ •• . ?. ' * ... ... 70 * ' ... , .. • • * . Ltr. to M.D.E.L#, fr. Dental 14 Jan. 1944, with Inch.*/• ‘ 71 •' •■■■■'"- ', . , r’ , - - •' ' * Memo.-tof M.D.E.L-*, frV Post Dental Surgeon, Carlisle i?a#, 7 Mar. 1944; subject: "Dental Operating. : • Unit” (M.D.E.L.). , : , •’ , - Q,, fr, ChfResearch Coordination Br,, ‘Technical Div,, 'S,’G,0,, £8 MaT, 1944, CONFIDENTIAL; ‘ * subject:’ "Truck,' 6x6:, /Dental, Operating” (A.M, R, & D, Bd,), Extracted in ‘clear;iS“ *“ , 4 ■ ' ‘ ' V" to. Chf.,, :Qperations Service .(Attention: Dir,, Techniqal/piy,)S,‘G:,Of, fr,* Chf,*/ 'Catalog Br,, Supply/ S,G,0,*, *25 Mar• 1944,"'CONFIDENTIAL;. / "Truck, 6x6, Dental, Operatirig"* (A.'M.R,,* & D,* -Bd,)-, Extracted in clear, ♦ • ♦ I • - • See n,; 84, above; .also cee-Memo.*-Routing Slip to Maj, Lipton, 28 MarJ 1944 (A,M,'R. & D, $d,) t--‘ 528 ' 87Memo • , t o Chf., Supply' Se rvi ce, • S , Gv-O,;, f r, -Dir*, Te chni cal inkDiv., S.G-.O*, 7 Apr, i9441 sub j ecjb-r £ ftfrwQjs,r2Wo&y" 6x6, <1 JDental Operating11 (A.M.E.- & D, Bd.-}~* .c *. * 88Ltr. to C.G-,, A.S.F., fr. S.C.O., 28 Mar, 1944;* subject: "Request, for Change in Basis of distribution for.- Truck, • 6x6, Dental;-, Operatin^Y-C-M^5;* & $>* • •" . mn r ■■ • ■ 89See n. 86, p. 528. Ind*. to S .G-,0., .fr. Dir,,: Plans & Ope rat i one ,* , Hq,, A.R.F,., 3.1 Mar, 1944; -Basic; see n,88, above (A.ii.R. & D, 3d,) , ri tv:7 91lst Ind,; to M.D.E.L,, fr, S.G-.0.4, 13 Apr. ;1944i. B^asic*’ ■ Itr. to S.C-.O., fr, M.D.E.L., 7 Mar,. .1944Jh subject? - "Truck, 2-g-Tpn, 6x6, Dental., Operating” (M.D.E.L,) , ? .f - ;; - *Qp t « . ■ , r :W:'i —t ’S 1st Ind, to S.G-,0., fr. A.ii.P.O., 26 Apr. 19'44i.Basic: not cited (A.M.E, & D, 3d,), Or? *“ * ■ - * . * *. . ■, *% -; • ■ - * . Transmittal Sheet to Development Br..,;'Tachhi'6a-r S.G-.O., fr, Chf., Supply Coordination Br,, Teclmxcal Dry, K .SfO'.Q,., 2 May ,1944, with In.cl.s, (A.M.-R, & D. Bd.:) . r ■» . + „. t. . , c ' X)A * ■ , . > - ‘ i * '• — Memo, to Chf.Supply. Service,. 6,0,0.fr, ,Dir..,: Technical Div., S.G-.O,, 24 May 1944; subject? "Truck, 2-|—Ton, 6x6, Dental, Operating” (A.M.E* & D„ Bd.)., - 3 9 .r ♦ •«[ 95 1st Ind, to Hist;, Div. * §.,*0,0., fr. -A.M.P.-0.,, ,.,31 Oct, 1945; Basic?. Itr.. to A.M.PcO. t *fr. Hist. Diy.*f-^,G,0,, _. 225 Oct. 1945 (H^st.,'Div, t S.O*0,), ■ v . 96Ltr, .to ,S .0,9., fr. Dir, j M.D.E.L., 2;6 Jun,.d944»- subject? "Amendment-! to M,D,E.L.T*S. Ho, ’108-A, Truck^.v2j Ton, 6x6, Dental Operating" (A.M.E. & D, Bd.) • ... t ) 97 .A.O* Itr. tp Commanders of all -theaters, defense commands, departments, ..and Bases, overseas, 22 Sep. ,1944;. subject? ■L "Item 99588-06* t^u;qk,- 2-Jyt9n, 6x6, -dental operating" , . ( A.M.E, &•;D. 6 ■ % ; « 1 98 * - * . . , , 1st Ind. to Hist. Div*., S.G.O,, fr. a«.M»P.O,, 31 Oct. 1944; -Itr, to AoM.P-,0., fr. Hist. Div., S.G.O., 22 Oct. ; 19,44 (Rist. Div., SfG.O.). 99I'oid.,: v: ‘ • ‘ * ’ f ‘ to C.G-,, PQA; C.G., NATOUSA; C.G., C3I; C.G., So. Pac. Base Cmd; C,0., ETO; and 0,0.,. SVQPA, fr, Chf.,-Supply Service, 26 Oct. 1944* COHPlDEHTlAL; subject? "Medical Department Trucks" (Rec, Rm.‘, S.G.O., 4'51‘.2), Extracted in clear. p Memorandum Report on* Mobile Dental Operating Units. 11 Feb«rl944, * Materiel Command, Engineering Division, Aero Medical' Laboratory, Serial Number ENG-49-598-2 6 (A.M.R. .& D. Bd.). >• ' ' " * . -•/ , . ■ • * • - ’ * ’ : . n • „. »• * -Memorandum Report on:. Mobile Dental Operating Units..7 Oct. 1944, A.A.F, Air Technical Service, Command,• Aero,> Medical Laboratory, Serial Number TSELA-5B-6’98-26A (AAR, ’& D, Bd.) • . f 'r. # n. 2, above. The discussion whicji follows is drejni from this 11 February 1944 Report* ■ * % 5See n. 3, above. .. :J ’' . 'bMemo. to Dir., Technical Div., S.G.O., fr. Br., Technical Div,, 5.G.O., 10 Jul. 1944; subject? "Visit to Wright Field, Dayton, • Ohio, on 9 July'19441’ (A.M.R, & D. 3d.). 7 * * • , * Date of standardization of Medical Department model - 16 March 1944; see 2d Ind. to S;G,0,, fr, Requirements Div., A.S.F., 16 Mar. 1944; basic; Itr, to Hq,, A.S.$V* fr, -.S.G.O., 8 Mar, 1944 (A.M.R, & D. Bd.). Date of original procurement * order. for Medical Department model -t 17'June 1944; see 1st lad. to Hist. Dir,, S.G.O,,.fr. A.M.P.O., 31 Oct. 1945; basic; Itr. to» 0. fr.‘ HistDiv., - *S*C*0.,22 Oct. 1945 (Hist. Div,, ,3^0.0.).« • ~ “ Date of inspection feyvMedical Department of Aero .Medical ♦ .Laboratory model - ■ 9 July 1944; see i4emo* to Dir., 'Technical Div,Jx.G.Ov ,, f r. Development, Rr., Technical Div., S.G.O., ID Jul, 1944; subject:1 ’’Visit to Wright Field, Dayton, Ohio, on 9 July 1944” (A.M.R. & ®. Bd.), ft • $ » ?See n. 6, 'above, , * • '••• «ir._ * * < ' t- * ” ■ ' * • . , to 'C.O,,- A.A.F. (Attention: A.A.F, Board Control Office), fr. Pres., A*.A.F,; Board, Orlando,. Fla., 12 Jan, 1945; subject: ’’Mobile Dental Operating Units” .’(Rec, Bm., S’.G.O., 451.2 Carlisle 3ks,-N), ’ * " •* “ i-LSee n. 3, above, ; .. •- r i Air Bulletin. Dec.. 1944,. Vol. I, No, 2, RESTRICTED, p. 7-. Extracted in clear. " 4 10, above# v • lad. to Dir., Medical Field Service Lad., Carlisle, Pa* (Thru*’ l££S^i^^tt©ntlon«' DehiTal Div., (S;«Q-.0.1; fr, "Supply Div.f Air Surgeorits* Office, • Hq*, A.A»F* ,•• 23^Jan. 1945; da sic: * gee n. 10, p. 530 f (Bee. Em., S.G.O., 451.2 Carlisle Bks.~H)V In,d>: fro' Dir*'* Medical Field • Service.-Bad.,, Carlisle Pa.t fr*.Dentah Div., S.G.O., 5 Fed. .1945'; '’basic': s.ae*-.,, n. 10, p. 530 (Rec.’-Bm,, 541.2 Carlisle' Bks^.-H). T fi A°Memo* to Hq., 2d Service Command, A.S.F., Governors Island, N.Y., fr.-Regional Kosp., Ft, Jay, N.Y*, 1*Fed.. (A.M.S. & D. Bd.). Memo to Rental Surgeon*s Office, Hq., 2d Service Command,’ A*S*F*, Governors Island, N.Y., fr. Medical Supply Office, Regional Station Hosp,, Ft, Jay, N,Y., 5 Fed, 1945..(•AtM,R>; & D* .Bd,)-.' I ‘ * ...; p i#r ' • • . ; • ‘ * 'V ,, u - r. 17lst Wrapper lad-, to S.G.O., -fr, M.D.B.L., 7 Mar, 1.9451 ¥ } basic? not cited (A.M.R. & I), Bd.)* ieM«- ' ■ y; _ , ' 1 Q y • , •. . i , r • • * -• 1st Memo*< Jnd>fro- »Dir., Dental Div., S.G.O.-, f r • Dir,t, # Technical’. DiV. ,* i? Mar , 19*45*; basic: * not cited-v —■ (a.k.p:. &3i,3dv)....:-a '.-a an : L?i t: Ltr*t torPost-Dental Surge on*,-‘Ft, Sheridan,, 111, , fr, 3y’. Olson, Capt, D. C*V»i6lS:;:SOW Station .Medical' Activities;>i- Ft; I-ncl-; 1 --of :-l'fr ter:k,S.'S.XIV *. fr, S.G.O,14 May* 1945; hudject:- nModile Dental Operating Uni tn "■&.D. Bd #). ; . Xnd* to S.G.O*, *fr. M.D.S.L., 6 Jun, 1945; dasic: Itr. to M*D,E,Li, fr, S.G.O,, 14 May 1945; subject: HMobile Dental Operating Unit” (A.M.R, & D, Bd,), 22 Interview with Col, Rex McK. McDowell, D.C., Dental Div,, S.G.O,, 19 Fed, 1946, to S.G.O,, fro The Commandant' (FS*-P),’ U.S. Coast Guard, Washington, D.Cr,, 19 Jun, 1945; subject: f,Dental Operating Truck, 2k ton,- 6x6’, request for” (Rcc.’Rm., S.G.O., 451.2). OA essential Technical Medical Data and Annual Reports. Calendar Year 1945 (Hist Div;, S.G.O.). 25ltr. to Asst, Surgeon, Medical Sec*, Hq,, 12th Air Force, APO 650, fr. Office of The Air Surgeon, ’Hq,* 12th Air Force, iP0 650, 1 Nov, 1943; subject: nDevelopment of Mobile Dental Unit;# appears as Appendix I,-Part C, to Memorandmn Report on: Mobile Dental Operating Units. 11 Eeb. 1944, A.A.F. Materiel Command, Engineering Division, Aero Medical Laboratory, Serial Number ENG-49-698-26 (A.M.H. & D. 3d.). 532 CHAPTER X TRUCK, 6X6, SURGICAL OPERATING I*. The Auxiliary Surgical .Croup.' Since the Trade* Sj-Ton, 6 x .6, Stirgic 1 Operating was developed as organizational equipment for use "by certain com- ponents of the numbered Auxiliary Surgical Groups, the narrative of its development will doubtless have more meaning if a brief explanation of the composition and mission of an auxiliary surgical group is given first,. Typical of its kind was the- Second Auxiliary Surgical Group,., which was active in North Africa, Italy, and Southern Prance*,. .According to, one of its annual reports, an auxiliary surgical grpup, tta Theater reserve unit,11 is "composed of a group.headquarters, general surgical, orthopedic, neuro- surgical, thoracic and maxillo-facial surgical teams, shock, gas., dental prosthetic and miscellaneous teams", which, though they, operate primarily in Army and Corps, installations,, may be "attached to Base Sections, Task Forces, Hospital Ships, Divisional; Clearing Stations and Ranger The function of these highly specialized and well-trained units is "to supplement the regular Medical and Dental surgical services during periods of peak loads and to provide a flexible and mobile method of augmenting".other. Medical installations-., "when the tactical situation, demands Furthermore.,, they usually function .far forward, for "Approxi- mately 80$ of their employment"—in the experience.of the Second Auxiliary Surgical Group, at least—"has been in .field hospitals set up to do non-transportable casualties, adjacent to clearing stations*"3 , -r It-was for the use of these professional service .teams, teams designed to "reinforce any medical- installation or unit •requiring additional surgical facilities or personnel in a theater of then, that the. Truck, 6x6, Surgical Operating (Development Project.. P-35) was.designed*- IX• Project Initiation. According to a contemporary newspaper-account, the need for a specially designed surgical operating truck—a vehicle much more elaborate than the surgical truck that had been developed and standardized nearly nine months before for use 534 RESTRICTED b>y the armored di vi s i o'ns o c cur red; t o - The Surgeon General in May 1943 during an inspection tour of ‘the * North Africah battle area.6 To substantiate the ideas of The Surgeon General, the Field Equipment Development Branch on’2t3 "June- 1943.. requested , of the Research Coordination Branch “that a research project he established for the revision of. the. contents and- arrange- ments contained in the present 6x,6 Truck, Surgical” and explained that Is necessary in order-to provide an operating truck desired by General Kirk for use by the • Auxiliary Surgical The Field Equipment Development • Branch further indicated that “This development has been coordinated with the O'fficA of The Quartermaster General and a tent is being designed by them based on the desires ’express- ed by General Kirk” in a conference, attended by the Director of the Medical Department Equipment Laboratory, held 22 June, 1943.8 •' . ■ • M . • Simultaneous with this, intraofficc request, The-Surgeon General's Office formally asked The Quartermaster-General to establish a project to develop a suitable tent for useamth ■■ the proposed. Kedicfal Department vehicle and to authorize direct communication between the Office of The Quartermaster General and the Medical Department Equipment Laboratory-until completion of the.project* :*<•; ; - ■ Acting, pr’ojnptly upon the request of the Field Equipment Development'Branch, the Research Coordination Branch rof The. Surgeon. .General1s Office obtained from headquarters, Army Service .Forces—apparently by telephone—authority to proceed with the project and*to spend on it $1,000 of research-funds When this request was formally handled two days later,- .• however— on 30 June 1943—Headquarters, Army Service Forces, temporarily withheld- its approval until The Surgeon General1s Office could clarify its proposal to use the standard .surgical truck as the basis for the contemplated surgical operating truck for the auxiliary surgical group* 'i.*: In its letter of 30 June 1943 to The Commanding General, Army Service Forces, The Surgeon General*s Office explained that the Medical Department at that time had a Truck, Surgical, which had been standardized by Army Seryice Forces on 28 October 1942 for use by Armored Force medical battalions; that this truck ”has a special body and equipment for the per- formance of limited surgery by the Bn* Surgeon in the truck”; and that with it was employed a special tent which ”is pitched over the truck and used as a dressing The Surgeon, General's Office declared further, however, that “Reports from the field indicate need for a highly mobile surgical 535 truck to permit the performance of more extensive surgery in the forward areas”; that the development of such a truck at the Medical Department Equipment. Laboratory was proposed,. with the "standard 2-g- ton 6x6 truck, without special "body” being "utilized as the basic vehicle”; and that Necessary surgical equipment will be installed in the truck in a semipermanent (demountable) manner,"12 "As discussed in telephone conversation with your office (Major Thomas) 28 Juno 1943," the letter concluded, "request authorization for initiation of subject project and expeddi— turc of research funds in the amount of $1000,"I3 3y indorsement. Headquarters, Army Service Forces, indicated its belief that the development of the surgical operating truck, "is desirable if it_will result in the elimi- nation of the special body vehicle /.the Truck,. 2g—Ton, 6 x‘6‘, Surgical/ mentioned ,,, in basic letter, Since "The Commanding'General, Army Ground Forces, has indicated that there is.possibility the truck, surgical, with special body designed for use by the Armored Force Medical Battalion pah be- replaced by the vehicle proposed for development, provided development is successful," Headquarters, Army Service Forces, before .giving its final approval of the proposed project, desired that "comments as to the possibility of eliminatirig the special vehicle be made" by The Surgeon General*s Office "in order that this correspondence can be referred to. the Armored, Force ,"1. Thereupon followed a careful clarification of the. relationship between the two special-purpose trucks* "It is contemplated’ utilizing the 2-g-ton 6x6 truck with /the type of body, employed for the standard surgical truck as the basis of development of this item,*1 The Surgeon General1.8 Office explained; "Thus while the body is standardized in the sense that it is in present use, it is actually a special type body and not of conventional cargo type, Whereas the surgical truck used by the Armored Force "is in reality a mobile aid station, since its equipment is not highly* elaborate and it provides space for surgical treatment within., the body of the vehicle," The Surgeon General!s Office continued, "The pro- posed surgical operating truck will have somewhat more .' extensive equipment, notably a sterilizer and a much larger reserve of surgical supplies*"^-7 Consequently,.although the basic bodies of the two trucks would be the same,."the installations will differ somewhat, and treatment of',patients will be carried on .“entirely outside the vehicle ‘ Apropos of the suggestion that the new surgical operating truck, if successfully developed," might 'serve also as the special, vehicle’; fqrv the -Armored Force • .The’ Surgeon General!s Office "believed it'possible 11 that the Armored Force may he able to employ .the vehicle proposed for development by , " deletion of portions of the additional supplies and equip- ment” and felt that ”If.SQ,this would eliminate the objection of having two special similar surgical, trucks *”19, , It was felt, nevertheless’-, that Hthere still will-remain a need for a. truck Wit]h special .body” inasmuch as ’’several passible; .- the same ""Sody as that employed-!or the’ surgical ' truck” were being con side red •-•by* the Medical'Department1-and because, ”It,', is not. -belie.ved possible ’to ..design -a ’ satisfactory,syrgical’truck-without, employment of a. special body*”^0 * ’ 1 • ” ■ I " ■ ' ; • .' . • 4 ‘ These comments having been rendered as directed,; The" Surgeon General’s Office requested that Headquarters,• Army- Service Forces ,■ approve the proposed project ’’with the.- understanding that close liaison will bo'maintained between' :- the Medical Department Equipment Laboratory, Carlisle • Barracks, Pennsylvania, and Headquarters, Armored Force, Fort, Knox, Kentucky,” and promised that ”Every attempt wall be made to develop a vehicle which, will be satisfactory both f'Pr the ' general use contemplated by this office and for employment by the Medical Battalion, Armored Force in lieu of the present/ standard surgical Apparently skeptical that: one - truck could be made to serve- both purposes, -The Surgeon ■ General1 s Office concluded its request with. this. bbseryatichiS Even if this goal cannot be attained exactly, -it- is desired tp.emphasize the fact that ‘experience in theaters-of operations has demonstrated" clearly the imperative need for a mobile surgical operating truck and further- has demonstrat6dr.the- fact that, the present surgical truck lb Inadequate for. the performance of more than very limited emergency surgical treatment* In short, the .need .ib for . . • mobile operating room facilities,'whereas the present vehicle provides only 'Emergency room ' . • *• ■' - On 9 July 1943, in consequence of this explanation, Headquarters, Army Service' Forcesapproved the ,f development of a Truck, 2-g—Ton, 6x6, Surgical', Operating based upon .: r- the standard Truck, 2-g—Ton,'6 x 6, Surgical. (Armhred'iTorce) and on 13 July 1943 the 3Tield.Equipment Development Branch and the Surgical Division of The Surgeon General*s Office were notified of this favorable action by higher authority.*^ Until this moment, it will bo observed, two’ important 537 RESTRICTED provisions of AR 850-35 had either been ignored or overlooked "both by The Surgeon General1 s Office and- by Headquarters, Array Service Forces* (l) Military characteristics as such had not "been formally determined, and (2) none of the actions resulting in .approval of the project had been processed through either the Subcommittee or the Medical Department Technical Committee, Quite promptly thereafter, however, The Surgeon Generalfs Office voluntarily rectified this irregularity when it initiated action to process military characteristics of the surgical operating truck in accordance with prescribed procedures. • jOn 2 August 1943 the Chief of the Field Equipment Development Branch requested the Medical Department Equipment Laboratory to submit tentative military characteristics of the’ proposed.surgical operating truck;25 the Equipment Laboratory complied.five days later;and the Field Equipment Development Branch, on 13 August 1943, informed the Research Coordination Branch that tentative military characteristics of the Truck, Surgical, Operating were as follows; . a. That the Truck, Surgical, Operating be an adaptation or conversion of the now standard Surgical Truck* b* That the equipment for installation in the truck be designed and arranged to provide for the followings (1) Storage space for the necessary material for a minimum of 80 surgical procedures, (2) Adequate moans for the scrubbing of arms and hands preparatory to the carrying out of surgical procedures*. (3) Adequate means for sterilizing the material necessary for surgical procedures* •• •* c. The equipment shall be permanently installed in the truck* ■■ • d* Size and quantity of equipment shall' be hold to a minimum compatible with the- operation o"f such a unit*27 ' 1 ■ ' ■ On 23 August 1943 the Subcommittee on Field-Equipment recommended that'military characteristics^’as ■ stated above be adopted for the Truck, Surgical, Operating;2® and- two weeks later, on 6 September, the Medical Department Technical Committee—except for changing the nomenclature to Truck,' 2jr-Ton, 6 16. Surgical Operating—approved the -report of its Records of, these actions were transmitted to the Commanding General, Army Service Forces,'oh 13 September 1943 with the request nthat the recommendation by -the Medical Department Technical Committee for adoption of military 538 ■•*: .-'-ibe approved."33 After' securing con- ‘ cur fence of -the :Afmy vGrouu’dv.Furqes, Headquarters ,Army Service Fofd§s', •appf.ove.dctiie-.stateDent of charac- teflstics: fof-tfo Truck,: S-g-Top, 6 x 6, Surgical’ Operating*32 And on 7 October El 943. the Research Coordination.,Branch r. notified Ot£er - interos tod.-* agencies within The ; Surge oh . ' General'1 §; Off ice of'the.-approval of Headquarters-,. Ariay Service ypreesi arid'1'instructed: the Field Equipment Development.Branch to inf ofn the Medical Department- Equipment Labor at.ory of this action*33 Thus some'1 3-g: n:onths after ;thc first formal suggestion thatr approval of the project hy higher authority he sought the initiation phase of Development Project. E-SS. .Truck. 2-|—Ton, 6 x- 6-,’ Surgical Operating was properly completed in accordance with the provisions of AH 850-25» DeycXopm.entah faork on the project had meantime "been progressing rapidly and'smoothly• By the time that the statement of military characterist ics of the truck was approved, ■ indeed,...The Surgeon General himself, along with some of his staff, as will he seen in the next section, had already inspected the pilot model at the Medical Department Equipment Dahoratory. III* Development Phase* Rapid development of. the surgical .-operating truck was considered to be of such urgency .that-yeven before, The Surgeon General's Office, formally requested approval of the project several very practical but informal .moves had been made to speed the development alopg.1- • .. . . A* Preliminary Steps * On 15 June 1943, for,example, the Field Equipment Development Brhn.ch requested; the Distribution Division of The Surgeon1 General Is ‘ Offi.ee to ship one Truck, 2g~Ton, 6x6, Surgical with its tentage to the Medical Department Equipment Laboratory Tfas soon as possible for the purpose of conducting'experiments with reference to changes in the internal arrangement of the Truck, Surgical*" At the same time, in anticipation of the formal establishment of the pro- ject, The Surgeon General's Office directed the Equipment Laboratory to conduct experiments "to test the feasibility of changes in the Truck, 2^—Ton, 6x6, Surgical"33—modifications that were believed necessary to the successful development of a surgical operating truck based op the surgical truck in use by the Armored Force* Although military characteristics of the proposed 539 vehicle had not as yet been determined, The Surgeon was: being taken to get the project quickly'under once•approval * of Headquarters, Army Service Forces, had been secured. B* * Construction of the Pilot Models r By the end of July the Medical■Department Equipment Laboratory'‘reported that the surgical truck requisitioned for conversion ttito the pilot model of the surgical operating truck had arrived on 30 July 1943 from the Few-York Ordnance District and that ’’Final plans regarding change"in design and equipment to be installed in the truck, surgical, operating, are pending the arrival at this laboratory of Colonel Clinton' S* Lyter, M, C,,, who is being ordered to this office for a two (2) weeks1 period temporary duty in this connection!”4**1 At that time'‘the‘Equipment laboratory anticipated ’’that-the work on the truck for the auxiliary surgical group .will*be completed in about ten days,*41 When it. learned that the truck had been delivered. The Surgeon''GeneralVs. Office promptly ordered Colonel" Clinton S* Lyter, Commanding Officer, First Auxiliary Surgical Group, Fort Sam Houston, Texas, to the Medical Department Equipment Laboratory to ’’assist in the development of an operating truck for the auxiliary surgical Oh 10.August 1943 Colonel Lyter reached the Laboratory,43 > ■: • During Colonel:Lyter1s touroof temporary "duty, development of''the now,,bruck seems to have progressed'quite well* The Equipment Laboratory reported'at the end. of" August that ’’’final plans regarding equipment to be -installed” as well as design of the surgical operating •truck had been completed; that conversion af a standard surgical truck into a surgical operating truck, except for. the' installation of one had been ’’nearly completed”;: and that a tentative list of equipment for. the proposed unit had been forwarded at Colonel Lyter’s request to The ..Surgeon- General,44 Although the surgical and medical supplies requisitioned had not"yet been received, the Laboratory expected them, to arrive.within the week; and it.,indicated, in conclusion, that ”the surgical truck, operating, .will..be completed and ready for inspection, by The Surgeon General ton:-or . about 10 September 1943,”43 Most of August and September was ”spent in converting 541 the interior of the truck to meet the requirements set forth by Surgeon General*s -Office in their letter of* 15 June 1945 and in requisitioning supplies”,nevertheless, few diffi- culties were encountered in structurally transforming the surgical into the surgical operating truck, into which all cabinets and interior equipment had 'been; installed by 20 September 1943#4? ”Eurther development of this project,” tho Equipment Laboratory reported at the end of September, ”is awaiting any changes which might evolve from’ the inspection which the Surgeon General is.anticipated to make on October 4, 1943#” At .the same time the Laboratory indicated that The tent for the surgical truck, operating, which was*constructed at the Jeffersonville Quartermaster Depot, Jeffersonville, Indiana, was received on September 27, 1943. It has been set up and inspected by the.,personnel of this Laboratory and*is now ready for inspection by the Surgeon General.4® 0. Inspection by The Surgeon General# •’The Surgeon General, accompanied by two general officers of his staff, inspected the pilot model of the truck and tent, as anticipated, on 4 October 1943^—just a few days prior to Army Service Eorces1 approval of the. military charac- teristics of the unit,i- Although several of his decisions , necessitated much additional work, some of which was not strictly developmental, 'The Surgeon General in the main was nquite pleased” with both the truck and the tent* 1, Proposed.. Modification of the Tent» One" result of The Surgeon General’s visit was a proposal to modify the surgical operating tent* In one account of the inspection the Equipment Daboratoiy stated that roof ventilators in 'the tent, liner were also to he pro- Its Monthly Narrative Report for October;, however, made no reference to this; proposed change; it indicated, instead, that the design.and construction of ;the tent had, been approved by The Surgeon, General ’’with .the exception that a. decrease in width of :tha, tent,.by jtwo panels,.and the addition of a blackout entrance was Since formal, development of the tent was :a responsibility of the master Corps rather than of:..the Medical Department, these.,, changes are mentioned briefly and only incidentally. 2# Liaison with Armored Force# A'second result of The,Surgeon. Sehcral’s 542 inspection-, was :furtirer liai son ...with, the Armored. Force— liaison which- the:Mqdical Department had promised Headquarters, Army Service ;,F<3tees,. ito maintain, while the surgical operating truck"v/as .being-.developed. On 5 October 1943 the Me'dical Department Equipment laboratory wrote as follows to the Headquarters ;of the Armored Forces General Kirk was here yesterday to see.the new model Surgical Auxiliary Truck and Tent and; seems quite pleased with both, A few tent modifications somewhat along your suggestions . and which we had supposed the QM was putting in, i* 0, proper blackout entrance and roof venti- lators in the inner liner, have been made. He now wants you to see the new inside truck set up, as he believes that it is much better than your present surgical truck, especially since you do not want to use a table in it. This one is made up to carry supplies and equipment* The General wants to concentrate on - .one model if possible. He asked me.to write-you - and have, you come up to see this.one as soon as < possible• y .. ’ ..... About two weeks after this request,-.the.1 : Surgeon of:the7Armored Force inspected the*surgical operat- ing truck at the Medical Department Equipment Laboratory to determine the feasibility of using it in lieu of the surgical truck developed initially for the armored divisions* In a recorded interview he indicated that the new unit, despite the" desirability; of several of its features, would be inadequate!' fojr his needs, mainly because the mission of the armored medical battalions differed from that of the surgical auxiliary groups* , More specifically, although the ”two layer” tent was nsatisfactory” and other features highly, commended the vehicle for use by the auxiliary surgical groups, the Armored Force Surgeon was convinced that his adoption of the new surgical operating truck would not give armored units nenough flexibility in field workfn55 Not only could he anticipate the occasional need ” of doing work in these surgical trucks before the surgical tent is heated,” but he also felt that the armored medical battalions would need a place to do a few operations when the situation so requires, rather, than be- compelled to unpack and set up the tent complete which would be the case if we accepted the truck set-up, I also feel that there will he many tines when one or two operations will he required .while enroute behind a Unit going into position. Under those circumstances it would he desirable to utilize one truck and use the interior thereof for such operative procedure* Otherwise, the truck can he taken conplete except that I would like to have the done light, the operating light, left in for.our units* -The bins arc excellent for the auxiliary surgical group, hut would not permit sufficient space • for any operative work in the truck, I there- fore think our present arrangement is /for the, armored nodical battalion/ more satisfactory, • , ,58 Copies of this recorded interview having been transmitted by- the^Director of the Plans Division tq the Executive Officer and to other interested agencies within,: The Surgeon General’s Office, all thought of developing a unit to be used by both the Armored Force and, the auxiliary surgical groups then seems to have been dismissed. 3• Decision Relative to Service Test Models. A third decision resulting from The Surgeon General*s inspection of the pilot model—rbne that effected procurement ultimately more than it did development—1*.was that 12 additional surgical trucks should he converted as soon as possible by the Medical Department Equipment Laboratory into service tost',models of the surgical operating tfuck*. In asking The Surgeon General*s Office to requisition the surgical trucks and equipment .necessary for such an,undertaking*, the Equipment Laboratory explained on 7 October 1943.. that gthe. convers ion could be performed.“niore expeditiously;,than- attempting to have vehicle standardised, for procurement now*1 :Inspection of the newly developed, unit by the Armoredeforce, not,-yqt having.j ;- occurred, the Laboratory observed that ,!Standardization can be-, taken up later with a;view of having the, Armored Conmanda},so... adopt this new model inOlieu of,their present”surgical truck*] and it added that "Surgical auxiliary trucks it ijk is; expected, , will bo very limited in"number unless adopted;by:the-Armored .. Upon receipt-of -this letter from the Medical m. Department Equipment" Laboratory* The. Surgeon General* s Office, promptly initiated these two appropriate actions? (l) It requisitioned the 12 trucks-and-certain, equipment needed by the Laboratory in effecting theiproposed conversion?5 and 544 (2) it instituted the procedure required by AR 850-25 to have the 12 trucks approved as service test: models hy Headquarters, Army Service forces*50 * Transformation of the surgical-trucks into surgical operating trucks was immediately initiated* when the vehicle requisitioned through The Surgeon General’s Office were delivered to the Laboratory on 22 November 1943, at which time, it was estimated that the conversion would be completed within'approximately two months,51 following favorable consideration by both the Subcommittee and the _ Medical Department Technical Committee,furthermore, the second of these two actions was subsequently terminated after Headquarters., Army Service forces, on 6 December-1943, returned to The Surgeon General this approving indorsement5 1* The item, Truck, 2-|—Ton, 6x6, Surgical operating is classified as follows*• ■ , Required type Development type Service test type, 2, The conversion of 12 standard surgical trucks -(■ Item No, 99590) into service test models together with expenditure of research funds in the. amount of $12,000 for the conversion and $.9,072 for trailers, tents and generators is •authorized, 53 ’ ’ 4.' Industrial Development of Sterilizer, ' Another result of The Surgeon Gene rails inspection of the pilot model on 4 October 1943 was an intensified effort by industry, working with the- Medical Department Equipment Laboratory, to develop for the surgical operating truck a suitable sterilizing unit for- dressings and bandages,: This activity began on 7 October 1943, when the Laboratory requested from The Surgeon Gcneralls Office authority flto have the American Sterilizer Company furnish twelve (12) experimental, small sterilizers for use in these trucks, to be built according to specifications desired by General Kirk,”54 The Laboratory__explained that nThese sterilizers if found satisfactory, /were/ to be later standardized- as Item 99500, Sterilizer, Dressing and Utensil, in lieu of the present model which is not very portable,”^ On 23 October 1943 the American Sterilizer Company initially proposed to the Medical Department Equipment Laboratory that a jet steam-heated hot water system 545 and sterilizer combined be employed on the surgical operating truck*®® Acknowledging receipt of the manufacturers drawing* illustrating the proposed layout, the Equipment laboratory promptly replied that : The plan appears feasible, and it is proposed to send the truck up to Erie for a period of approximately five days for installation and test there, the truck to be sent when materials for installation are ready* This is your authorization to proceed with the manufacture of the pilot unit to consist of complete sterilizer unit and hot water tank including gasoline burner. Purchase order will be forwarded upon completion of the unit and when cost is determined*®? , As originally designed, the sterilizer-hot water assembly consisted essentially of the following components* (l) "a standard 16 x 24" dressing sterilizer" mounted at a* slight angle on the* counter in a corner- of the truck, "leaving just clearance enoughtat the front end for the swing of the door"; and (2) "a 12" copper hoiler, properly jacketed," to which would he applied "A standard Coleman gasoline stove, having 3-10,000 h. t. u. burners."®® The company*s representative also suggested an "arrangement of the hot water' tank somewhat different than the one you have been using, which..we believe can he very simply mounted, and which should simplify'your piping.He explained further that , The heating of the water will be accomplished through a long .copper tube., .properly■-‘restricted . at the discharge,end, so that"the condensate of* the heating steam will pass directly into the '. hot water tank, -thereby conserving the heat which would otherwise be wasted if we applied the con- ventional coil with .steam trap,?® The designer intended for the hoiler to he operated, finally, "at approximately 25 pounds steam pressure, and the dressing sterilizer at 15-18 pounds steam pressure, utilizing a steam control valve inside the truck.."?-*- The "excess of steam pressure in the hoiler," he said,-"will pro- duce smoother operation of the dressing sterilizer." On 15, November 1943 the pilot model ofthe surgical operating truck was driven to the factory of the 546 American Sterilizer Company at Erie, Pennsylvania, for installation of the sterilizer-hot water assembly* When the work was completed a few days later, the manufacturer report- ed that The. truck is now equipped with* ' ’ • ’ ■ ' One 16-x :24H'Model V (steel construction hot dipped galvanized) steam,’.heated ’American-. Dressing Sterilizer, ■ ’ . ! '■* • * *. ’ j One Hot Water.Heat Exchanger and Tank approx- imately 6* in diameter and 50° in length. One Copper Boiler, gasoline heated, .by means. of a Coleman Burner having a capacity; of . • .. • cither 30,000 or 40,000 BTU, arranged for : . mounting outside the truck, and complete with safety valve, s.team guage, fill-in funnel and valve gauge glass, and a jacket made of steel, asbestos lined, double wall construction. The price of this equipment, mounted in the truck at ‘ow plant is $730,25 net, Eor additional units, complete as outlined above, but not installed,, and without interconnecting, piping, but complete with all.valves, traps, etc, we can-furnish-this equipment complete as described for $541,40 per set f, 6, b, Erie, Pa,, in lots of ten or more;, On 25 November 1943 the Department Equipment laboratory authorized the American Sterilizer Company Mto proceed with the construction of 12 units”; at ; the same time it specified, however, that ”These' sterilizers are to be Everdur with the door brass castings instead of galvanized steel,,f74 Simultaneously, the Medical Supply Officer, Carlisle Barracks, told the manufacturer that ,rthis office can give AA-1 Preference Rating” for this equipment, Taking cognizance of the proposed change in specifications, the American Sterilizer Company promptly informed the Laboratory that The additional cost per unit in lots of ten or more will be $97,00 making a total cost per unit in this quantity of $538,40, net, f, o, b. Brie, Pa, 547 We are further assured "by our factory that production can he scheduled to insure deliv- ery in the vicinity of 30 to 45 days after receipt of order,^ Thus it is apparent that the original intention was to equip the twelve service test models with a combination sterilizer and< hot water system that was identical*— if not in material, at least in design—to -that which had been install- ed on the pilot model surgical operating truck destined shortly to be field tested by both the Fourth and the Fifth Auxiliary Surgical Groups, Nevertheless this original plan was almost immediately modified. As soon as the pilot model truck with its newly installed ’’experimental steam generator, water heater and sterilizer” had been returned from the factory to the Equipment Laboratory on 23 November 1943, tests had been ”immediately, initiated to determine the suitability of the equipment in question,”?? Although ’’Pinal conclusion in this regard has not yet been reached,” the Laboratory reported'at the end of November, ”it is very probably from preliminary findings that the unit will not be considered suitable.”?8 Those responsible for the development subsequently changed the design ”from ajet steam heated water system and sterilizer unit to a separated system using a coil to heat the water and a knock down sterilizer utilizing gasoling heat.”?9 .-urn The reason for this change, explains an officer of the Equipment.Laboratory who was instrumental in the development, "was not that ,the first systern ,didn!t work but rather that it was inefficient and worked too slow*"80 Just how efficient it had been is revealed in the following memorandum reporting results of the operational;engineering tests performed by the Laboratory: 1. The heating plant of the Surgical Truck .e consists of the followings . a* 1 each 4 burner gasoline stove, 40,000 _ BTU. . ...■■• l.cach Steam;Generator and.Fittings• 1 each,Hot Water Tank (6 gal) with . h Piping, and Heating tube,*,, 1 each 24 $ 14 inches galvanizedvhori- zontal.. Steam Sterilizer with-piping. 2* To operate the unit it is necessary.:to fill the generator 3/4 full of water then start the burner. It'.usually takes 20-40 .minutes to: obtain steam.. Once, steam has been obtained water.can be heated 100.9, F: in; thrfee minutes. This is done by allowing steam to~bubble through 9-vent' holes located in the heater tub®. The sterilizer can be used in approximately one hour after starting and both the hot water heater and, sterilizer.can be operated at the same time,/ The following table will'show the operation of the ' .unit 1. < • ' ’ Time to obtain steam from ;'.'u . Z ......” cold start , . 20-40 minutes Time first steam can bo used, for heating water r;v-30-45 minutes Time elapsed from cold start . before sterilizer can be used 55—70 minutes. 1 filling of generator with water lasti s_7 V." , • 4 hours 1 filling of gasoline stove las.t/_s_7 5 hours 'pnee unit is heated up hot water is ‘available at all times regardless of use, ' Sterilizers and hot water heater can be used simultaneously,, if steam valve, to hot water, tank is cracked (only) • From a.- warm start- the t dme; pe r i o ds a re cut't o a'b out ■§■ the, above.: figures:, ! 3* The unit has the following disadvantages. a. Weight concentrated front right. b. Generator protrudes "beyond body 3 inches. c. Piping he came complicated due to both cold and hot water lines as well as steam lines. Obviously this allo'ws greater change of holes d. Both hot water system and steriliser dependent on one source of heat, Coleman gasoline stove. e„ Unit is slow -to operate (l hour) from cold start and will operate only 4 hours on initial charge of water. 4, The unit has the following advantages? a. Brings all operations within truck without 549 any exhaust fumes, b, Heats water very fast and maintains high temperature, Because of the Equipment laboratory's dissatisfaction over the combination sterilizer and hot water heater, the American Sterilizer'Company was apparently asked to put a hold order on the 12 units intended for, use in con- verting the surgical trucks to surgical steri- lizers of a design acceptably modified were,, later installed on the 12 converted surgical operating trucks before they wore shipped overseas,^3 B# Preparation of Equipment List. . % Prior to* concurrent with, and eiren-..extending beyond some of these actions that resulted from The Surgeon General*s inspection of the pilot model truck on 4 October 1943 was the combined effort of several Medical Department agencies to compile a list' of•' appropriate equipment—principally medical and surgical-—that would be needed in operating the truck. A tentative■list of equipment, one may recall, was first submitted oh 25-August 1943 by the Commanding ,Officer of the First Auxiliary Surgical Group while he was detailed to the Equipment Laboratory; ta-aid in the early development of the surgical operating truok.. This list was. properly coordinated within The Surgeon General1 s Office. Then the Chief of Surgical Service-, and the Assistant jChief Surgical ITurse of the 51st Evacuatl on i Hospital we re sent Equipment Laboratory on temporary duty nto supervise packing of the pilot model surgical.truck”8® and thus » determine practically the equipment that they believed should be included. . ! ■ ■: , • On 22 .tELejte,;visiting mitted to the Director of the Medical Department Equipment Laboratory-a report-on’thh .methodthey had’employed in con-4 ducting their * %ests;i ’ together, with lists of recommended equipment (see Appfepdix ,M) • There followed a great deal p more of coordinalive activity, both before and after field * testing of the pilot model,®” until on 22 January 1944 an ’’official list-’’., (see Appbnslx’N) was ready for'publication by The Surgeon Generalrs Office-^88 : ■ ’ u'p E-# Description of Pilot ' Mode-1. A tentative list of equipment having been prepared and the combined sterilizer and hot water system having been 550 RESTRICTED installed at the factory of the American .Sterilizer .Company the pilot model of the surgical operating truck was ready for field testing. Reports of the tests conducted will be con- sidered directly; but first let us review the following extract from a typed memorandum among the records of the Research Coordination Branch of the now-dissolved Technical Division^—a memorandum unidentified by date, authorship, or otherwise except by title—which succinctly describes both x the mission and the physical, characteristics of the newly developed mobile unit (see Figure 35)5 The S-jg-j 'ton* 6x 6, Surgical, Operating Truck ..consists of a 6x6, Ordnance chassis with" van'body equipped with special cabinets andHaccessories [_ see Figure 36/, It is sup- plemented by a 1-ton trailer, a surgical op- erating tent, and a 2,5 KW motor generator. The truck is packed with sufficient general surgical instruments to perform approximately one hundred major surgical operations. When the supplementary sets provided to special surgical teams are added, it is s'uited for all types of surgery, ‘In' Use, the tent is attached to the rear of the' truck and-serves as an dpejrating arena for the two. teams /see: Figure 37/, while the truck serves as a sup-.'-, ply and sterilizing room. The generator pro- vides all electrical energy required by the unit. This assembly is intended to supple- ment the operating facilities of anuEvacua- tion or Field Hospital. It is not designed to operate alone since neither mess facilities nor bed capacity is included,®^ 3sV Field and Operational Testing, Beginning in the second half of December 1943 and continuing for several months thereafter, the pilot model of th§ surgical operating truck was tested first by the Fourth and later by the Fifth Auxiliary Surgical Group4 1* Decisions Resulting from Equipment laboratory Tests* Meantime, however, as reported by the Medical Department Equipment Laboratory at the end of December, - A pilot model of the surgical truck with 551 experimental steam generator, water heater and sterilizer was thoroughly tested /by the Equipment Laboratory/ and conclusion reached that the combination of the heater, and sterilizer whs not practical, and it was decided that in the twelve (12) surgical trucks now being outfitted at this station, the water heater and sterilizer will be separate units.99 The Laboratory reported further that the structural conversion of the twelve trucks was nearing completion; that with receipt of a ’’new list of equipment" on 15 December 1943, "requisition for supplies necessary t.t ’outfit the twelve (13) surgical trucks, operating, under construction" had been "immediately initiated"; and that "Completion.of these units is • » • anticipated on 1 February 1944*"9^ 2. Testing by Fourth Auxiliary Surgical Group* The report just referred t%;—the report of activities of., the Medical Department Equipment• Laboratory during, the month of December 1943—concludes- with the information that The pilot model surgical truck, operating, with trailer was forwarded to the Fourth Auxiliary Surgical Group, Lawson General Hospital, Atlanta, Georgia, for service test, leaving this station on 18 December 1943* This truck arrived at Atlanta, Georgia, on 21 December 1945.92 A letter fr.om The Surgeon General's Office to" the Commanding General, of the hospital recommended ’’that the Truck, 6x6, Surgical, Operating, he set up besides your hospital and function under actual operating conditions for a short period of ten (10.) days to two Weeks” and ’’that a report he furnished this office with reference to the use o'f this Truck hy 20 January 1944, upon the receipt of which steps will he taken to standardize the vehicle. Another letter from the Director of the Medical Department Equipment Laboratory to the Commanding Officer of .the Fourth Auxiliary Surgical. Group transmitted ’’instructions for the steam generator, hot water system and steam steriliser. • , photographs of the tent * . , and an, instruction, >b.okle.t on. the generator unit,” as well as a tentative list .of equip- ment with the suggestion that such shortages af. equipment as >• existed at the time of shipment from the iahor.atory ”should ho requisitioned locally prior to tests,”94 , »■ « .• 552 On 1? January 1944 the Fourth Auxiliary- Surgical Group submitted through channels to The Surgeon General a carefully prepared, comprehensive, and objective report on its field and operational testing of the pilot model surgical operating truck. Since the complete text is presented as Appendix 0 of this monograph, only a summary of the report is introduced at this time, :",Tho truck underwent a road test by being driven,^”fully loaded with trailer attached,” from Carlisle Barracks', Pennsylvania, to Atlanta, Georgia, and examination of its contents upon arrival revealed that "hot a single bottle was broken and so far as could be determined, none of the items were damaged by the trip,”95 Although no permanent damage resulted, it was nevertheless observed that, ”duo to inadequate drainage, the faucets in the rear of#the truck, the. condensation float on the sterilizer and the foot pedal under the sink were*frozen,”98 'With1 the' surgical operating unit nset up between two wards of Lawson General Hospital,u the Fourth Auxiliary Group, using nonly the equipment carried in the truck,” actually performed* twelve operations and found that ’•For the most part, the unit functioned in an excellent manner*”9? ♦ ' ■: ' •; tfhc instruments provided were ’’adequate in both number and type”;the hot'air.heater and fan were. ”quitc efficient” and the small electric generator ’’ran several days at a time without difficulty, and supplied suf- ficient power for all needs”;99 and the tent provided ’’adequate space to allow two teams to work without Although ’’Weather conditions during the days when operations were actually performed were anything but ideal, consisting of rain, wind and, at times, sub-freezing temuenatures,” the pilot model then was ”both warm and dry so that neither the patients nor the surgeons suffered any discomfort*”^ The test report indicated, too, that illumi- nation would be ample if only two instead of three field operating lamps wore used; it recommended only minor modifi- cation of the litter supports; and though it stated that screened windows ’’would be a distinct advantage if the unit was functioning within an area where insects arc plentiful,” it declared that the blackout screens on the windows were ”quitc sat isfactory*”3 Finally, the report showed, after the truck and trailer had been packed with the equipment recommended ’’there is adequate space available and still leave room within the truck for two people to work” while manner,”9? surgical packs or, with the proposed type_of inside sterilizer and heating unit; /personnel could/ actually he sterilizing equipment” while the truck was in transit#4 Adverse criticisms of the -unit, with one exception, were all of relatively minor importance4 Utility of the unit would he improved, it was believed, by providing for the following* (l) heavier catches on cabinet doors; (2) slight modification of gooseneck over sink and .of drain pipe underneath; (3) covering for power inlet plug bn outside of truck body; (4) luggage straps over cabinets to facilitate packing of supplies; and (5) ladder or hand and toe holds on b outside of truck body to make filling of water and airheatpf gasoline tanks easier,5 More important, perhaps, were thirty- odd suggestions for changes in or. additions to the tentative ' equipment list;®. a ' ■N'The larges.tyde.fect and one which .caused almost constant trouble,” however, ,fwas the steam Upon arrival of the truck in Atlanta-—and frequently there- after—s mail--leaks in.the tank had to bo repaired, ‘’Inasmuch as Colonel7Q,Uinnpl /Director of the Medical Department Equipment-B&horatory/ has informed us that, typ&'..combination steam steriliser and water heater will not be1 Used on futurb models,” the fourth Auxiliary Surgical .Uroup reported, - is u not believed necessary to -go into dotails a's"to its’ defects*’—v Nevertheless it did observe-, -among many .more minor deficiencies, that ’’Steam is not produced rapidly enough ‘or in sufficient quantity”;® that ”3oilor capacity is inadequate”; that ”stcam condenses on the inside■of the sterilizer with consequent soaking of the surgical packs”; and that maintenance of a. head of steam sufficient for;.; sterilization was difficult,-*-® It was believed, however, that: ”The use of a separate steam steril- izing unit apart from the water heating unit, such as is being planned, should solve these dlfficulties;*■*-■*- - . The Fourth Auxiliary Surgical Group■opined, furthermore, that the ’’unit as now constructed is hot- suitable for work in cold climates” because the uninsulated outside water pipes ’’froze at a temperature- of 26°-'-F. while the truck was in Although it understood ’’that later trucks will have inside plumbing,” it,did suggest that ”on the present models these exposed pipes .be insulated toafford some protection from the cold,”-*-5 Notwithstanding the sub- - freezing weather, on the other hand, ”no trouble was experi- enced from freezing of water or watery solutions inside the ■ truck itself',” . 554 3. Testing by Fifth Auxiliary Surgical Group. Approximately two weeks after .the Fourth Auxiliary Surgical Group had completed its field and operational testing of the surgical operating truck at Atlanta, Georgia, the commanding officer.of the Fifth Auxiliary Surgical Group, Forth Sam Houston, Texas, began negotiating with The Surgeon GeneralTs Office for use of the truck by his organisation, which was shortly to go on bivouac,15 The Surgeon General’s Office approved his proposal thus to use the pilot model and issued'appr®pr-iate instructions to effect the transfer of the truck*1'* Fully*loaded and with trailer attached, the pilot model qurgical operating truck was driven from Georgia to Texps; and reached Fort Sam Houston on 8 March 1944#1® There it was ■J ” until ,-25 May'1944, ’’both'in the per- formance-of .animal surgery and in ASF demonstrations,’J19 It was shipped oh‘26 May 1944 to the Medical Department Equipment Carlisle Barracks, Pennsylvania, vV : • Since the cabinets inside the truck had worked loose en route from Atlanta to Fort Sam Houston.*.- the report submitted by the Fifth Auxiliary Surgical Group' on. 25 May 1944 recommended "that stronger attachment of the cabinets be,pro- vided* ; The unit itself ’’functioned well,” however,- and such defects as were found were ness.entially the game as those noted by the Fourth Auxiliary Surgical Group,Save for a few additions and exceptions to the previously' rendered' report— such as the recommendation that a portable fracture,, table-h® added, or that the litter supports-' be ■ higher,* or'.that a- ceiling ventilator with fan be installed in the truck,'or that certain- modifications be made in the -recommanded':list of 'equipment-- the Fifth concurred with.the report .of the Fourth Auxiliary Surgical Group.r Suggestions /contained in ‘the' report of the Fifth,Auxiliary Surgical .’Group (see Appendix P) were then appro- priately coordinated within The Surgeon General’s Office-and with , the Medical Department Equipment' Laboratory^ G* Modifications Subsequent to Field Testing. Before the Fifth Auxiliary Surgical Group had sub- mitted its reactions to the pilot model, the report of the Fourth Auxiliarv Surgical Group, promptly upon its receipt, was appropriately coordinated within The Surgeon General’s ■ Office and its recommendations were concurred,;in. Then, on 25 January 1944, this report wag forwarded to the .Medical Department Equipment Laboratory with the request that changes be made to overcome the undesirable features reported”, and that ’’this action be expedited in view of the urgent overseas requisition covering these twelve trucksthat is, the 555 vehicles which the Equipment Laboratory had converted into surgical operating units. On 5 February 1944 the Director of the Medical Department Equipment Laboratory replied by indorsement that “the nccessary,changes have been made to overcome the undesired features reported by the Fourth Auxiliary Surgical Group” .and that "These changes have been incorporated in specifications and drawings covering the truck, 2j*-ton, 6x6, surgical, operating.Furthermore, "In view of the anticipated standardization of one type truck for use by the Medical Department,n the Director indicated, these drawings and specifications had been so planned as to utilize the type of chassis and body which will he submitted shortly by this office as the basic truck for all types of mobile units of the Medical Department, As such, the standardization of the truck, 2^-ton, surgical operating, will conform basically to the one truck which the •Medical Department is expected to standardize at a later date.2^ One paragraph of this indorsement, which also served to transmit to The Surgeon General’s Office certain drawings and specifications relative to the newly developed unit, con- tained the recommendation that the truck, 6x6, surgical, operating, as embodied in the applicable drawings and speci- fications bo considered suitable for use by the Medical Department of the II, S, Army, and as such be adopted as a standard vehicle for the Medical Department,28 H« Disposition of Sorvicc Test Models. A brief digression is desirable at this point to relate the disposition of the twelve surgical operating trucks•being, fabricated at the Medical Department Equipment . Laboratory, Already The Surgeon General’s Office itself had arranged for the timely delivery of the trailers28^and . other equipment818 necessary to complete the units. It had' also informed the Commanding General, European Theater of , Operations, in London, England, that the twelve trucks would be ready for; "shipment to him on 1 February 1944, had requested that ho requisition the trucks, and had asked that his requisition indicate the priority desired,81 This information was received on 19 January 1944,82 556 On 31 January 1944 the service test models, ’’complete with trailers and equipment (less the shortages which were reported to The Surgeon General), were turned over , , , to The Quartermaster, Carlisle Barracks, Pa,, for shipment”;33 and on 5 February 1944, in the same indorsement that recommended standardization of the truck, the Director of the Medical Department Equipment Laboratory reported to The Surgeon General that ’’Twelve (12) service test models of the surgical truck, operating, constructed in this Laboratory during the past two months, wore packed in accordance with the latest equipment list and driven overland to Boston, Massachusetts, on 3 February 1944. Within 7-g- months after the first step was taken formally to initiate Development Project. P-55, then, the pilot model of the Truck, 2-y-Ton, 6x6, Surgical Operating had “been developed and tested and the desired modifications had "been made both in the service test models and in the drawings and specifications that would ho used in future pro- curement; and within four months after The Surgeon General himself had proposed the construction and within two months after Headquarters, Army Service Forces, had approved the proposal, 12 more surgical trucks had been converted hy the Medical Department Equipment Laboratory into surgical operat’- ing trucks. As recommended by the Medical Department Equipment Laboratory, the newly developed unit was now ready for standardization. IV* Standardization Phase, Even before the Medical Department Equipment Laboratory formally suggested standardisation of the new unit, the Chief of the Field Equipment Development Branch, Surgeon Genoral*s Office, had recommended in writing to the Chairman of the Medical Department Technical Committee ’’that the Truck, 2-|—Ton, 6x6, Surgical, Operating, be reclassified as a standard article,”35 Consequently, the Medical Department Technical Subcommittee met on 2 February 1944 and recommended that the Truck, 6x6, Surgical Operating, ”bc classified as required type, adopted type, standard article,” The report of the Subr- comraittoc presented certain pertinent information as required by AR 850~>25 and, further, it recommended that; (l) Medical Department be responsible for* 557 A • 4 ' * (a) Specifications, determination of requirements, provision of funds, and issue of the entire item, (b) Procurement of special installed equipment beyond that furnished by Ordnance, (2) Ordnance Department be responsible for specifications', purchase and inspection of trucks chassis and body with electrical wiring, hot water heater and tanks, sink and plumbing, and PE-75T 2,5 KW Generator (Signal Corps) mounted on a-1-ton 2-wheel cargo trailer, (3) Quartermaster Department is responsible for specifications, purchase, and inspection of tent, (4) , • • • - r • ' (5) Basis of issue be: One (l) per two (2) team, General Surgical’ One (l) per two (2) team, Orthopedic One (l) per two (?) team, Maxillo- facial One (l) per two (2) team, Neuro- surgical One (l) per two (2) team, Thoracic Surgical, (6) Monthly replacement will be: (a) Zone of interior 0 (b) Theater of Operations S.O3? This recommended monthly replacement rate, a footnote in the report of the Subcommittee explained, was ’’based upon experi- ence of the replacement required for Truck, 2a-Ton, 6x6 (Cargo),”38 The unit cost, ”based on latest procurement,” the report explained, was $5,500,00 for truck, trailer,-,: generator, and 558 instailed equipment* The instruments and supplies in the Equipment List will cost approximately $4,500,00 in addition to the above,39 The total number required ”if recommended basis of issue is approved” waV'indicated as 159 for 1944 and as 53 for Finally, for 1944 the ”TotaI cost if recommended basis of issue is approved” was stated as $874,500,00 less equipment; $1,590,000,00 including equipment,” and for 1945 as $291,500.00 less equipment; $530,000,00 including equipment,”^ Meeting 7 February 1944, the Medical Department Technical Committee recommended that the recommendations proposed in the Sub- committee report be adopted with the follow- ing modifications! (1) Medical Department be responsible for! (a) Requirements, funds, storage, and issue of the entire item, (b) Procurement of special installed equipment beyond that furnished by Ordnance, (c) Procurement, storage, and issue of metal base plate for securing generator to- the trailer used with . the truck, (2) Ordnance Department be responsible for! (a) Specifications, purchase, and inspection of truck chasis and body, electrical wiring, hot water heater and tanks, and sink and plumbing, (3) Quartermaster Department process for standardization the Tent, Surgical Truck, Operating as modified by the Medical Department. (4) The following items be listed on T/E for use with subject item! 559 (a) PE-75T 2,5 3£,W. Generator (Signal Corps). (b) 1-Ton 2—Wheel Cargo Trailer, , (c) Tent, Surgical Truck, Operating. (5) Equipment List for subject truck be classified as required type, adopted type, standard article, (6) Estimate of unit cost be $4,200,00,42 On 8 February 1944 The Surgeon General*s Office for- warded to Headquarters, Array Service Forces, copies of (l) the report of the Subcommittee,. (2) the approval of the Subcommittee report (with modifications previously noted) by the Medical Department Technical Committee, (3) the signed concurrences by members of the Technical Committee, and (4) a description and photographs of the item. Concurrently-, The Surgeon General s Office ,frcquosted that the recommendation by the Medical Department Technical Committee for standardi- zation11 of the Truck, 2-g—Ton, 6x6, Surgical Operating nbc approved,11 Substantially as recommended by the Medical Department Technical Committee and its Subcommittee, the Procurement Assignment B*ard, Headquarters, Army Service Forces, on 10 February 1944 indicated that responsibility for procurement of the' item TRUCK, 2-|-T0iU, 6 x '6,: SURGICAL, OPERATING loss installed surgical fixtures and equip- ment is assigned as follows! Specifications Body specifications subject to technical requirements of Medical Department Ordnance Determination of ~ • Requirements’ Medical Department Provision of Funds _ Medical Department Purchase - Ordnance Inspection - Ordnance 560 The Medical Department is responsible for all functions of procurement for installed surgi- cal fixtures and equipment*^ Then, on 20 February 1944, Requirements Division, Headquarters, Army Service Forces, also following closely the recommendations of The Surgeon General!s Office, classified the unit as required type, adopted type, standard article; charged The Surgeon General with storage and issue of the item; approved the recommendations relative to basis of issue, replacement factors, and equip- ment; and indicated that nTho Quartermaster General is being directed, by separate communication, to process the item. Tent, Surgical, Operating, Truck, for standardization,n^ This indorsement from Headquarters, Army Service Forces, con- cluded -with an expressed desire that The Surgeon General !,submit promptly to the Director, Requirements Division, this Headquarters, changes in the Army Supply Program result- ing from * the above action, Promptly the Technical Division notified other interested agencies within The Surgeon Generali Office—namely, S'upply Service and Fiscal, Surgical, and Training divisions—of this favorable action by higher authority and then granted per- mission to the^,Medical Department Equipment Laboratory to drop the project from its Monthly Narrative ReportThe new surgical operating truck was now considered ready for procurement—ready within less than eight months after formal initiation of Development Project. F-35, V* Procurement Phase, Procurement—or at least production—of the surgical operating truck, like that of the surgical truck for the armored medical batalion discussed in Chapter V above, was at first chronologically entwined with development. While the surgical truck was in the developmental phase, one may recall, a letter of intent to purchase 24 production models was proffered as inducement to get the pilot model commercial- ly constructed. While the surgical operating truck, on the other hand, was still being developed, the Equipment Laboratory itself fabricated and sent overseas 12 production models, which had been classified as service test type. Possibly after standardization of the new unit—but still during the early stages of its procurement—the Army Medical Purchasing Office seems also to have employed the expedient 561 of converting, by contract, other Medical Department vehicles (probably standard surgical trucks) into surgical operating trucks» for correspondence from the Purchasing Office mentions the cost of ’’revamping of old trucks,Unless this theory be accepted, there seems to be no explanation of how there could have been in use or on hand as of 17 April 1944 "About 36” of these units50 when the original order for 24 of the surgical operating trucks, according to the Army Medical Purchasing Office records, was not placed until 24 Juno 1944 and when delivery of the first nine units of this original order was made on 10 October 1944 and of the other 15 on 27 October 1944.51 However the vehicles may ha \e been procured at first, records of the Army Medical Purchasing Office reveal that by 31-October 1945 a total of 207 had been ordered and delivered.^0 As listed in the Modi cal Supply Catalog, the unit cost of Stock Humber 9259105, Truck, 2^-Ton, 6x6, Surgical Operating was $4,200, and the unit cost of the medical equipment for the truck (Stock Humber 9959110) was $5,222*95.53 On the basis of these figures, then, the 207 units cost the Army Medical Department a total of $1,950,550.65. VI* Evaluation. As with most of the other projects previously discussed, an appraisal of Development Project. P-35 resolves into an analysis of (l) the practicability of the item developed and (2) the .success with which the project was administered. A, The Item. Except for the gross inadequacy of the combination sterilizer and hot water system—a deficiency which was rectified even before the first lot of 12 left the Medical Department Equipment Laboratory, those who tested the surgical operating truck in the Zone of the Interior found-it generally excellent. (To judge only by pictures of the two, it appears much more field-worthy than a similar G-erman-develope.d surgical ..operating trailer captured toward the close of the war, Although a thorough analysis of overseas reaction has not been -attempted, preliminary examination of reports from Europe and. the Mediterranean suggests that the amount of favor with which the American-developed units were received was conditioned by the tacticab employment of the organization making the report. ' The first Auxiliary Surgical Group, for example, 562 which operated in the European Communications Zone until 12 April 1945,-'55 reported that r,As used in this' theater, Auxiliary Surgical Groups had no need for motile Surgical Operating, and, as a consequence, it had in April 1945 turned hack those trucks which had been previously issued to it,£? On the contrary, the First United States. Army, which had been supported during its initial landings;- on the beaches of Normandy by the Third Auxiliary Surgical... Group, officially declared^that ’’The practical value of the /mobile surgical operating/ unit in augmenting the operating room facilities of an evacuation hospital is Even those who found the truck superfluous, however, had no criticism of its engineering design.or construction, - : Until a more thorough study of field use can be-.., made, therefore, the historian of Development Project. E-35 believes that the fairest Evaluation of the effectiveness of the Truck, 2-J-Ton, 6x5, Surgical Operating in theaters of operations is to*be‘found in this summary opinion of.the Third Auxiliary Surgical Croup* When casualties are heavy and hospitals'few, such as _in the early'days _of a beachhead, . . mobile /surgical operating/ units arc excel- lent# When casualties become predictable CO and hospitals numerous, they are excess#1-; B* Administration of the Project, Though in its procedural aspects this project could have been handled better, few of the developments discussed in this monograph were generally more effectively administered than was Development Project. E-35» 1# Liaison, Especially noteworthy was the liaison maintained throughout, Eirst, The Quartermaster General was asked to authorize direct communication "between his office and the Medical Department Equipment Laboratory.to On the surgical operating tent. Then, the Commanding Officer of the Eirst Auxiliary Surgical Croup—one of the units for whom the truck was being designed—'•was ordered to the Equipment Laboratory on temporary duty during the early developmental stage to make recommendations concerning the surgical operat- ing truck and its equipment. The list of equipment which he submitted itself underwent extensive coordination before it was finally approved. Meantime, close, intelligent, and understanding relations with engineers in industry were 563 maintained while a suitable sterilizer was being developed* And finally, as promised by The Surgeon General*s Office when Headquarters, Array Service Forces, was asked to approve the project, "the Armored-Force was -adequately consulted with regard to the feasibility of replacing its surgical truck with the,proposed surgical operating unit. Liaison activities among,, the various interested agencies, therefore, loft nothing to-be desired, ’ 1 2.,‘ ' Procedures, Paradoxically, administration of the procedural aspects, of Development Project. F-55 was at once both.blamo- worthy and commendable, V (a) Project Initiation, - • • During formal establishment of the pro- ject,- one will, recall, procedures required by AB. 850-25 were not; mctipulously observed. The request for project-initiation, far example, had passed through neither the Subcommittee nor the Medical Department Technical Committee, Even before military characteristics were formally, proposed, initiation of the project had been approved by Headquarters, Army • Service Eorces—though not until some time.and considerable effort;had been spent in clarifying, correspondence between that ■■headquarters-and the office of The-Burgeon General- Volun- tarily The Surgeon General's Office later processed military characteristics in accordance with AR 850-c;d; but had the. - -proper procedure been observed from the first, even this slight misunderstanding of Headquarters, Army Service Forces, wovld doubtless have been obviated. ' Whether this procedural irregularity resulted from a mere oversight or from a laudable desire to expedite the development, the historian can only speculate* But the frequency with which similar irregularities had occurred and had be-on corrected in other projects then com- plete would seem to preclude the possibility that the irregularity in this instance occurred -solely from oversight* An analysis of how the dates of this project fit into the broader pattern of-World War II leads to‘the Conclusion that the Army Medical Department was, on the contrary, taking every possible short-cut to have surgical operating'trucks ready for the invasion of Europe that was to occur the following June, Such an aim—then held so highly secret—is of course not apparent in the correspondence. But if this really were the purpose in short-circuiting the procedure prescribed by AH 850-25. few would challenge the motive of the attempt to 564 - - w. expedite the project initiation",'even though it did fail to result in the’ desired saving of time* (h)• Classification of Trucks as- Service - Test Typo•• ...: - Unlike the action initiating the project, the action to .classify the trucks constructed by the Equipment Laboratory as service test type was administered strictly in accordance with the literal requirements .of AR 350-25. Con- sidered in its relation to the broad aspects of this project and to the much broader pattern of the world-wide military situation as it then existed, the classification of these trucks as service tost models also seems, to have been a clever and praise-worthy expedient to get the surgical operating trucks into production so that they night’be ready for the- invasion of Europe. By classifying the proposed trucks as service tost type, funds allotted for research and development only could be used legally for their production; and since final standardization did not wait upon overseas reports as to practicability of the trucks in combat, the historian-is led't o conclude that it was the desire to got them into pro- duction rather than the- intention of having them, actually ' ' s-e-rvico tested that led to classification of -the trucks as. . sehvibe test type. . . Again, if the motive for classifying the-' units as service test type he interpreted correctly, those administering Development•Project. E-35 should he commended for their ingenuity. To their entire plan only one possible serious objection might he raised--and as to the validity of that- the historian probably has no right to judge. But with the fabrication of the 12 surgical operating units being done by the Medical Department• Equipment Laboratory, work on other research and development activities at that installation came to a virtual standstill. As one officer assigned to the Equipment Laboratory later remarked, ‘ ’Here The Surgeon Generali Office was using . •a Development Laboratory as a small scale pro- duction factory for the' badly heeded twelve units "for overseas.- Needless to say the limited.person- nel of Medical Department- Equipment Laboratory was * unable to do much development work when the entire shops and staff were busily engaged in turning out; the twelve units,• 565 (c) Standardization. In its decision promptly to standard- ize the surgical cjperating truck, The Surgeon General’s' Officeacted as planned from the first, upon the, basistof tests performed by the Fourth Auxiliary Surgical Group* A possible explanation of the reason it did not.wait on performance reports of the service test models overseas has already been suggested* The service test models soom to have been intended only as production models, but under a different name. That it did not await results of the tests of the Fifth Auxiliary Surgical Group may be explained by the fact that these tests .had not been anticipated, -since they were instigated, one may recall, by the Fifth Auxiliary Surgical Group itself rather than by The Surgeon General’s.- Office* Although experiments conducted during maneuvers—if not during pombat—would have been more desirable as a final basd§ for standardization, the report of tests. conducted'*On the grounds of Lawson General Hospital by, the Fourth . Auxiliary Surgical Group was thorough and, under the circum-r stances/,, q/yttO adequate. And the formal classification of ;'the-.Truck, :3-|-Ton, 6x6, Surgical .Operating as a standard , article was'exemplars of the procedure required by AH 850-25, All things considered, then, Development Project. F-35 was a model of effective administration* FOOTNOTES TO CHAPTER X to The Surgeon, 7th Army, APO 758-, U* S,-Army, fr, CO, 2nd Auxiliary Surgical Group,. 8 Jan* 1945;- subject: ’’Annual Report [1944/;11 p, 1; et passim. -SECRET (Hist, Div,, S,G,0,). ' Extracted in clear, : 2Ibid, , 3Ibid... , • . .. : ' 1 • . ' • • :..r • • 4T/0 & , pj* 34* V 5 ••yll:- ••• : ’ . V • “• . i . See Chapter V, pp, 295-353, supra, -• " °Elizabeth Henney, ’’They’ll Take Care of Him In a Hurry, If He's founded,” in the Washington Post (9 Nov. 1943),.p, 4—B (A, M.. R, & D. Bd,)• 7 Memo to Chf,, Research Coordination 3r,, fr, Chf,, Field Equipment Development Br,, 25 Jun, 1943; subject: ’’Research Project for Revision of Contents and Arrangements in the Present 2^-ton, 6x6 Truck, Surgical”; et_ passim (A. M, R, & D, Bd,) * 8Ibid, to T, Q,, M, G,, fr, S, G, 0,, 25 Jun, 1943; subject: ’’Request for Research Projects be Established” (A. M, R, & D. Bd,), to Chf., Field Equipment Development Br,, fr, Chf,, Research Coordination Br., 1 Jul, 1943; subject: ’’Truck, Surgical Operating (A. M, R, &. D. Bd,), See also penciled notation on memo, to Chf,, Research Coordination Br,., fr. Field Equipment Development Br., 25 Jun, 1943 (A. M, R,. & D, Bd,). to T, C, G,, A, S, F,., fr. Dir, , Plans Div,, S, G, 0*, 30 Jun, 1943; subject: ’’Truck, Surgical, Operating - Development Project on” (A, M. R, & D, 3d,), 42Ibid, 13Ibid, 567 14lst Ind, to T, S. G., fr, Hqf,'A. c . E., 5 Jul, 1945; basic! see n. 567 (A. M.' R; & D*. Bdf). 15Ibid. ‘ *•* . • ,.. t g • :r r • ‘ * • - 2nd Ind. to C. G,, A. $* E.,'fr. Dir,, Plans Div., S. C-?>Of, 6 Jul, 1943; basic!' se-e a*. 11, p. 567; et passim (A. M. R* & d. Bd#)• ■. ;■ ” • '* / " ' - r , Bbide» et • . • 4 »'' 9 •* r Ibid, . ... * ‘ • ’ ■ 1 | •^Ibid.; et passim. ■ V ■ .■"'I I }' !■ -I . .. . — ■i S ■ . * et passim. . . * . ‘ PI * .%*'*• , ■ “ , Ibid.; et passim 22IbjdJ; et passim. ■ « , * i 1 ' * 23 ; 3rd Ind. to T. S, 0,, fr. Dir,, Requirements Div., A, §* -•» 9 Jul, 1943; basic! see n, 11, p, 567 (A. I-u R. & D, 3d.)f 24-. • _ Memo, to Chf,, Pie Id Equipment Development Plans Div** and Surgical -Div,, 13 Jul, 1943;* subject*! “Truck, Surgical, Operating - Development Project onn (A. M, R..& D. Bd,)* f 25Ltri to Dir., M, D, E, L., fr. Lt, Col. John 3f Elopp, 2 * Aug* 1943; subject! “Request for Military Characteris ties*1 (A, Li. R, & D, 3d.),. ;lnd. to T, S. G., fr,"Dir., M. D, E, L., 7 Aug. 1*943? basic! see'n, 25, above (4* M, R. & D. 3d,). ? 7 ’ . * Memo* to Chf., Research. Coordination 3r., Plans-Div S* G* 0*, fr* Chf., Eield Equipment Development 3r., Plans' Div., 13 Aug, 1943; subject! . “Military Characteristics re, Truck* Surgical, Operating* E-'SS” (A. M, R, & D. Bd*)*: :.. , ; ;; to M, D. T* C., fr. Subcommittee on Eield Equipment, 23 'AUg, subject; “Truck, Surgical, Operating” (A. M* R* d: D,. Bd.). 4 * < <■ • • •• %. Oo 22IIemo* Jior record/ fr, Secty., M* D. T, C,, 6 Sep, 1943, subject! “Truck, Surgical, Operating” (A. M.. R. & JD,< Bd;')» And see also Min, of M. D, T,■ 0_,, Metting* No*-.9*. 6. Sep, . 1943, Item Ho, 71, “Truck, Surgical, .Operating,” pp* 4-*5f RESTRICTED (Rec, Rm.t, S. 0. 0, 451f3-l->V Extracted in,;' clear. ‘ . - ' V" • *•*,’ • .. to C. G,, A* S. P,;, fr* Chf., Operations Service, S, G, 0*;, • 13.' Sepi 1945; subject-!* tf Truck'/ 2-J*-Tcfn, 6 i 6, Surgical, Operating” (A,> R»- & D. Bd>) * * . > 3llst Ind, to-C* G,, A, G, P,, fr* Hq./A, S, P,, 22 Sep. 1943} basic! see n, 30,. above (A*. M, Hi &' D, Bd,) and 2nd . Ind,,. to. C, G,, A* Sv P,, fr, Hq./Ai G,-*P,,*4 Oct’.' 1943; basic!.-see n, 30, above (A. M, Hr. & D. Bd*),- Ind, to T, S* G#l fr, Requirements Div*, A* S. P,, 6 Oct, 1943; basic! see n, 30, above (A. M. R. &■ D. Bd*)* rj rr 00Memo to (l) Chf,, Pield Equipment Development Br,, Plans Div,, and (2) Dir,, Surgical Div., 7 Oct, 1943} subject! ••Truck, 2-|—Ton, 6x6, Surgical, Operating” (A* M. H#- & D* 3d*)« _ / to Dir., Distribution Div., S. G. 0., fr, Chf,, Pield Equipment Development Br,, 15 Jun, 1943} subject! ’•Truck, 2-g*-Ton, 6x6, Surgical” (A. M, R, & D. Bd,) * to M, D. E. L,, fr, S, G, 0,, 15 Jun, 1943} subject! , • irTent-,- Changes in Truck, Big-ton, Surgical11 (M* D. E, L*)* 36i, v; ' Ibid, ?4oid. ’ ,''rT:■■ • • •• 38rbid. ..... .• • * * ‘ ■ ' ’ to Dir,, Distribution Diy,, S, G,* 0,, fr, Chf., * Pield Equipment Development Br,, 25 Jut.# 1943; subjcefct!' •Requisition for X-Ray Pield Unit, Pluoroscopic; 2-§*-Tpn, 6 x 6-Truck, Surgical0 (A. M* R. & D. -Bd,). * “ Narrative Report. M, D, 1,, 1-31 Jul, 1943, p, •22 (A,*Mi H, ’& D, Bd.), - * * to Dir,, -Plans Div., fr. Chf,,‘Pield Equipment Development Br,, 31 Jul, 1943 (A* M. R; & D, Bd,). to Chf.,- Personnel ’Service, fr. Plans Div.i 31 Jul, •1943 (A, M, R, & D* Bd,), Narrative' Report. M. D, E. L., 1-31 Aug* 1943, p* 18 (A. M« R. & D» 3d.)i 44 . Ibid*! et passim. • • The*tentative list of equipment, however,*did not include 569 any ,that was to .be permanently installed* .(Ltr, to T, S, &•> fr. D* 2, L,, 25 Aug. *19*45; .subjectI ’’Tentative List of Equipment for Surgical Truck, Operating” - A, M. &• Bd,),; ahd for' text of the list, see ibid.. Incl. 45I~old. 46ltr. to T. S. C., fr. Capt. C, T, Kellogg, 7 Lee, 1945;:, subject? ”Truck, 2\ ton, Surgical Operating,'.6 x 6, Project P 35 tncl. ’1, p. '3 (Hist. DiV., S. C* 0.,) . ».’■ • : r'“' ..... .. V- Narrative Report. M. D, ’S* L,, 1-30 Sep, 1943; p. 19 (A. M. R. & D, Bd,) . • • , ... ' j °Ibid., p. lO’.t, * AQ . ,, « * * = Ibld», p. 20. t. • . A • 1 ">QIIonthl.v Narrative Report. M. D. 3, i,* 1-31 Oct.. 1943, .p, 19 (A* M. R. & D, Bd.). , 51 1 Ltr* to Hq, Armored Porce, fr, M* D, B-, L*. 5 Oct, 3,943" (il. D, ,3. L, ) • ‘ ■' V t , ’ ;■ ; - 52 T, . , , . 101a* ’ * ' . • .V r • * .Monthly, ffarratdve* Report;,* M, D, 3. L,, 1-31 ■ Oct*, 1943; p* 20 (A. M. R. & D. 3d.). 54 * ' • * n. 51, above, *; * •' \ Interview with Col, Corby, M, C,,” 21 uct. 1943 (A, M. R. & -A 4 -DQ.* J 9 9 56Ibid. . .. 0 Ltr, to S, C, 0., fr, M, D, S, L,, 7 Oct, 1943; subjects. ’’Experimental Surgical Auxiliary Truck Unit” (M. D. 3, L,).# 58 ■ • . »-n ::<-••• . • • * ’ . Ibid.;- e»t» passim, * , See,, for example, memo. Distribution and Requirements Div., S.. £* 0,,'fr, Chf, £ield Equipment - Development 3r.f Plans Div., 11 Oct, 1943; subject: ’’Request fpr transfer of Trucks, Surgical” (A. M, R, & D. .3d,), and memo, .(w/incl,) to Distribution And, Requirements Div,, S, G, 0,, fr, Chf>, Pield Equipment' Development Br,f 28 Oct. 1943; subject: Truck, 2-1—ton, 6x6, Surgical, Operating” (A. M, R. & D. > Bd*)« to Chf,, Research Coordination Br*, Plans Div,, fr, Chi*, Eield Equipment development Br*, Plans* DiV*,- IS Nov, 1943 (A. H. R. & B, Bd,)„ ’ ’ " . '/ Narrative Report. M, D, E,.L.# 1-30 Nov, 1943, p*. 13 (A. H, R. & B. Bd,), The estimated, date of completion was given in this,, report as. 15 'January 1943;, hut 1944 was obviously intended for the year, 'sinoe the report was submitted ,’f qr* the’ month of November 1943# * i ;:' 62Itr, to C, C., A, s’/p.V fr, Chf-., Operations Service, S, G, 0.,, 26 Nov, 1943; subject: -’’Truck, 6 x 6, .Surgical Operating” (A. M, R. & B, Bd,). * ». ,••• 63lst Ind, to T., S,. G.,., fr. Hqfi A, S, E, , 6 Dec.* 1943;. • basic! see n* -62, above (A. I!. R, & D, Bd*), 3%itr, to T* S., G,, fr, Bir„,*M. B, E. L.,,-7 0ct. 1943; subject! "Experimental Surgical-Auxiliary Truck Unit” (A, M* R, &'B, Bd.V, 9 • 65T, . , ■ Ibid, 33Ltr, to.M, B. E. L,f fr* American Sterilizer Co,, 23 Oct, 1943; subject; . (/Sterilizer and Hot Water Tank Equipment for. Surgical Operating Trucks”' .(M, D, E, L,). to American Sterilizer Co., fr. M, B* E^L-,, 27 Oct, 1-943 (H, DPE. L,),. . - . . * “ '' • •' °®See n, 66, above. > , 59Ibid, * * . TOIbid, * . . * - . * • 72Ibid* . 3Ltr, to M, B. E, L,, fr, American Sterilizer Co., 22 Nov. 1943 (M, B. E, L.), * * ’ • , 74- * * ’ # •; “Ltr, to‘American Sterilizer-Co. H. -B, E. L,, 25 Nov. . 1943 Cm, b, e, l..) . , '; - ■ '3Ltr* to American Sterilizer Co,, fr, Med,’ Supply Off., Carlisle Barracks, Pa., 25 Nov. 1943 (M, B.'E.L,). 571 76 -» * *’ • Ltr* to, a* D, B* L*, £r. American Sterilize!? Co*. 29 Nov*. 19S3 (M. D. E. L.). , - 77 , Monthly Narrative Report. M. D, E, L,, 1-30 Nov. 1943, p. . 13 (A, M. .R, & D. Bd.) f 78m. " 70 , • . . ■ '■'Ltr. to T, “S, 0., fr. Capt, 0. T, Kellogg, 7 Bee.-1945; ’ subject! "Truck, Surgical Operating, 6x6, Project F 35," Incl. 1, p. 10 (Hist. Div., S. G. 0.).; 80Ibid. 8ll-iemo. to Maj. A. 3, Christie, M. D, B. L.,. -fr.- Capt. G. T# Kellogg, M, D, E, L., Dec. 1943; subject! "Surgical truck Heating Plant" (M., D. E, L.), . 82n . *• *• Transcription of telephone conversation between Capt, Kellogg, M, Df E. L., and Mr, Ray Jewell, -Chf*, Engineering, American Sterilizer Company, 3 Dec. 1943 (M. D, B. L.). 8oSSe n*'79, above, . • 84ltr. to T. 3. .0., fr, M.-D,. S, L., 25 Aug. 1942; subje.ct! "Tentative List of Equipment for Surgical Truck, -Operating" (Av IV & D, 3d,'); and see p. 541, supra. Memo, to Lt, Col, John 3. Klopp, fr, JDir., .Surgid’ql. Div., 2 Oct, 1943; Subject:’ "Attached list of equipment for surgical truck, operating" (A, M, R, & D. Bd,)* 88Ltr, to S. G., fr, Capt, G. T, Kellogg, 7 Dec, 1945; subject! "Truck, S-g—ton, Surgical Operating, 6x6, Project E 35," Incl. 1, p. 4 (Hist. Div., S. G, 0.). *■ ■ See penciled note on 2nd Memo. Ind. tp Chf,, Research ., Coordination 3r,, Plans Div,, S. G,’0,, fr, Chf., Field Equipment Development Sr., Flans Div., 21 Oct, 1.943-; basic! memo, to Chf., Research Coordination Br,, Plans Div,, fr, Chf., Field Equipment Development 3r., Plans Div.,, 11. Oct, 1943J subject: "Request for Trucks" (A. M, R, & D, Bd.); memo to Dir., M, D. S, L., fr. Lt, Col, John B, iClopp, Asst, Ip* OJ» 1 Dec. 1943; subject: "Truck, Surgical, Operating," v/ith incl. (A, M, R, & D,, Bd*) Jp.ltr, • to S. G,, fr. Dir,, M. D, E. L,, 15 Dec. 1943; subject: "Tentative Equipment List, Surgical, Truck, Operating" (A.-M, R..&.D, '■ A Bd,), 572 to Chf*, Field Equipment Development Brt, ,Plans Div., Operations Service, fr, Capt,Paul H, Languor, Jr.,- M* C*., Asst,,Procurement Advisory Br,, Professional Service, 22' Jan* 1944 (A. M. E, & D, Bd,). memo.; subjects ’’Truck, 2-g-Ton,’ S' x *6, Surgical, Operating11 ’(A* M. R. ,& B% ♦ Narrative Report. M, D, S, £,] .1-31 Dec, 1943; p, . 14 (A, M, R, & D. 3d.) , 91Ibid, * . ♦ 4 • 92Ibid, * * ». * *• “r " ~1 ♦ , % 93 Ltr, to T, C, G., Lawson General Hospital, Atlanta, Ga., .fr* Chf., Operations Service, S. C-, 0., 13 Dec. 1943; subject? ’•‘Truck, 2-g-t.on, 6x6, Surgical, Operating” (A. I;i. JT-. & D, jsd,) . * ‘ , 94Xtr. to GO, 4th Auxiliary Surgical Group, Lawson General Hospital, Atlanta, Ga., fr. Dir., M, D, E, L.t 2.1 Dec, 1943; subject : ’’Surgical Truck, Operating” (A. M;. R. & Df Ed,), . • * . 9^Ltr# to T, S. G, (Thru? Plans and Training Officer, Laws on General Hospital, Atlanta, Georgia), fr, Lt. Col,-H, A. Kind, Commanding, 4th Auxiliary Surgical Group, 17 Jan, 1944; subject: ’’Truck, 2^-ton, 5 x'6, ’ Surgical, ;.d * Operating,” Inci*? T, p, -1 CA* M, R,. & D. 3d.) f “ffid, ’V:;tP • 97Ibid. ‘ • •' • . .... 98jMd. \ ' . . . . ■ qq • - ♦»■<. * * *■ • * s. loid.. p. 2; et pas's in. •. . • : * • i • , . . 1' ;; • # Ibid.. ,■ p.' 3., , u .. • . •u rP’ : ; • - , P-. ■C ■ ■ ’ . ‘ ; V ■ .. p. 3,' • ♦ V*- , .. ■ ; ■. ■ .. • . * • •• •b . • *. i . _ . *'• ' . * *' • .. p. 9; fet 'passim. ■ r /-.CJ • 5 ' ’ A ■? • .. * . v "■ w Ibid. r pas~s*im. • *•' I * ,3 5md.; pp.’ s ff. -. , • .. 573 7TV 1 .* ** *■ ’ liiii1., - ■ • . > • ■ - ► V 8Tfc !. ‘ .'i3~ » * • Foie., p* 9‘ Ibid.. p, 1, 1QIhicl.. p. 2; et. pagsimi ’* * ‘‘ * * , p, 2, ' 1SIhid., p, 4, P2 * * . * *•• IMd,, p, 4; et passim.. t .c >a 14- IMcUr p. 4* 15 Ltr, to Lt. Col, Elmer D, Cay, M, C,f Commanding, 5th Auxiliary Surgical Group, Ft, Sam Houston, Tex., fr. Training Div,, S. G, 0., 8 Feb* 1944; lt£ to Lt. .Col, John B.XLopP, M. C,, Field Equipment Development Dr., Plains ’Div., S. G. 0,,*.fr, CO, 5th Auxiliary Surgical Group, Ft* Sam'H dust* on,* Tex., 12 Feb, 1944 (A. M, R, & D. Bd,),*.,’: 1st Ind., to CO, 5th Auxiliary Surgical Group, Ft, • - Hdusfon,'“Tex*, fr. Deputy Chf., Operations Service^,. S, „Q> 0,, T9 Feb, 1944;“ basic? ltr, to Lt, Col, John 3, ELqpp, 5*i:eld Equipment Development J3rf, Plans Div,, S. G. 0,f fr. CO, 5th Auxiliary Surgical Group,* Ft,-,Sam Houston, Tex,,. 12 ' Feb, 1944 (A. M. R, & D. Bd.), v * > . « • ‘ 1 7 Ltr, to CO, 4th Auxiliary Surgical Group,..Lavson .General- Hospital, Atlanta.,., Ga.V fr, Lt. ‘Cor, John B. Kl.opp, ,• //S* G. Oji 19 Feb, 1^944f .sueje*ct* "Truck, Surgioal-y “ Operating" (‘A. M,'"§» "& D,*'Bd,),' *] O . .js * ’ ,;h * **.,*. .1 ■ "Report on Truck, Surgical Operating, Ton, 6 x 6,n fr, Lt, Col. Dugald S, MacIntyre, Exec, ’Off,, 5th Auxiliary Surgical Group, Ft,’ Sam” Houston", Tex,, 25 May 1944, p, 1 (A. M, R, & D, Bd,)f i, , .*■ f 19Ibid,. p. 1, ' * »• • - i - ■_ • ■ to Lt, Col, John B, 'KTopp, ’Field Equipment1 Development Br.V'Plahs DiV. / S,r G, 0., fr, Hq,, 5th Auxiliary Surgical Group, Ft, Sam Houston, Tex., 25 May 1944 (A, M, R, & D, Bd,)* • , • PI See n, 18, above,. . ,. , v.-■_ . • • /-• ;; ;; , piste sim, ' ’ ’" ‘ " ',°See memo, routing slip to Lt. Col* B, N* Carter and Major Eink, fr, J* B. Klopp, undated (A, M, R, & D. Bd*); and memo* routing slip to; Lt* Col, Klopp, fr* Major Langner, 6-6-44, with penciled note thereon dated 8 Jun* (A, M*- R* & D. Bd.) • 24Ltr, to Dir, M. D, E, L,, fr. S. G; 0*. 25-Jan* 1944; subject: "Truck, 2-g-ton, 6x6, Surgical, Operating; Support, Litter, Operating" (A. M, R.- & D,*Bd,0* •' 25t, ., IhlCl, - • . * 26lst Ind. to T, S, G,, fr. Dir, M, D, E. L,,- 5 Eeb, 1944; basic! see n, 24, above (A. M, R, & D, Bd,).. 27Ibid. 23 Ibid.- 29 * See memo, to Chi.,, Eield Equipment Development Br„, Plans Div,., fr. Research Coordination Br., 7 Jan*. 1944; subjects "Truck, 2-|—Ton, 6 x* 6, * Surgical Operating" ■ (A. M, R, &;D. 3d..).. * •' _ • :i ‘ * i ■ * * ° lipmo*. to Dir., Distribution and Requirements .-Div,., -9,. G., 0., ;-fr, Chf., Eield Equipment Development Br,., Plans Div,., 12 Jan* 1944subject: ‘"Request for Spare Parts Kits; Pumps and Spare Burners” (A*. M, R,. & D, Bd,.‘); and tsee; memo, to Colonel Welsh,' fr,. Chf,;, Research Coordination Br,, 20 Jan. *1944 (A*. M; i,', BdiJ .* ‘ . ' i"'. ' 1 . ; * . '* ‘ i ♦ * •. f . , • • of tp.C, G,, ETO,*.: fr, Eield Equipment 4 Development Br,, Plans Div,.* G, 0., .15 Jan 1944, * COP PI DENTIaL (A, M, R, & D, Bd,.),. Extracted in clear, • * •*' 32 * ■ ' * * c' •' v.-~ Sec memo, for record crp.ss-jrefereqqing .CM-In—12395 to ‘.RYP.OE,--War;; fr,.;.USS0£,’ -London., ; 1-9- Ja;iti 41.944;' subject: "Request fer trucks” (!A, M,- R*. &;;D,v !$•»)*,. ... 33 Monthly Narrative Report., M.,.D, E.- 1-31 Jan. 1944, p. *X3' OW M, R, & D, Bd'.) ; and for. report of shortages * . * referred to, see Itr., lo ;T, S, G,, fr,'Asst, Dir. M, D, S, L.,*28 Jan, 1944; subject: "List of Equipment for Truck, 2g—ton, 6x6, Surgical, Operating" (A, M, R, & D. Bd,), 34 See n, 26, above, ' . • • ' - * 3oMomo, to. ChmM-,M. D, T,. C„, fr, Chf.% Eield'Equipment Development Br,, Plans Div,,.2 Eeb* 1944; subject: "Truck 575 2-M'Ton, 6 x j5k, -Surgical-Oper^tirKg!1 *(A, M; R.* •&’ IT,-Bd,), gg #. v. X • • * nodical Bepartment Technical! Subcommittee rpt* on- Truck, S-J-Ton, 6x6, Surgical,: Operating, to, M, B-, T’. C,, 2 Peld. 1944*, ’p’, 2*. (A,*1 M, R. & B, 3d,,.) , : * ■. » . 37IM4** p* 3-8M», p, 3, g9IolcU. p. 4. 40 T" . , c I Old#. p, 5, 41 Toidty p• 5; et passim, 42M.in» of M. B. T. C,, 7 Bed, 1944, HE STRICT IB, p, 4 (Hist. Eiv*f S. 0, 0,), Extracted in clear, . •. 43Ltr. to.C. 0,, A, S, P,, fr,.Chf,f Operations Service, S. 0, 0,, 8 Peb, 1944; subject: "Truck, 2-jg-Ton, 6x6, Surgical, - Operating" (A, M, R, & B, Bd,J,- • • A i • ’ * " ' ' Mst Ind, .tQ .Bir,, Requirements.Biv,, Hq,, A, S, P., fr. Acting Chairman, Procurement Assignment 3d,, Hq,, A, S, P,, 10 Peb, 1944; basic: see n, .43, above- (A, M, R,; & D* Bd,). 45 - ■ ■ • ■ * * • * ■ 2nd Ind, to T, ,S, G,-» fr, Dir,, Requirements/Biv,,. .Hq, , A. S. P,, 20 Pob, 1944; basic: see h, 43,- -above -(A, *M, R. & B, 3d,), "bIbid. t » V . to Chf,, Supply Service; Bir,, Piscal Biv,; Bir,, Technical Biy. t- 22 'Pe:b. ‘1944subject: ,wTruck^.-j2.-|^Toh, 6 x 6, Surgical ..Operating", '(’A, M. R,* & B. Bd,) *.* '/ . /IQ ’ * * * " ' •‘Monthly Harnative Report. M, B, E. L,, 1-31 Mar, 1944, p. 14 (A* M,.-;R. & -P-» 5^4)..♦, . • ■ ■ ■ ■■ ■’■ -Ind, to Lt, .Richard &, Yates', S> G> *0., fr, Maj,• A, Kornbacher, Historian, A, M, P, 0,, 31 Oct. 1945j basic: lt-f ,: to J-Caj, ‘Arthur .Kornbacher-,''A. M, ’P,t O,,* fr, Lt, ’ Ri chard E, Za.tosj,-- 22 Oct", 1945 (•• ETC 84 84. ... • SWA 21 * * 'St..:-. 52Sgg n. 49, p. 576. * *r ' " 52Army Service Forces Catalog. MEfp-3 (l Mar.' 1944-)*,* - ■ -r 5/ • •' ' ■ ... ‘See memo, to Dir M Surgical Consultants Div*, fr, Dir., Technical Div-,, 21 Jan. 1945; subject; ’’'Captured ’Gorman .Surgical Trailer," w/incls* (A, M, .R. & ,D. Bd.). t ■ , 55Ltr, to -T* -S, -£*, fr, CO, 1st Auxiliary Surgical ‘GrPup, A* P. 0. 408, U, -S, Army, S Jun, 1945; subjcdt: "Period ■Report, Medical Department Activities," p, 1, SECRET (Hist* • ‘ Div*,.S,-G*-0.)« Extracted in clear, 56rbid,, p. 5* ... 5^I»bid*. p, 3. * * CO , First United States Army; Report of Operations. 20 October 1943 - 1 August 1944. Book VII, Annex Ho, 16, p. 99, RESTRICTED (Hist. Div*,' S. G, 0,). Extracted in clear, s X Repoit to The Surge on General from the Third Auxiliary Surgical Group .for the Year 1944, p. 46, PlSSTRICTED (Hist, Div., S. G, 0*), Extracted in clear* to T, S. G.j 'fr, Capt; . G* T, Kellogg, 7 Dec, 1945; subject; "Truck, 2-g-ton, Surgical 6x6, Project E .35,." Incl* 1, p. 35 (Hist. Div#,„S. G, 0), 577 ’ QUARTER XI COMPARATIVE SUMMARY AUD' AxIALYSIS This chapter is divided into two sections. The first section contain? a^general classification of the administrative practices described in preceding portions of this study, and includes an analysis of major administrative trends from 1939 tio 1945. In- the second section an interpretation of ’these selected aspects of research and development performance’ is offered. Certain broad hypotheses are advanced to exulain pronounced trends in management practice. Eor those categories of administrative action which exhibit a less discernible pattern, individual analyses are presented. I. Trends in Project Administration. A* Project Initiation. 1* Establishmeht of a Military Requirement* ! *, * Despite a. marked•increase in research and development facilities during World War IX, total overseas demand-for new items of.medical field equipment was, through- out the war period, consistently greater than anything the Medi cal Department wasr equippe d to sat isfy •.;; Prom, the s tart, therefore, .it was necesshry to insure, first, that only the most essential development, projects would be undertaken, and second, that of those items scheduled f»r development the most urgentlj-” needed items would be developed first* The evaluation of'the military requirement which-existed for each proposed new’item of equipment, inasmuch as it served as the basis for this entire process of selection, was thus-an administrative action of the first importance* . According to the provisions of AH 850—25. the authority to decide whether a proposed development project was or was not militarily necessary rested with the ’’using arm or service” To what extent was this procedure aidilered to in the: establishment of the developments described in this study-?. Were'statements of agencies other than using arms or services accented as valid evidence of the existence of a military requirement?’“'What trends, if any, are discernible in Medical Department practice in these respects? In two of the projects with which this study has been concerned (the straight pale litter and the folding pole litter), because of the special nature of the experimental work to he undertaken, no formal establishment of a military 578 requirement was- necessary. Project initiation was desired in these instance's simply for the purpose of developing satis- factory substitutes for aluminum, which was in exceedingly short supply, for use in the-construction of the standard straight and folding pole litters. Since no new litter items were.being proposed—the aim being merely.to insure continued production ‘of litters already in use by the Medical Department— thfe-:above-mentioned provisions of,Army Regulations wore not applicable:. . ■ .. ; ■ In all’other projects described ih this study, the establishment of a firm military, requirement by the appropriate using arm or service- would appear to have-- been, a specified prerequisite to project initiation., In - only three instances, however, (the amphibian litter si'op, the ski litter adapter, and the snow and ice ambulance) does -therevidence indicate that compliance with this., regulation was approximated. Establishment of a project to develop an amphibian litter stop was based upon a specific request for such an item, submitted to The Surgeon General,-.by the - Director of the Requirements Division, Headquarters, Army Service*Forces, The request included a brief .statement of the purpose of the proposed attachment and an enumeration of its advantages over present methods Of ship-to-shore evacuation. It is not clear from the data whether'Army Service Forces was entering this recommendation on;its own initiative.' or in behalf of the Transportation'Corps,-the appropriate using service in this instance, ■ In any event the request had previ- ously been cleared-with the Assistant Chief of Staff, G-4^'■ s o therewas iittie doubt that a definite military need existed. . On the basis of a memorandum from Headquarters, Army Ground Forces, which stated that a military.requirement then existed for a nmountain litter, the initiation Of two projects—the ski litter adapter .and the snow and ice ambu- lance—was proposed by the Medical Department. While both project requests were subsequently Approved by t*he Medical Department Technical Committee with-representatives of Army Ground Forces present and concurring—indicating that this interpretation of Ground Forcesneeds had been sustained— it is not evident from the record that a clear military requirement had been established in either case* During' the. • course of the snow and ice ambu- lance project; a toboggan litter adapter vfts developed. After construction work .hadvheen completed,- ai.‘description’of the new item was sent "to Army War Collegeland a reply was later received, from:-that office stating "that the tahoggan litter adapter'was- :tov he an essential item of equipment.,r^'-,"'In vie'vr of the above sequence of .events it would 579 appear that in this instance an independent development pro- ject had "been -initiated and*Carried through to conclusion without prior written indication’of any kind as1 to the existence of a definite military Requirement’for the under— taking. ; : ■ . ;■ ... ” : .. Whatever may he said of the .formal adequacy of the above procedures, it vould nevertheless appear that the full intent of AR 850-25 had not been realized in most instances* As will be seen below, although net admissible according to regulations, project requests submitted by agencies other than the using army or service-* contained on the whole more convincing evidence of the existence of firm military requirements than those submitted by Arn\y Ground Forces. 9f the seven projects not initiated by,..the using arm or service concerned, two were initially proposed by agencies outside The Surgeon General's Office, Reopening of the terminated medical laboratory project was . requested by the Ninth Medical Laboratory, stationed at Forth Sam Houston, Texas* This project proposal was an elaborate document containing* (l) a statement of the major functions of the laboratory; (2) an analysis, in the light of these functions, of. the inadequacies of the laboratory as presently constituted; (.3) a description of a mobile, unit Improvised by the* Tenth Kedical Laboratory and a discussion of the test findings on this -vehicle; (4) a list of, tentative requirements for the proposed development item; and ('5) a brief analysis of the various vehicles which might -be- constructed'10 meet these- requirements*- This report .was-‘cleared through the Laboratories Branch ,of the Preventive Medicine Service and the Plans -Division, Surgeon General1 s Office;, before final submission-to Headquarters, Army ■ Service Forces* • A letter received from the Senior' Consultant in Ophthalmology, European Theater of Operations,,. appears to ■- have supplied the initial impetus which led to the establish- ment of a project to develop a nev. mobile ’optical repair unit* • This officer1 s -account of the.criti'cal ■ difficulties,, ;; then existing in this overseas theater as a result, in part,/ of the complexity of; the field optical unit, then in use was given careful study by the Chief --of: .the-'Optdeal Branch of The Surgeon General*s -Office* The need for a revision of the existing unit was further confirmed by‘The Surgeon General upon his return from an inspection trip ’Overseas* After a formal conference had. been held to, consider the specific modifications to be..,undertaken, a requesffor project initiation was sent- to the-Plans Division for clearance with hi ghc r aut hor i ty • r 580 j,_-* ,;.0f the five projects remaining, two appear to have 'been Initiated at the request of The Surgeon Generali the surgical truck and the surgical operating' truck projects* The existence ‘of a-military requirement was based in the first instance on a careful study of the medical inflictions of the rapid expansion of the Armored Force, A detailed. ., analysis'of the situation was presented 'to The Adjutant General An the Medical Department’s formal request;for pro- ject initiation. In the case of the surgical operating truck, overseas/no Oil'was-'determined by The Surgeon General after sfti extended tour 'bf the North African Theatey, ,r , The establishment of a milit'hiy/fecfair-ement for a medical laboratory trailer, project was, performed by the Plans and Training Division of The Surge oh"General!s Office. In its project request to the Adjutant General it was pointed out that a similar project had beeninitiated in 1933 by The Surgeon General after a careful study* of. the needs of the Army Medical Laboratory, but, due to a lack of .funds, this earlier project had never become active* The proposed reorganization of the present laboratory to include three mobile subsections was explained, and the' inadequacy off prbsent vehicular equipment in•the light , of thebe .-proposed changes summarized. Reference was made to the mobile Unit' currently used by the Pennsylvania State Btard' of; Health as' a concrete indication of-the feasibility of'the,proposed project.., Increased work load of the medical laboratory as., a result -pf recent: -changes in tables of organization ,was cited as a further evidence of the existing military-need. In its second petition tp Tpe Surgeon .General (the first, made in 1939,/had been rejected) requestihg establishment of .a dental laborat ory;;truck 'project, ..t he : Dental Division of The -Surgeon General ’ s Of fib®- began 'by restating the aims of the- field dental laboratory; service and followed this with a-'--.detailed analysis of the then standard portable laboratory, evaluating this item^in the /tight of these objectives'. Statistics regarding the volume of overseas prosthetic work Was -cited as evidence of the current military need for a new laboratory unit. Possible alternatives ‘■to the present model were--then' discussed and 'the advantages ■’of.* a self-contained, prime.-mover type of vehicle pointed out. This project request wAs studied by the Plans Division, "approved, and sent to the Medical Department-Technical Committee for formal presentation to Army Service Forces, Despite the wide' variety of methods employed, in only onb case was project initiation seriously delayed as a result of failure on the part of those concerned to conform to Army Regulations* A dental operating truck project was 581 first proposed in May, 1942, by the Dental Division of The Surgeon General*s Office. While this' request stated that an immediate requisition for three such 'units had been placed by the Air Corps, major emphasis was placed, upon the utility of the proposed unit in the Zone of the Interior. This request was subsequently rejected by higher authority'within The Surgeon General's Office on the grounds' 'that the existence of a definite military requirement had not been established. In July, 1943, the Twelfth'Air Force, 1 stationed in North Africa, submitted'ah cut-of-channels request that consideration bo given a mobile dental operating truck improvised by that unit as a conversion possibility for standard issue. Ho action was taken on this proposal by The Surgeon GeneralTs Office, and the Twelfth Air Force, after, obtaining a special allocation of 24 Ordnance trucks "‘for conversion into dental units for the North African Theater, next sent a petition through channels urging establishment of a dental operating truck project at the Aero Medical , . Laboratory, Wright Fiqld. This request was approved and an Air Force project established. ; # At this point the Dental Division of';'The Surgeon General's Office re-introduced its proposal for the establishment of a Medical Department project to develop a mobile dental operating unit* This petition stated that numerous fqr such..a*.unit-'f]f6in overseas theaters and that a military,.;nebH:-£or■thd:‘item in the Zone of the Interior to service small detachments and training.areas- was npK quite,:.evident*' 1 ": ! " "• * • Whether as a'result of the' Dental Division1 s arguments„or because- of the; necessityof"preventing standardi- zation of a-mobile1 unit whose.truck parts would not be interchangeable.with;Medical'Department’mobile units (the Air Force a. different basic vehicle). The Surgeon General*s>Office gave,its consent to establishment of the proposed project and-this action was approved by Headquarters', Arny Service Forces. While a dental operating unit was there- upon constructed, tested, standardized, and procured in a remarkably short period of time, because of the long delay in approving this project few units reached overseas theaters before the close of the war. In concluding this section it may ho said that while regularized procedures for ascertaining the existence of a military requirement were followed in only a minority of instances, no unwarranted development projects appear to have heen initiated and in only one instance (the dental operating truck) was project establishment seriously delayed. As for the adequacy of the evidence they contained, the project 582 requests described in the., section' Varied greatly. The most direct evidence of the existence of a definite military requirement was contained in the proposals '.recommending ' establishment, optical repair truck.'and burgical operating .frpek;- pro.je.ctis. in these. ins tandes v -the' petitions wore based upon firs t^hahd'knowledge of-, overseas 'heeds. ... •v wjthlthe'exception of- thectpbdg^an’litter , adapter fpirvdiibh no prior statement :ctf~ Milltary-% need appears, to have*."been-obtained, the least'- airfotmt of evidence on-this .point wad presented hy Army Ground Forces in connection with the establishment of the ski'litter adapter and snow and- ice 'ambulance projects. The remaining project requests occupied a broad middle-ground between these two extremes. In general, the inadequacies of existing equipment-, and the way in which these deficiencies* could be remedied' by the development of new or improved items wore effectively indicated. The urgency of these proposed actions, however, was less convincingly demonstrated. clear t rends in Medical. Department practice are discernible-in establishing .military, requirement* 'Pro- . cedures varied widely throughout the entire period of the war* 2m Formulation and Processing of Military. Characteristics* •. -• • • The careful formulation of.military character- istics for each new item 'of'development and the prompt Z processing'of this...-data through prescribedchahhcls 'was ,, for. -.- several reasons.,- an important part of the- process''of pro- ject initiation. In the first* place, every statement of military characteristics was, at least in part,- a Tefleptipn on the clarity with which a given set of research objectives had been visualized by the initiating agency* As ddch'at.■- was of definite value to the military authorities responsible for final approval or disapproval of the .project request. Secondly,- clearance of military characteristics through a designated technical committee provided ah‘excellent opportunity for early discussion of the project, in-specific . terms, with representatives- of all interested arms and . services. Finally, once all procedural steps had been com- pleted and project initiation formally approved, military characteristics, by staking out at least the broad outer limits of the proposed investigation, r.furnished a necessary minimum of directional control over research and development personnel. A ’ According to Army Regulations, military characteristics for an intended new item of equipment were to be r,formulated by‘the’'using arm or service, approved by the commanding general of the force in whose cdmria.nd the military characteristics originated, and coordinated through the technical committee of the force or service charged with the procurement of that class cf equipment* To what, patent were these provisions complied with in the projects described in this study? , 7V A review of the preceding chapters discloses * that in no instance is there evidence that a statement of * military characteristics was initially formulated by the -; ~ ■ • using arm or, service concerned. Only once, in fact, does it’-- appear that a using agency made any substantial contribution in this respect. In the case of the ski litter adapter, shortly before final standardization proceedings were begun, Headquartersh Army Ground Forces presented to the Medical Department a special list of recommended characteristics for the now item. These suggestions were subsequently condensed and added as a fifth military characteristic, supplementing the original four drawn up by the Medical Department and approved at the time of project initiation* Inasmuch as the ski litter adapter had already been developed, Army Ground • Forces* contribution in this instance had been largely academic.* ' Tn-the one- other ihstance of outside’partici- pation in the formulation of military characteristics (the surgical truck project}* no changes in - original■Medical Department listings;appc,; r. to.have been:effected.. Shortly after this project approved’-, • Headquarters of the ■**•’ Armored Forces at Fort ox, , ,Ken'tucH^/"submitted a series of five additional characteristics to’be established .for the new item* There is no indication"from the ’data, however, that those were ever formally incorporated', into the project. ; In all other cases, military-characteristics appear to have been prepared exclusively ..'by-•the • Department—usually by the Equipment Laboratory .at Carlisle Barracks, Pennsylvania; in short, by research and development' personnel, themselves* Turning now to the adequacy of, the 'mi lit ary characteristics prepared, while minimum standard’s'of con?!1 :i pletencss and precision-would appear to have hcen attained in all instances the least/satisfhct'dry'performances in these respects wore in the .straight,pole litter, the., folding pole litter, the medical laboratory' trailers, and the surgical truck projects* In. the last-named instance at least certain of the difficulties experienced in coordinating structural specifications with the Armored Force would seem to he 584 traceable "to inadequate" initial■formulation of military characteristics' fob'-the'-pilot model■ vehicle* • .'.bin-'-all- other'instances a relatively high level of precision andncomuletesess -was maintained. Iri contrast to previous . practicey t&© danger now was over—precision of statemdntvo.'Whtle■,in-.general this opposite extreme was suc- cessfully, in one instance the enactment of too rigid military characteristics proved to be a serious detriment to research and development 'personnel, ■ ■ In the case of the snow and ice ambulance pro-- ject,-one'of■the characteristics adopted for the proposed vehicle-'provided that it was to be "so designed; that it can be pulled by a mount, small tractor, or if 'necessary by"human hand* This last specification--that the conveyance should - bo towable by-hand—effectively ruled out of'consideration ■ ‘ , virtually all-motorized vehicles* -Since Army Ground Forces'-’ !’- had presented only a very generalized requirement in this instance, the necessity for this particular narfOwing of the project was not evident, ‘ - The subsequent history of this Sasie'would deem- instructive. First, the pilot model snow and'ice ambulance, constructed by the Equipment Laboratory according to project specifications, was rejected because of its unsatisfactory field performance. Second, it was stated by the-testing agency—the Mountain and Winter Warfare Foard, Camp Hale, Colorado—that the military characteristics which had'been v2 established for.this project were, in effect, unattainable, A conveyance light enough to be towed by hand would lack sufficient durability to be tOwed by.a snow vehicle. :Third* it was found by the medical personnel at Camp Hale—and this finding was sustained by the Board—that no military-require- ment existed for a towed snow and ice‘ambulance for use in mountain terrain. Fourth, employment of the M29 Cargo Carrier (a'standard'Ordnance vehicle) was recommended by the Board as fully satisfying existing Ground Force requirements. These conclusions were subsequently concurred in by Army Ground Forces, Army Service Forces, and The Surgeon General*s Office, and Development Project . F-29. was • thereupon terminated. Though lack of an adequate preliminary inves- tigation of research alternatives would-'appoar to have "been an immediate cads’®' Of the-above'■difficulties, the enactment of too restrictive military’•'characteristics had prevented a more complete' initial survey from being made* •• •-As for the'promptness of preparation of military characteristics, as well as the coordination of this data through the Medical Department Technical Committee, there was considerable variation in practice. In one group of projects, military characteristics were prepared and forwarded through channels to higher authority, but. wore never formally processed through the Technical Committee. In tyo: of these cases (the straight pole litter and the folding pole litter) military characteristics’ had been promptly prepared and included in the -formal*pfoposal for project initiation. In a third instance (the medical laboratory trailer) such a list does not-appear. to have been prepared until approximately two years afte’r pr.oj-ect initiation, t , ■ * A of projects may be distinguished in which, although-military .characteristics were, cleared ■ through the. Mddical Department Technical Committee as required by. -regulatDons', the initial preparation of, these character- istics was delayed for periods ranging'from one to six months, Five items belong in this category—the toboggan litter adapter, the amphibian litter stop, the optical repair truck, the . medical laboratory truck, and the surgical operating truck. In all of these instances military characteristics were formulated too late to serve either as a guide for those responsible for final approval of the projects or as a means of broad directional control over research and, development personnel. Construction of a pilot model had been completed in these instances by the time a statement of military characteristics had been approved. One project (the surgical truck) while it hears some resemblance to those in the above category pro- perly belongs in a separate- class. Here, approval of military characteristics was delayed approximately one month, not because of a delay in their preparation buty.be cause•of over—anxious ness • In an attempt to expedite''’the" project, the list had been submitted.-directly to The Adjutant General’s Office instead of the Technical' Committee, * The Medical Department was subsequently directed to’•re-route this information through prescribed Channels, A final category of projects may be mentioned in which military characteristics were not only properly prepared, but were promptly'coordinated through the Medical Department Technical Committee before -submission to higher authority* Four projects may be included in4this class—the ski litter, the snow and ice ambulance,*the dental laboratory truck, and the dental operating truck. Except .■‘for the fact that military characteristics had not in these instances been originally formulated by the designated using agencies, all other procedural requirements had been strictly Observed, As "for administrative trends over the entire period covered by this study’, the following summary is offered, Ho trends are - observable with regardfto. Tfsihg - agency participation in the preparation- of military character- istics# The only‘-substantive contribution ma'de by a using am appeared in a later project sthge,- after.an initial list of characteristics, ‘ formulated, the Medical Department, had already been approved, ; As for'the promptness with-which military?- characteristics., were 'prepared*- from a chronological standpoint a moderate retrogressibn'.Is indicated, For the ’h period, 1940-1941, the ratio of prompt to delayed formulafiohs was three to two;~for.:the period, 1943-1944, *(no prp-jects ' described in this sfudy were initiated in..1,942) the ratio was' three to five, ‘• * ? Considering the'.quality - of these formulations, prior to 1543, statements of military/: characteristics were relatively imprecise* and incomplete, .After that date a uniformly high#stahdard -both of precision and Completeness was maintained, with only; one lapse into the opposite ..extreme of of statement;# ...r ’ . ' ' r-V.-r-... ■■ . 'In the forwarding-'of military char ac to r,4. s IjdttV-’■ ■; through prescribed•channels, ah' equally positive ch?onolbgical trend is discernible,: Prom 1X40 to 1941, military character- istics were correctly processed through the Medical "'-V Department Technical Committee on only two out of five' occa- . sions, both of "these; instances of conformance with regulations occurring in ‘the latter year. During 1943 and 1944, clearance of this data through the.Technical Committee was accomplished in every instance. B, The'Conduct of Preliminary Research Investigations. Prior.to .the .initiation of-the development of any item of equipment, „a -tbchndcal service . ■. should investigate such work as may have'been, performed along closely’similar lines by other technical services*, by other, departments of the. Government, .and by other agencies-, with a. -view to directing effort along the most .productive lines and diverting it from lines .‘Jiaving little promise. Knowledge of the analogous development work in foreign armies';; should be sought through the Military , ' ’, Intelligence Division of the War Department -T : “General Staff.P . * ‘X „■ . • To what extent were the above and other related pro- cedures followed in the pre-development phases of the projects with which this study is concerned? What trends, if any, may be observed in. Medical Department practice? '' In beginning this discussion it should, of course, he pointed out that the need for preliminary research investi- gation varied greatly from project to project. At one extreme were pioneer experiments, such as the snow and ice ambulance, t& first mobile medical*laboratory, and the surgical truck. Here no familiar military precedents existed and consequently the need for exploratory research was great. At the other 'extreme were such specialized developments aS the folding polo litter, the ski litter adapter, and the toboggan litter adapter# In these instances, the precedents were many and controlling, and only a highly restricted area remained for independent investigation. Most of the projects with which this section deals, however, occupied some broad middle ground .between these two extremes. While, for example, the straight aluminum litter of 1S35 served as a model for both the straight steel and straight wood litters of World War II, considerable deviation in specifications and design was permitted. Similarly,-while adoption of the same basic vehicle as had been used in the development of the surgical truck was mandatory for all succeeding medical truck proje.cts, the design and construction of interior fittings as well as the selection and placement of equipment and supplies offered a considerable opportunity for original research and experimentation. It will be seen from the foregoing summary that, in spite of wide variations, some degree of preliminary investi- gatory research was necessary for each of the projects■, con- sidered* It is. with this area' of- diseretiion—whether in the individual case it was great or ,small—that the following discussion is -coiicerhecL . . ‘ • 1, The Study of Past Experience, At least •seven distinct'steps were:'required for the performance,/within the full meaning- of Army Regulations, of a thoroughgoing preliminary research investigation, #A logical first step in this- process, was the systematic study of all relevant past- experience, Stpdy of tbis kind had'a dual utility-# First,', it was the surest method'of ’’directing effort along ..the -most productive fines and diverting it froii lines havihg little promise,” as stipulated in>AR -850-25., . Second, knowledge of the historical background” in the'1' field■1 of research concerned was essential for those responsible / for giving final.approval or disapproval of .a proposed • . >• development*pfojact# in,clus.i'Ch of, this material,!therefore, in all formal, re-quests' fp.r.-. project .initiation ..was-- routinely n- desirablc, •v* ‘ • - • ' h'- / • -. ‘ : ? _ Though-ah'ample Record of past Medical Department'practice was available for each of the eleven fields of research with which this study .has been concerned, in only five instances was this material included in formal proposals for project initiation or continuance. In the case 588 of tho straight and folding pole .litters and- the. medical: - ;- laboratory trailer, a separate section of the initiation ‘ ,.-: request was devoted to historical'background,. These _ summaries were brief but they appear to have been-adequate;.: for the purposes intended,' .In- two other instances (the-- # . dental laboratory: .truck and the, optical..repair t ruck) /’while separately ■ sections, were not included in the -formali'prcJ'e'j«t.:^'Jif .nufae.rous references, to-'past practices in\the-se^fraids were;woven into the body of the ., report-, V • cv- . ;• ‘ •• : " • ... • ‘ In all other cases, no historical data-appears . to have been included in the initial requests for project , establishment, ' In two of these:instances, offiission of this ■ - material would seem to have delayed approval of the project concerned. In the first request for.initiation cf, a dental operating truck project, no reference was made to the ' existence of two such units in Prance during World War I,- their satisfactory performance at that time, and the demand for additional vehicles of the same type on the part of dental officers serving wi'th the American Expeditionary Eorces, The above-project request was subsequently rejected on the ground that overseas need for such a unit had not been demonstrated, ♦ . In'a second case (the surgical operating truck) failure to include in the formal project request adequate historical data indicating previous practice in handling forward,area-surgical operations, the Inadequacies of such practice, and the - further inadequacy"pf the otter standard surgical truck;to meet this situation, led, to a misunderstand- ing on the part of higher, authority of the..basic purpose of the project,.. Only after extended; correspondence was this mattef-staisfactorily clarified, and establishment of the project formally approved, • r -. Prom a -chronological, standpoint, the level of ■Medical Department performance with respect.to this first preliminary,step appears to have declined markedly after 1941* Prior to that date, all.project initiation, proposals con- tained at least a minimum of relevant historical background material*-• ;Af(ter that date, such information was . included in only two oht of bight instances, ■ ;. f \ r .f This is not to say that Medical Department research, and,development personnel didenot, themselves, have an ample awareness -of :previous research practice in each of the fields, here considered* In the- the ski litter project, for example, it is clearly- indicated in the data dealing with the development phase of this undertaking that Equipment Laboratory officials were fully informed as to the earlier ski litter adapters which had been devised and were 589 firmly determined to avoid the errors which had "been made in the past in this field. Illustrations of this type could he multiplied. However, in the view of the authors of this monograph,- this knowledge, of the past was in most instances simply' the natural- by-product pC .the1 individual officer’.s . own first-hand experience, and not' the result of documentary study* This opinion is-based upon numerous interviews con-' ducted over ah eighteen-month period, as well as considerable day—to-day'association with research and development person- nel for periods ranging from..four to six It was observed that, generally speaking,' familiarity with pre-war documents 'relating.-to -the. projects here considered was, insofar as research and development personnel-were concerned, the exception rather than the rule; • ; S, - The Study- of Existing Military Equipment, This step was particularly necessary where the development item was to be adopted to a standard supply article, but it had value in other cases as well. Only after a careful survey of current catalog listings was it certain that an existing item of military equipment, either in its present form or after modification, would not satisfy project requirements as adequately as would a completely new item* Such a study, therefore, was a useful safeguard against either the initiation or continuance of unnecessary develop- ment projects* Inasmuch as seven of the development; items discussed in this study had been initially proposed with a specific standard equipment model in mind, no further catalog study was. necessary in these’instances• -The straight and folding pole; lifters wore to bo patterned after their aluminum counterparts of the pre-war period, while the ' standard surgical! ruck was expressly indicated ajs the basic model for the five, subsequent medical truck projects, "• ’• In, the three adapter projects, however,, an intimate knowledge of related items of standard military- equipment was essential* In two of these three cases (the ski litter adapter and the toboggan litter adapter) this necessary information was promptly and systematically obtained* Specifications and drawings of all Quartermaster skis, and toboggans were requested and, upon receipt of this data, selected models wore requisitioned for experimental use* Research and development personnel already had, of course, complete knowledge of all standard Medical Department litters, ■ Vfolle in Tpqth of those-instances, certain adaptation difficulties were subsequently encountered, these would not appear in any way attributable to the manner in which this investigatory step had been carried out. These particular problems arose either .as a result of later developments which could not have been-'forseen, or as a result of special conditions existing at the time preliminary research investigation was. conducted. ' “ In the case of the amphibian•litier stop—-the third of these litter adapter proje preliminary investigation bf all related military equipment does:not• appear, to hdye'been' undertaken, : *;IhsteadV'':ah’ httacHMsht was . developed which/wai adaptable' 6niy;'t6f;those vehi,Gie'S'which had been initially secured;f -li-was-:sub-* sequently'discovered that two-other’ types ‘Of amphibian trucks were being'used in the field, and it was thereupon found necessaryto postpbne standardization action several months while specifications and drawings of all types of amphibians were being Obtained and the finished litter stop redesigned to meet these additional requirements. In three instances (the snow and ice ambulance, the medical laboratory trailer, and the surgical truck) pioneer development-work was to be undertaken. Consequently, investigation of all relevant existing equipment was especially necessary. In only the last-named of these projects, howevey, does a complete survey appear to have- been made. Vhile the possibility of converting Quarter- master sleds or toboggans into an experimental snow and ice ambulance was given considerable itudy, only one Ordnance vehicle (the T-l5 Weasel) appears' to have been examined in this connection*' The narrowness 'of scope of this preliminary investigation was, as' has been indicated in ah darlier ’ ■ section, largely necessitated by the restrictive military- ■ characteristics adopted for.the project* Inasmuch,>however, as it was . subsequently discovered that the-'1489 Cargo Carrier, a standard Ordnance vehicle,, adequately'satisfied-1 all;-• military requirements, it/Would appear that excessive restrictions,on thb scope ‘Of 'research had,' in thi-svinstance, resulted" in the initiation and continuance' of -ah unnecessary development project* •" ! * p- " " " ■ • rt'frr: d . In the case of the medical laboratory trailer, while a complete .study of all military vehicles does not appear to' have, been made, under the circumstances- such a study would have been largely academic* As a matter of f act y" the Medical, Department was aware of the existence of a h. number qf.'promising'alternatives to the vehicle finally- i'• : -■ selected,, but .‘available research funds ($500) were insuffi- cient to permit the requisition'of any of these* Ultimately the first surplusn.trailer that could be located was pre- cmpted and development work begun without further preliminaries* This pilot model trailer was subsequently rejected* Several years later, when the project was reopened, conversion of a standard Ordnance truck was successfully'accomplished. This basic vehicle had existed at the time the original trailer laboratory had been developed,*-'-'-uR- #In arriving at' a ■final decision regarding the general specifications of.the pilot model surgical truck (a specially designed van bbdy mounted, on a'standard 6x5, light cargo chassis), the Medical Department may well have been influenced to a large extent by the fact that the First Armored Division had already constructed an experimental mobile surgical unit along roughly similar lines. It is, nevertheless, equally clear from the data that this decision was reached only after a survey of all Ordnance vehicles then in production. The requirements of this particular investi- gatory step had, therefore, been fully met. The final ' results ' obtained,’ In* this .instance were impressive. The unit subsequently developed was not only..’highly satisfactory as a surgical truck, but it proved to be an'excellent model for a series of five other specialized medical '•vehicles, To summarize then, in three cases, a thorough study of all relevant standard items of military equipment were made. Each of these projects resulted in the production of a satisfactory end item and no delays, attribu- table to the neglect of any aspect of this investigatory- ■ stop, appear to have been encountered^ In the remaining,three cases, this preliminary investigation was omitted, either in whole or in part. Of this latter group of projects, only one yielded an acceptable end product* In this one instance, however, a major com- plication was encountered in a later stage of the * undertaking which was directly traceable to an initial failure to per- form a more complete survey of existing military models. Two projects ended in failure, in "both instances attributable to the type of vehicle which had been selected for experimentation. In one case it was subsequent- ly discovered that an item of equipment, already in standard use, would fully satisfy all military requirements. In the other it was, later found that an existing standard' item..could be readily adopted to the use intended, 4 •• As for trends in administrative performance in this field, 'none is discernible. 592 3 4. •. Survey-'of' Commercial Items* . - A survey of reievent commercial items was another step;.in the; preliminary investigatory process * This stop was necessary.for- two reasons * ,Xn the first, place, commercial items were as a rule highly adaptable to mass production and thus offered a considerable .advantage over new development., items’ -for which extensive industrial :.r,c- ■ tooling- would: .be r.ei'quired. - Because of the ext.femc importance of this, faction, it was a: stated policy of the Department.; that commercial items should be adopted—and with, the fewest modifixations; practicable—-whenever such a procedure would satisfy existing military requirements,® . ■ ... ... , * . i. ; , • t:r.zslr. & second value to this■ particular investigatory stop lay-in the fact that coramercial items, even -when found inadap.table-;to military purposes, often contained some new principle of]construction or design which could, bo’incorporat- ed wit]b^p#ofdt into subsequent military models,”’ The importance of civilian-.-equipment as a source of ideas for research and development personnel was demonstrated in one of’, the proje cts discussed below* y .In seven of the projects examined.in this study, the military items proposed for development.appear to have had; no;'Civilian counterparts,9. In these inst.an.ces,, . thercfpr;%-: bhe step now Under dis'eus-sion was unnecessary, -in the cases of the straight pole litter,, the folding pole litter, and the -mobile medical laboratory, however, there was a relatively large number of.at. least roughly, analogous commercial items, V* . - j Performance ' in these three instances varied considerably, although in no- instance does it appear that either: a systematic canvass or sampling of this data,, was • •. attempted, • . In the two litter projects, information .received by the Medical Department regarding civilian litters’ or stretchers ’ was ,' in. virtually all instance?, unsolicited, -'ft should be noted, however, that in those .projects—-whore hope..... ... of obtaining a large production contract automatically . ;.-v0 . stimulated;..manufacturers of their sales agents to ‘submit samples -was .less '-necessary' fOr research ,and development personnel to assume.IHe •■initiative in ; respect,, Actually,• in both-thob-e instances considerable-; •. , quantity of circulars, phot ©graphs drawings', and descriptions of commercial stretchers was obtained,. , In a few ins tan ces Sbmplbs were voluntarily 'submitted. In neither of the two major phases of the mobile medical laboratory was it possible for research and development personnel to exercise free choice in the 593 selection of an experimental vehicle,- In the first phase of the project, funds were insufficient to permit purchase of a civilian truck or trailer,' By the time the second phase had "been initiated,- a "basic model for all -mobile medical units had "been established—-the newly standardized surgical truck— so, in this instance too, outside purchase of an independently, selected-vehicle was not possible,' - * However research and development personnel still retained considerable freedom of action. Few restrictions exis.tcd as- to the type’, of interior construction to be adopted, the particular utilities to be provided, the laboratory supplies and-Equipment to be included, or the method of storage to be followed,- An investigation of all types of commercial laboratory vehicles was therefore indicated. While the United States Public Health Service, a number of state-boards.-of health-,--find several field survey units of the Corps of Engineers all’posesscd mobile medical laboratory units -constructed by private manufactures, only two of these—a Coca-Cola trailer used by the Corps of Engineers and.a self-contained laboratory truck used by the Pennsylvania State Board of Health—appear to have been studied during either of the two phases of this project.- In one of these instances, the data received was unsolicited. Information regarding the Coca-Cola trailer was sent to the Medical Department originally by Army Air Forces. In the case of the Pennsylvania State Board of Health model, the * demonstration of this unit at Carlisle Barracks appears to have been made at the request of the Equipment Laboratory. Although a number of Coca-Cola trailers were subsequently purchased by Army Air Forces, this unit was found to be impracticable .for Medical Department use. The Pennsylvania State Board -of Health model, on the other hand,..' wa.s a discovery of the first" importance* This Unit was, apparently the first self-contained, single—vehicle*laboratory ever viewed by research and development pertonnel* ; It. whs. also, judging from the records, the first mobile’ unit . V inspected by the Medical Department in which removable ' cabinets•wore used in place of chests for the storage of equipment and supplies* Inasmuch as both of these ideas were subsequently adopted, and inasmuch as no previous reference to either of them was found in the project data, it would appear that they were largely derived from the examination and study of this particular commercial item. Summarizing this section, it may he said that, on the whole, little attempt was to conduct a thorough canvass of all analogous items of commercial equipment in any of the three projects to which this procedure was applicable* However, in those instances where, . the hope of obtaining large 594 production contracts supplied-ahiincentive to manufacturers to submit samples of their products voluntarily, the need for such a canvass was proportinatcly reduced. In the one major instance in which an active;attempt appears to: have been made to investigate a particular commercial Item, the results were, impressive. Several basic ideas in subsequent vehicle construction would seem to be traceable to this source. 4, The Study of Related Development Projects. This investigatory step was-of value for several reasons. In the first place, by obtaining at this preliminary- stage the: latest information regarding all related development..-items, Medical Department research and development personnel could design a given pilot model, s-o that it would be adaptable not only to'; related' items' of equipment currently in use, but. also to those items likely to be standardized in the near future. Secondly, the, possibility of duplicating research already initiated by another Technical Service could be foreseen and, if desired, avoided* Inasmuch as the responsibility for parallel experimentation of this type would ordinarily rest With the agency which, by this action, created the duplication, it was to the interest of the Medical Department not‘to under- take such action unknowingly, , Finally, whbn'this preliminary investigation •* included a study not only of those dove 1 opinen t projo cta ; ■ ■ already in existence, but of .those.pianite'd. for thb hbar" future as well, a high; or&er ‘of advance' research '..coordination was sometimes possible.* Under certain conditions' -a develop- ment project might then-'be'-conducted':Wit-h a two-fold purpose in viewt .to produce an jitem which would not only-satisfy the military requirements for that particular projeqt, but- which would also be convertibleWith, a-.minimum'Of manufacturing . . difficulty, into a -number’ lof de.sired related items;* Corning n.ow to the data itselffor two of the projects with which this study'is concerned (the straight pole litter and the snow and ice ambulance) no related development projects appear to have been either in progress or in the advance stage. While the. records do not indicate that any formal attempt was made by research and development personnel to carry out an investigation in these instances, it is possible that the facts were sufficiently self-evident to make such a'survey unnecessary* In all other instances related development projects were in progress or*in the late planning stage. Research and development personnel required no.elaborate 595 Investigation, ..however* . to -learn of the existence of. these • projects.# All hut -two were Medical Department undertakings* OfjthQf two outside ,projects, one was being conducted hy the OrdnaACp. Department and involved an item (the amphibian truck} for. which the Medical Department had been expressly requested to design a litter stop attachment#' The other, an Army Air Forces project-'(the dental operating truck) had been learned of informally* In only two instances did possession of this knowledge of related development projects appear to be of no particular advantage to the Medical Department*. In the case of the ski litter adapter, although medical research and development personnel were engaged at the same*time in the development of a mountain litter, no attempt seems to have been made to design the adapter to fit this new litter item*. This, appears to have been an oversight* later* however, in submitting a basis of issue for the ski litter adapter, Army Ground Forces expressly excluded the mountain litter. Last- minute modification of the ski clamp to insure adaptability to this new development item was, therefore, not necessary. The medical laboratory trailer project also presented a special situation* Here, Medical- Department personnel were so impressed with a new development item (the bus—type truck) that they wished to substitute this item for the, trailer—type vehicle then being used in the development of a mobile-medical laboratory* . This'request was disapproved by The Adjutant General’s:Office* As it-happened, neither the bus—type truck nor the. .bismi-trailer proved to be a satisfactory field item so no loss or gain was involved* " ■' . • Except’ fo.r-the above- two instances, the Medical Department seems to have uniformly profited from an early awareness of all related.development projects# 'In the case of the amphibian litter.-atop-project which, in point of time, overlapped the standardization phase of the Ordnance Departments amphibian truck project, knowledge of this latter undertaking enabled the Medical Department to take a decisive line of action which was to help materially in the solution of one of itsown development problems# As soon as""" it-had become evident , that no single litter attachment could be devised which would fit all types of amphibian-truck coamings, a uniform’coaming‘design was quickly prepared by; ’ the Equipment Laboratory* It was•thereupon proposed to the Ordnance Technical Committee.-.that an additional military characteristic, providing-for unifdrnr coamings on all amphibians, be 'included before this item was approved for standardization# This recommendation was adopted, special nmodification work orders” were issued to all field instal- lations where amphibians were in "use, and, as a result, the range of adaptability of the amphibian litter stop was marked— 596 1y increased. In the development of th&'--foldfng’pole litter, detailed first-hand knowledge of another closely related research undertaking-4-the-..straight pole litter project- enabled the Mhdical Department, to solve a construction pro- blem which had been holding -up do ye 1 opine nt work for months*' The basic design of'"a-double—folding litter had, with a few minor exceptions, already been accomplished# Ho suitable material, howevery-*tCould bo4 found for construction->of the side poles. Every material considered was either: too, heavy, too light, or on the critical list. The development- and . subsequent adoption of a laminated wood pole for use in the straight pole litter ..opened .the way to. a solution of this folding problem. With this-, idea, borrowed from a sister project, a successful’/end'item was standardized within a matter of'weeks# '• ■ • .. • ' 'The Medical Department's crowning achievement, in this respect, however, was attained In the elaborate and technical preliminary planning which attended the development of the surgical truck* Here* with a clear knowledge of,, the series of additional specialized medical vehicles which, were to be developed- at a later date, the selection of a standard truck chasSis: and the design of a special Medical Department van body was carefully undertaken# Dody construction, interior fittings, utilities,.and numerous other factors were deliberately planned with the view of creating:a vehicle whiih would serve not only as a surgical truck for the Armored. Forces, but would also serve as a basic model- for - a -series of five more mobile medical- unit s# The relatively; small .pumper of modifications-that were found necessary--in-.'the; succeeding . truck projects testifies to’the skill'with which this . initial, vehicle had been planned*-. > ” ■ v ** ) " One final instance of the - importance; of. this preliminary investigatory step is the case of the dental operating truck. Here, not one hut six related .deyelopment projects were involved* The surgical t ruck and the dental laboratory truck had already been 'standardised#.- The medical laboratory, optical repair, and .surgical operatijig trucks—• all built around the same basic. in: varying’ ’ stages of completion# At this point dt' was' learned that* Army Air Forces had just initiated an independent project to develop.a dental operating truck, using an entirely different basic vehicle,' The Medical Department acted swiftly to initiate a parallel development project of its own# The parallel experimentation which ensued and which eventually resulted in the adoption of a vehicle .developed by-the Medical Department, was costly, but it prevented’large scale pro- curement of a vehicle which differed basically from all other mobile medical units# Viewed in this light, the net gain to 597 the- War Department as a whole had-been-considerable# ' ’ '■ ■ : - /j In' summary it may be said that,, while the .evidence does hot indicate that formal procedures were used dh the accomplishment of this fourth. investigatory step, under the- particular circumstances which obtained such-pro- cedures were not necessary# Research and development person- nel had a- first-hand familiarity, with most of the related development projects cited, and in the other instances were able to obtain^all needed information informally# However gained, the possession of this knowledge.in all but two instances was of marked advantage to the. Medical Department* Especially was this true where related development projects in the advanced planning stage were concerned# 5# The Study of Foreign Equipment# All of the justifications for the preliminary study of American-made equipment, both military and applied with equal force to the study of foreign.models•: There- was an especially compelling reason,- however, f or the closest possible study of enemy .equipment, -In war,,-the out- come' of'a competition between belligerents in. the field of research and development might often have.a direct relation- ship-- to victory of defeat'on the battlefield. Under these circumstances the quantity and quality of military intelligence reports and the promptness with which these reports were channeled to research and development .personnel was of the utmost importance,- ..... ; To what extent was such information sought by Medical Department research and development personnel in.: connection with the projects under consideration here? What was obtained? What can be said of the amount and quality of the unsolicited information concerning foreign models -which was received'by the Medical Department? What trends -can be discerned in the carrying out of these procedures? To begin with, in seven instances (the /snow and ice ambulance, the amphibian litter stop, the surgical truck, the medical laboratory truck, the. dental operating- truck., the optical repair truck, and the surgical operating truck) no information regarding analogous foreign models appears to have been on file either in the research and development sections of The Surgeon General1s Office or at the Equipment Laboratory during the course of experimentation# In two of these instances, some relevant Information of this type was received however,-.after project termination. In the case of the surgical operating truck, which was standardized in February, 1944;, photographs of a captured German model were forwarded to The' Storgeon- General1 s' Office-shortly'after R/E'dayi . Judging,from this data it would appear that , ‘ in this-particular, instance, no.'brucial loss had resulted,'from 'failure' to obtain: the information earlier . The i£4rf wafc -’mounted on a trailer type* vehicle '(trailers ■ and -‘-been: carefully investigated by- the •' Medical in this, connection and load been rejected as overseas) and was tod elaborate in construction* tb--be as effective a, forward area'unit as the Pepart'pient"model* . It:is-possible, of course, that certain, specific' feat'iires. of t he German unit might'have been incorporated'with-profit in. the Equipment Laboratory design had these photographs been available when the surgical operating truck project was still in progress. A second instance in which information regarding-a pertinent foreign item was not received*-until after the project concerned had. been terminated, was the case of the and ice ambulance. During the winter of 1944- just a few months after the formal termination of this unsuccessful project-for lack of a suitable experimental vehicle—the Finnish*Akja, or snowboat, was extensively tested by the 76th Division on maneuvers held in the vicinity of Camp McCoy, Wisconsin, Aside from certain minor structural weaknesses, which were considered rectifiable, the item was found to be an extremely effective over-the-snow ambulance* From 15 February 1945 to 8 April 1945, the Finnish Akja was again tested—this time on* special cold weather maneuvers conducted by elements of the Canadian Army.* In the -official Observers Report which was prepared by a mixed military commission upon conclusion of these exercises, it was stated that the Finnish Snowboat or been tested in comparision with the M29 Cargo Carrier and various other winter evacuation vehicles and had been found to be distinctly' the best all-around means of over-the—snow transportation of - h-.; c ,v; .-I,,.;,. 'Evidently, the Medical Department would have .■definitely .'benefit ted ’had information regarding the above item been obtained at • an earlier date* .. Tjahrch is no written indication however-, that a systematic attempt was made by research and''development: personnel inthe 'ins’tances to■> . canvass the field of analogous foreign equipment,- :• Inasmuch as adequate description data regarding the Showboat would seem to have been readily available, the importance of this particular' investigatory step is vividly illustrated. In five- of the projects with which’ this study is concerned, data regarding analogous foreign models were 599 examined by research and development personnel. In most instances the information that was received appears to have "been unsolicited. Through the initiative of United States military attaches and certain representatives of the American Red Cross- serving abroad, photographs, drawings, technical descriptions, or physical models of the British, Canadian, Czechoslovakian, Swiss, German and Austrian straight, pole litters were obtained by the Medical Department, .Information concerning a folding pole litter of Swiss make was forwarded to The Surgeon General’s Office by the manufacturer’s Uew York sales representative* Through the same channels, two of these litters were subsequently received and bested by the Equipment laboratory, Finally, prior to initiation of development work on a mobile dental operating unit, a, descript- ion of two such units developed in England during the early part of 1943 was sent to the Director of the Dental Division of The Surgeon General’s Office by a dental officer serving in the European Theater, In only two instances is it evident from the data that information regarding foreign equipment was directly- sought by research and development personnel. Oh one occasion the Research and Development Division of The Surgeon General*s Office requested andrreceived from the Canadian Army Staff in Washington, D. C,' photographs' of the 3-toh Dental Lorry then being- used by the Canadian Army as a dental operating truck. " ‘ ’ On a second occasion, at the suggestion of the Director of the Plans Division of The Surgeon General’s•Office, Dr. Whitman Mead Reynolds, an expert on the medical aspects of winter warfare, prepared' and submitted to the Medical Department a comprehensive monograph on the' medical problems of mountain troops. This study*—which included a detailed discussion of the techniques of ovor-the-snow evacuation, descriptions of military practices in various parts of the world, and photographs of a wide variety of Frencif,,' German, Swiss, and Italian litter conversions of winter operations— was of special value for the ski litter adapter and toboggan litter adapter projects. In summarizing this section, it may he said ' ‘ that in none of the projects here considered do regularized . procedures appear to hAve been established for obtaining relevant technical data concerning analogous foreign equip— mcnt items. Quantitatively speaking, in only five out of twelve instances was such data- available to research and development personnel during the preliminary phases of research investigation. Most of this data was unsolicited—• only two instances having been found whore such information was directly suggested by the Medical Department—and 600 RESTRICTED included more references’ td civilian than to military‘items* Eo marked trends'’ ih -the pr.eformanc© of this investigatory step are discernible. On balance, however,' it would appear that more foreign equipment data was received during the' early years of the war than during the later period. 6. The"Study of Field Improvisations. Inasmuch as field improvisations were perhaps the most valuable single source of technical ideas available to research and development personnel, the carrying out of this investigatory step was of particular importance* A certain amount of this information was, of course, obtainable automatically—field units sending in reports of their improvisations direct to the Equipment Laboratory, or1 the appropriate research agency within The Surgeon General’s ■ Office* The greater part of this data, however, was contained in the quarterly and annuaJL reports submitted by all medical units and medical' field installations to the Historical Division of The Surgeon General1s Office. • • To what extent were field improvisations , investigated in the projectssnow under consideration? What effect, if any, did knowledge of these items have upon sub- sequent research and development? To 'begin with, in no instance do project records show that field unit reports on file in the Historical Division were .ekaifiined by research and development personnel. Apparently, in all instances only those improvisations were studied which were directly received. In five projects (the straight pole litter, the snow and ice ambulance, the dental laboratory truck, the optical repair truck, -and the suergical operating truck) no data of this type appears to have been submitted.- In six other projects, however, information regarding pertinent field improvisations was received aad was carefully studied by research and development personnel. In only one instance (the Lippmann ski litter adaptation) did this information prove to be of no value for the project concerned. Here, an improvisation was described which embodied an idea which had already been considered and rejected by the Equipment Laboratory. In all other instances the ideas presented had merit, either in turns of over-all design or the design of a particular component.* The Schwichtenberg litter, designed' by a* medical officer assigned to the Station•Dispensary at Wright Field, was submitted to the Plans and Training Division of The Surgeon General’s Office- in Hay,-1939. This model, while ultimately rejected by the Medical Department, nevertheless 601 introduced certain innovations in folding pole litter design that wore destined to be of ,long-grange importance# The present use of a folding rather than a stationary stirrup and the use of a hinge rather than a slipjoint connection for the side poles of the folding litter apparently had- their origin, in the Swichtenherg .improvisation. In thelease of the surgical truck developed hy the 47th Medical .Battalion of the First Armored Force / Division, the contribution was even 'greeter,. Constructed over.a.month before initiation of* a similar project by the Medical Department, this truck served tp a large extent as a model , for the latter undertaking* While the unit ultimately standardized was equipped with a specially designed van'body, instead of the standard cargo body employed in the improvised unit, chassis selection and .the choice and arrangement of numerous items of equipment would appear to have been heavily influenced by this earlier model* The value of improvisation as a source of technical ideas was further illustrated on the amphibian litter stop project*. Here, experimentation previously conducted sat the Amphibian Vehicle Training School under the sponsorship of the Office of Scientific He search and Development proved of considerable value to the Medical Department* While the particular method of fastening litters to the coaming of the amphibian truck .which was suggested by this experimentation was not followed., the plan which had been worked out for the placement of litters and their loading sequence was subsequent- ly adapted with only-'minor'modification by medical research and development personnel. - The experimental field laboratory truck, developed- by the Tenth Medical Laboratory and tested in the’ 1943 Louisiana maneuvers, was another item which definitely • simplified subsequent problems of research* In this instance the test reports on .the performance of this vehicle -clearly indicated!- , (X) that laboratory operations could be satisfactori ly performed with a truck; (2) that the use of cabinets for the storage and transportation of equipment was fartsuperior to the Use. of. chests■for that purpose; (3) that the standard issue cargo truck', which had been used in the experimentation, was deficient in that it did not have an enclosed body and lacked heating, lighting,■and plumbing facilities* It can readily‘be seen hdw this information, based upon actual . ,* field experience effectively narrowed the scope of subsequent investigation and helped make possible an early and .successful termination of the formal project which was later undertaken- in this field* Theslast of the instances in which imnrovi- sation played an important role was the dental operating truck project, .'.Here,.-data .regarding a. similar mit ;con-: structed by -the; Force in•No’rtE,Africa ’was available to' research and- development ..personnel, While the particular vehicle , used in'this fill’d improvisation v/as not .adopted—- by this time the Medical Department surgical‘’truck was the standard model .for- All'"specialized'mobile, units—:the com- prehensive equipment lists forwarded by the 12th Air Force were'of value.' With these as. a. guide, final!Medical ., '• Department lists.were•drawn;up in considerably less, time than hadibeen-required in earlier, projects. • " v iy1- In summarising this, section, ;it may therefore; be stated that of the six improvisations discussed in this ,study» five were of genuine benefit in one or more respects* All data regarding field improvisations which were received directly by research and development personnel-appear to have been carefully studied and, where indicated, acted upon* Information of this type does not 'appear to have been actively sought, however* Ho references were found in any of.the pro- ject records relating to improvisations described in .quarter- ly or annual reports of medical field units or in other . documents. It is unlikely, therefore, that most of the total information available in this field was obtained in the • instances-cited. ' .’ ■ • * 7. The Enlistment of Technical Advisors. While practice varied .according to the field of experimentation involved and according to the technical competence and versatility of research and development person- nel, few of the projects with which this study has dealt were conducted without some reliance upon the advice and assistance of outside experts. Therefore, consultation with such experts and, where- indicated, arrangement for their active partici- pation in the work to follow, was an essential step in the process of preliminary research, investigation*. , . Broadly .speaking, the' services of three separate classes of exports wore of potential value to the Medical Department in its conduct of medical .field equipment projects* First, there wore thos-c. manufacturers, private or governmental, who wore currently engaged in the production of items similar, to those- proposed for development*. Second, there were, the research scientists and other -subject matter specialists who were regarded as the scholarly authorities in the field concerned* Finally, there were the military experts—professional personnel in the various divisions ‘of The Surgeon Generali's Office, medical officers assigned to tactical units,-officers in charge of specialized training programs—who, through their knowledge of field operations, were host able to advise on the functional" requirements of 603 the new development. -What extent were these three main sources of .technical..Information successfully exploited in the pro- jects here considered? In six projects (the medical laboratory trailer, the medical laboratory truck, the dental laboratory truck, the dental operating truck, the optical repair truck, and the surgical operating truck), apart from discussion of miscel- laneous items of equipment which was accomplished through routine supply procedures in a later project phase, prelimi- nary consultation with manufactures was not essential. The surgical truck had already been adopted as the basic model for five of these vehicles, while, in the case of the medical laboratory-trailer, vehicle, choice was frozen to a single item due to lack of funds. - •••' - ■ In the remaining seven projects,’ where pre- liminary consultation with selected manufacturers was relevant*. Medical Department performance varied greatly. In the straight and folding pole litter projects, numerous key supplies, of existing military litters were circularized and invited to participate in the development work. To a large extent, the. successful end-items that were produced in those two instances were the direbt result of this close.manufacturer- collaboration, Inathe case of the surgical truck, early contact 'was established with Holabi.rd Quartermaster Motor Base, which agency ■subsequently assisted materially in the preparation, of.specifications for the pilot model vehicle, * Since most vehicle.manufacturers were already-overburdened with large war,-orders during this period, contact with • commercial manufacturers was, in this instance, delayed not through oversight but through inability tp find a company free to handle this'-small production order, - In two instances, (the ski litter adapter and the snow and. ice■ ambulance) while contact with.a private manu- facturer was established soon after project initiation, the choice of collaboration—-in both instances h carriage maker— would appear to hayO -been less suitable than in the instances cited, above. Hardware- manufacturers (in the case of the ski clamp) and producers of snow tractors, snow trailers, show- mobiles, and sleighs (in the case of the snow and ice ambu- lance) were more directly related commercial enterprise's], but no written indication was found that these were consulted. As for results, it is apparent that in both instances manufacturer-suggestions improved the final pro- duct* Whether a "better ski clamp could have "been produced under different auspices is a matter of conjecture, as no 604 such itofe was ever comparatively tested with the Equipment Laboratory model. In the case., of th£r Ch*ow and,.ice ambulance, however, relevant;, bh *tliis,point, " On the basis of comparative’ field-, tests -Camp 'Bale * Colorado, the two trailer models submitted by /the•Equipment laboratory were not only, found‘inferior, td tke %2 9, Cargo 'Trail ep, as jaahtioned earlier, but. were found' inferior., to an Allis-C|ialmers .,-SnPw Trailer as well* In this instance, therefore, the Initial choice. of manufacturer was demonstrably '- a; crucial factor in the .final result. • ;"v' ' ..... ; - In two instances , project’data does not indicate that any contacts with manufactures were established during the preliminary phases of investigation. In one of these instances (the toboggan litter adapter) successful, results were* achieved despite the omission, and "we re, • accomplished, in a very .short period of time. In’ the second instance (the amphibian litter stop) failure to establish early liaison'with the General Motors Corporation, manu- facturers of tne, .amphibian truck for which the litter attachment wab‘ to be designed, led to difficulties during, later phases of the project which were to delay final Standardization.of the item by more than six months. Turning now to the question of consultation with civilian researchers and subject matter specialists, in only two projects did.the Medical Department avail itself.of' this type of assistance. As mentioned earlier in another connection, in the, ski litter adapter and toboggan litter adapter project's,.-a special monograph containing a large number of photographs of Drench, German, Italian and Swiss litter adaptations was available for. use by research and development personnel*,:! This had been prepared, at the request of the Medical- Department,by-Dr, Whitman Mead Reynolds, an authority on the medical-aspects of winter war- fare* While this was evidently valuable data, it is impossible to determine to what extent it facilitated the projects in question. The early establishment of effective con- sultative liaison with selected military agencies was a nec- essary and profitable step in virtually all the projects with which this study has been concerned* While the ''-t'ype. of approach adopted varied considerably from project to project* in only two instances (the toboggan litter adapter and the • amphibian litter stop) does it appear that this preliminary stop was altogether neglected. In the former case no sub- sequent difficulties appear to have been encountered as a result of this omission. In the case of the amphibian litter stop, however, failure to establish earlier liaison with either the Tank-Autmotive Center (Ordnance Department) in Detroit, Michigan, or with the Engineering Amphibian Command at Camp Edwards, led to definite complications later on in the project. The pilot model litter stop had sub- sequently to be twice re-designed to meet the objections of these two agencies. , ! .... In two cases (the ski litter adapter and the snow and ice ambulance) advice and suggestions were invited from Army War College; the Mountain Training Cepter and the Mountain and Winter Warfare Board, both at Camp'Hale, Colorado; and the Second Division, in training atrQamp McCoy, Wisconsin. The only agency omitted from the above list which would seem to have been an equally qualified source of information was the Alaskan Defense Command.- However, while good coverage was obtained, the net results of ’these efforts would, after study of the correspondence concerned, appear negligible. Insofar as the Mountain and Winter Warfare Bpard was concerned, it does not appear that this agency was kept abreast of Equipment Laboratory developments in this field. When the completed ski clamps and trailer ambulance were sent to the Board for service testing, it was evident that the Board did hot regard either item as a practicable solution of the problem concerned. In all other instances not only was prompt liaison established with appropriate military experts, but in all cases involving agencies outside The Surgeon General*s Office, on-the-spot liaison was substituted for contact via correspondence. The contrast in effectiveness of these two liaison methods (the latter, it will be recalled, had been employed in the case of the ski litter adapter and the snow and ice ambulance) was well illustrated by the'results achieved in the six specialized vehicle projects, as will.be shown in a later section. A brief enume rat ion. will suffice to show the wide extent to which coordination with Medical Department and other Army agencies was established as a result of effective performance of this preliminary investigatory step by research and development personnel,. Following each project title, the agency or agencies with whom contact was immediate- ly established are given in parenthesis I. the s'urgical (First Armored Division; Headquarters, Armored Forces); the medical laboratory trailer (Army Medical Center;' Sanitation Department, Medical Field Service School); the Medical laboratory truck (ilinth Medical Laboratory; Laboratories Branch, Preventive Medicine Service, Surgeon General's Sanitation Department, Medical Field Service School)*; the dental labo- ratory truck (Dental Division, Surgeon General's Office; . dental staff, Carlisle Barracks); the dental operating truck (Dental Division, Surgeon General's Office; Post Dental Surgeon, Carlisle Barracks; Aero Medical -Laboratory, ¥right Field); the optical repair truck-(Specialties and Supply Planning Division, Surgeon General .Office); the surgical operating truck (First Auxiliary Surgical-Group* Fifty-first Evacuation Hospital)• . ■ r In concluding this section it may he stated that, while minimum use appears to have been made of research scientists phd other subject matter experts in the civilian population,' in all the major projects described in this study ample contacts were;established at the earliest possible date with leading manufacturers •' in the field and with key War Department agencies, tfhe dispatch and. thoroughness with which this preliminary' step was accomplished had demonstrably positive results in the later stages .of each of the projects concerned* * * .... In the. minor projects, these initial steps were seldom followed. While in two instances (the ski litter adapter and the toboggan litter adapter) no subsequent difficulties can be definitely traced to these•omissions, in two other Cases (the amphibian litter stop and the-,snow and ice ambulance) a causal relationship between neglect of these procedures and later failures or delays can be definitely established. ITo chronological .trends .are discernible. C* Development Phase, 1 • Manufacturing: HelatlonsM-ps# During World War I;X,. manufacturers, both ;;.f private and governmental, participated extensively- in- the.- ; development of medical field equipment. Apart from their general availability for consulation regarding specific technical problems, they actively assisted the Medical Department in at least four ways* (l) by presenting descrip- tive data regarding standard commercial items believed suitable for military use; (2) by voluntarily submitting physical models of this equipment for tost by the Equipment . Laboratory; (3) by performing special construction work on ti- the basis of specifications prepared by research and develop- ment personnel; and (4) by conducting independent .experimen- tation under the general supervision, of research and develop- ment personnel. In all of these instances, both from a public relations standpoint and from the standpoint of. attaining raaximpm research efficiency, the type of relation- ship established between)the Medical- Department and cooperating manufacturers.was of the utmost importance,. One particularly complicating;problem encounter- ed by the Medical Department in this-; connection was fhey;. • 607 question of monetary inducement. During peacetime, when manufacturing establishments were, in many instances, operating at a point below capacity, the hope of obtaining even a moderate production order was usually sufficient stimulus to lead manufacturers to offer their services to the Medical Department and other governmental agencies, With the outbreak of war, however, plant capacities were soon taxed to the utmost and, particularly in the-case of low priority projects, special inducements were necessary to attract the type of manufacturer desired. How the Medical. Department handled these various problems is summarized in the pages that follow. . To begin with, in seven projects (the toboggan litter adapter, the amphibian litter stop, the medical laboratory truck, the optical repair truck, the dental laboratory truck, the dental operating truck, and the surgical operating truck) only minor construction work was necessary and this -was performed in the Equipment Laboratory*s own workshops- at Carlisle Barracks, Pennsylvania, Inasmuch as commerfcial-contracts in these instances were confined for the most part to routine purchase of standard equipment and supplies, no special liaison arrangements were necessary. in all other projects, 'however, manufacturing relationships figured prominently in the process of pilot model, construction. Least valuable to the Medical Department were the unsolicited contributions submitted-by manufacturers or their sales agents. In the straight and folding pole litter projects, for example, although a 'amount of advertising matter describing civilian stretchers was received by the Medical Department, none of this information appears to have been of material value, tp Research and development personnel* Physical models, constructed without previous consultation with the Medical Department,- were also, as a general rule, found impracticable. ‘ .live such items (two straight pole litters, two folding pole litters, and one ski litter adaptation) were tested by the Equipment Laboratory during the period covered by .this report. All of those, including a plywood litter which-had-been developed by a private manu- fa-cturor working in close colloboration with, the Conservation Division of the ¥ar Production Board, were rejected on the basis of unsatisfactory'service test performance. Only one— a foreign model stated to have been adopted by the Swiss Army- appears to have had any influence on subsequent Medical Department research. This model not only had the virturc of having been designed primarily for military use, but it appears to have been one of the first packboard litters tested by the Medical Department, A formal development.^re- joct was latertliasti^uted-.t(p-ptoduce ..anoiiiproy.ed'lit-ter of this general type*.-..- w;:\ r : . a;.’: i V. ‘1 ‘ r, iprojeets , pilot nodi osuwe re -Constructed hy outside manufacturers on the basis.of detailed-specifications prepared by research,and development personnel-The first of these projects (the-ski litter adapter) had two construction phases* In the first‘phase (construction of a light weight ski clamp) no production liaison appears to have'been maintain- ed between the Equipment .Laboratory and the manufacturer. As ; a result, although specifications were carefully followed and the finished products were competently built, no suggestions for improvement :in -design or construction were requested of the manufacturer and none was volunteered from that source* In the second phdse (the heavy gauge.ski clamp), a close working relationship was established between the Equipment Laboratory and the manufacturer concerned* This .was '': - accomplished through .correspondence and through periodic ■ inspection trips. In this instance, a number of technical suggestions were -.offered by the manufacturer, and, in a ■ ; ■■ majority of cases,.’ these were adopted by the Laboratory as superior to original specifications. : , ■ A similar interchange of ideas took place during the construction phase of the snow and ice ambulance project* Again, through correspondence and periodic inspection trips effective production liaison was established and maintained. Again, also, numerous changes .were made in original specifications as a result of technical suggestions advanced by- the manufacturer. Masonite was substituted for a less durable and more critical material initially selected by the Laboratory for use in the construction of the-ambulance side waifls; and. floor.;.-, steel was' substituted for wood in the construction of the' axles; • runners were reinforced by- steel under—plates*; apd.boely aides were redesigned to provide for readier col v Each, of the above" modifications' were adopted by; thpgLaboratory in-preference to‘earlier s-tipu- • lations. Collaboration had again, therefore—at least- in-the view ox research and development personnel—produced- an'-d - ■ improved pilot model, , . ■ ■ • * ‘ In the case of.thp medical, laboratory trailer, liaison-between the Equipment Laboratory and the manufacturer concerned was accomplished through correspondence; in the surgical truck project-, because-of. its; extreme urgency, an on—ther-spot liaispn officer was present, throughout the con- struction period. While the evidence does" not'indicate that important specification changes-were made in either of these cases,:production was: accomplished with exceptional speed in both instances, . i-;. , \1 • Turning now to .those*projects in which -nanu- 609 facturcrs assisted-tire Medical ■ Depart merit "by conducting independent experimentation, it will be seen that the liaison factor was of even greater importance than-in the above instances. During the development of the straight steel litter, nine different experimental litters were submitted for field test by,,.outside manufacturers. In 'six of these instances, consultation was held with members of the staff of the Equipment laboratory before construction work was begun; all but one of ,t.ho pilot models produced after such con- sultation made, some definite contribution to the research problem at hand. -Included in the group was the litter ultimately adopted by the Medical Department. In three instances, liaison relationships were handled exclusively by research and development personnel in The Surgeon General*s Office, These supervisory’activities, however, were not coordinated with those then being carried on by the Equipment Laboratory, In none of these instances was a substantive research contribution made. Two cf the models were constructed of chrome—molybdenum-—a material already rejected by the Laboratory because of its scarcity. The third had been designed according to specifications already’ discarded by the Equipment Laboratory as impracticable for steel litter construction. -During the development of the straight and folding pole laminated wood litters, close liaison was maintained not only with participating manufacturers but also between research and development officers in The Surgeon General*s Office and the Director of the Equipment Laboratory* Thirteen manufacturers1 models were submitted in these two projects, and in all instances some important contribution appears to have been made. In no instance'was a litter*pro- duced according to specifications which had already been • definitely rejected# •'r •i-jl •• * The importance of the supervisory'functions exercised by research and development personnel in'the field of litter construction is well established by the foregoing data# Comparing the experimental contributions“made by out- side manufacturers as against those made by - the• EqUi pnent Laboratory,, however, it is evident that the development activities': directly conducted by the latter agency were of only minor importance* Original pilot models-were submitted by the Laboratory on only two occasions Hone of»these models successfully withstood service’tests, and-, apart-’from an improved hinge arrangement embodied*in four-double-folding laminated wood litters designed by the Laboratory, no single feature proved-worthy of subsequent adaption. It may-be con- cluded, therefore, that the advances made in the field were, in virtually all’-instances, the product of joint collaboration 610 between the Medical, Department and private industry—-with the manufacture rsv ±hejnselVes;’perf ortal-n-g'-the mayor- part of all physical constfiiction work. - ■ - v ’ ‘ , . The cost' Medical Department of work ■ performed by outside manufacturers in connection with the - development, of medical' field equipment,was., pn’the whole, relatively* pmall. Contract-arrangements, however, varied considerably according’to the nature of the. work undertaken. In those instances' where detailed specifications were drawn up hy the Equipment Laboratory, production charges—including any technical improvements in design or specifications made at the suggestion-:of the manufacturer—-were generally •• calculated,on a post-*plus basis for private concerns and at a cost basis for governmental agencies. In only one instance (the lightweight ski clamp) was an experimental order -of this type awarded on the basis of competitive bids. As. for' the:' •. quantities involved on these initial production orders, in ' only two instances (the medical laboratory trailer arid the snow and ice ambulance) was the number of physical models contracted for restricted to the minimum necessary for “ field testxiig-ptirposes, -In all other instances some' inflation- of., quantity requirement was necessary. In the case of the ski litter adapter, 48 sets of lightweight ski clamps and twelve sets of heavy gauge ski clamps were ordered,-■'In the case of.the surgical truck, the initial experimental order called' for the production of 24 vehicles. In the straight and folding pole litter prh-*; .. jectsn where., experimental research as well as routine con-> > struction work'was involved,-the development cost policies, a . adopted by the Medical Department passed through an almost :■ • • complete cycle. From 1939 until the latter part of 1941, all outside experimental work was undertaken at the manufacturer’s own expense, and the pilot models thus produced were accepted; by the Equipment Laboratory for field testing only with 'the :; understamding that this action involved no cost* Or obligation! whatever on the part of the Government, During the latter part of 1941 and the whole of- 1942, this policy was modified slightly to permit Medical , Department requisition of sample poles or litters at a price , sufficient to cover costs of material used hy the manufacturer* In these instances, development costs seldom exceeded $10*00 per litter. In 1943, however. Medical Department policies were further liberalized to conform to the latest War - Department Procurement Regulations* Under the new system* the manufacturer credited with successful development of an item was permitted to add development cost to production cost in arriving at a final initial quantity production of the item* Unless this hid was substantially higher thanHsShipping bids, the contract for the major portion of this initial production was to be awarded to .the.originati.ng’manufacturer, If, on the other hand, this bid was substantially, higher than other bids, the production contract’was to'be awardedjelsewhere, and the originating Manufacturer fairly .paid for his development work as Such.', ' 1 \ ■ I ■i * 'Whfle the motivation of this regulation was clear-—to provide a necessary additional inducement to manufacturers to assist in development work and to establish uniform cost policies throughout the War Department—its practical application was difficult. This was illustrated in the case of the straight and folding pole litter projects. At least six manufacturers had participated in the first project, eight had participated in the second, and nearly all had made some contribution to the prpblem at hand. In both instances the manufacturer who had produced the specific model accepted by the Medical Department was given final credit for the development. As it happened development credit for both litters went to a single manufacturer* Upon presentation of final bids for initial production contracts, this bid was decided to be higher” than competing bids and the initial orders were awarded elsewhere* A bid was then rendered by the originating manufacturer covering total development costs for both projects. This claim amounted to $34,,947,10 While this account was subsequently settled at a considerably lower figure, compared with the suras hitherto spent by the Medical Department for outside research assistance in this field, the new straight arid folding pole litters were the most expensive litter developments in Departmental history. In the early part of 1944, a new system of development cost determination was adopted by the Medical Department* A special type of development contract was instituted'‘whereby approximate costs were arrived at by negotiation conducted with the manufacturer prior to the initiation of independent experimental work* The new policy was designed not only to keep development costs within manageable limits but also, by eliminating the need fer inflated production bids to cover these costs, was designed to stimulate competitive, bidding on initial production con- tracts# Inasmuch as the projects with which this study is concerned were all initiated before this recent cost policy , was established, no data are' .available ..regarding its practical operation, , •; 612 2* Military Relationships, During the construction phase of the typical medical field equipment project, two types of military liaison were of potential value. The first was the establishment of a close working relationship betwfcfen research and development personnel and those-Medical Department., agencies whose special fleldp{of , related to the fcxperimental work in progress. In general, this type of .coordination tended, to insure that the proposed new item would be designed in accordance with the.best : . . standards of professional practice in the field concerned.... A second type of military liaison which was of particular value during the development stage'was coordination with-representa- tives of the using arm or service-. This administrative step,,,, which was essentially a means of obtaining the advice, and assistance of field personnelprovided additional assurance that the item ultimately developed would be not only functionally sound but also fully adapted to the anticipated conditions of field usage. To what extent were these military liaison, arrangements employed by the.Medical Department in the pro- ject now under Consideration? - re- considering first the establishment of liaison contacts with representatives of the using arms and services, in two instances (the straight and folding pole litter pro- jects) action of this type was not practicable. In the first place, in both of;these projects•construction work was carried” bn; continuously, for’a period of more than two years# Secondly* these development activities were for the most part being conducted in manufacturing, plants, located in various parts of the country* Under these circumstances, therefore, liaison with Army Ground Forces and Army Air Forces could not be effectively established. In all other cases a considerable measure of coordination with using agencies was feasible* However, in seven out of eleven projects the Medical Department failed to take full advantage of this opportunity* In these instances neither were liaison observers from field units present during the construction stage nor was coordination of these activities with the designated using agencies effected through correspondence* In four of the seven instances in which.this procedural step was omitted (the toboggan litter adapter, the medical laboratory trailer, the dental laboratory truck, and the optical repair truck) no subsequent difficulties were encountered which could be attributed to this omission* In the.Remaining three projects, however, this lack of coordi- nation would .appear to have-.had certain deterimontal effects* In .the ski litter adapter and snow and ice ambulance projects failure to.establish a working liaison with the Mountain and Winter Warfare Board at Camp Hale, Colorado, or the..Experimental Board-of the Alaskan Defense Command led to the production of items which were unacceptable to thqsc agencies, .-.It is possible, in the case of the snow and ice ambulance, that this item might never have been con- structed had a .representative for the Camp Hale Board been present at Carlisle Barracks during this period. The board stated,, after field tests had been completed, that Ground Force requirements.for an over—the—snow evacuation vehicle could be adequately satisfied by the use of existing standard equipment. As for the ski adapters, both the lightweight and the heavy gauge ski clamps designed by the Equipment - Laboratory were •unfavorably reported upon by these Ground Force testing agencies* Although the latter model was • • ultimately- standardized, this action was accomplished .over the objection of the Mountain and Winter Warfare Board, In the amphibian litter stop project,. failure to establish direct liaison with the Engineering Amphibian Command at Fort Edwards, Massachusetts, until after a pilot model had been designed and constructed resulted in a considerable prolongation of the undertaking. Upon receipt of this item for service testing, it was discovered by members of the Engineering Amphibian Command that the litter stop attachment had been designed to fit but one of, the three types of amphibian truck coamings which were then, in field use* A redesign of the pilot model was thereupon necessary-- an operation which consumed approximately six months. Of the four projects in which close-coordi- nation with using agencies wsis effected during the con- struction period, substantial benefits would appear to have been realized in every instance* In the surgical truck project, by means of correspondence, conferences, and periodic inspection trips, a close working liaison was developed between the Equipment Laboratory.and the Armored Force at Fort Knox, Kentucky* Whilebecause of the absence of an on— tho-*spot liaison officer, some -delays were experienced, the arrangement adopted nevertheless‘resulted inan eitremely practical synthesis of technical ideas* As shorn in an » earlier chapter, Armored Force contributions to the joint undertaking were many* * In the three .-.-remaining projects-, in this category., (the medical laboratory truck, the,.dental operating truck, and the surgical operating truck) coordination' 614 activities were considerably expedited by the temporary assignment of Ground Force representatives to the Equipment or; periods ranging from several days to two r;' "' weeks*. Correspondencei •in those cases, was held to a minimum*and vehicle conversion was accomplished in an unusually sho,3?t Lspace of time* The specific technical con- tributions made by liaison officers representing the Ninth- Medical Laboratory,:,tHe Aero Medical Laboratory, add the • ' » First Auxiliary Surgical Group, respectively, have been dealt with in preceding chapters of this monograph. Suffice it to say here that, as in the case of the surgical trucks project, these collaborative efforts yielded impressive results. Turning now to the question of the coordi- nation of construction activities with all Medical Department agencies whose fields of operation were closely related to the experimental work in progress, a somewhat different pattern * is presented. For six of the projects described in this study, no such liaison was required. Though several divisions in The Surgeon General’s Office were interested, in evacuation problems, coordinating the six litter projects with, these agencies would have served no useful purpose. The and folding polq litters had been Standard items of equipment since 1935, and no medical or technological developments were known to have occurred since that time which would necessitate any major changes in design. As mentioned earlier, the pur- ' pose of these two projects was merely to develop a suitable substitute for aluminunu As'for the other litter projects, 1 they were concerned exclusively with, the mechanical problem of adopting the standard litter to various types-of Army conveyances, so again no clearance with‘medical specialists was indicated. * , Typically, in the specialized medical truck projects, close liaison with interested divisions in The Surgeon General’s Office, Army Medical Center, or the Medical Field Service .School was necessary. This collaboration was needed mainly for the preparation of equipment lists for the mobile unit concerned. Seldom did these divisions attempt to participate directly in construction activities. In these instances the procurement of supplies and equipment for the pilot model, once a final decision as to the i tarns to be included had been made by the indicated professional division, was carried out either by the Equipment Laboratory or by the research and development division of The Surgeon General’s Office* The surgical truck project was an apparent exception to this general administrative pattern. Here, inasmuch as the proposed vehicle was to he used merely to provide emergency medical treatment in the forward ereas, no elaborate equipment lists and no special requisitioning pro- cedures wore required* Consequently, in this instancofi clearance with the appropriate professional division of The Surgeon General’s Office was not accomplished,- In all other Medical Department vehicle pro- jects, the selection and procurement of a relatively large amount of special equipment was essential. Administrative coordination in these instances was, on the whole, excellent* In all but one of these projects responsibility for initial preparation of equipment lists was expressly delegated to the appropriate professional division and this specific delegation of function was effectively enforced by periodic follow-up action on the part of the research coordinating agency in The Surgeon General’s Office* The results obtained by the use of these procedures were uniformly satisfactory. Equipment lists were promptly compiled, subsequent changes were few, and the construction activities dependent upon these decisions were accomplished with' a minimum of delay. The single exception to this generally high level of administrative performance was the case of the • medical laboratory trailer—the earliest of the specialized vehicle- projects. In this instance no initial allocation of duties appears to have been made by the research coordination agency in charge of the project and no continuing controls established over the actions of the professional division designated to collaborate in the undertaking. This decentral- ized administrative arrangement “continued in force, for a period of nineteen months. By the end of that period, con- struction activities had come to a complete standstill, equipment.lists‘were still being materially revised, and such equipment■ as. had previously bedn purchased was, for the most part, in the process- of being replaced* Order was restored only when, at therinsistence of.the Equipment Laboratory, further equipment revisions were banned, immediate prepa- ration of final requisition forms demanded, and a terminal date-set for comoletion of all construction .activities, Considering now the last step in this pro- cess-*—the requisitioning of supplies end equipment selected for inclusion in these specialized medical vehicles—in only one project (the medical laboratory trailer) was this procurement responsibility delegated exclusively.,to the Equipment Laboratory* The results achieved in this instance were such as to discourage further'use of .this .method in the projects that followed. The Equipment Laboratory, handicapped by its lower-echelon status as a Class IT installation and lacking purchase priorities, found itself unable to exercise its procurement function effectively. While every effort was ma.de to expedite equipment deliveries, it was seven months before a sufficient quantity of those items had been received 616 to permit shipment'of the pilot model for service testing. Th all-’succeeding- vehicle projects, more- i centralized procedure's'Were followed... Typically, the Equipment Laboratory1 procurement-activities were limited in those instances'''to the purchase of standard and readily available items of supply, while non-standard or scarce equipment was obtained through direct procurement action by The Surgeon General’1 s Office. In only one instance (the optical repair' truck) was the Equipment Laboratory obliged to procure key supply items,- and on this occasion its pro- curement position ‘was adequately strengthened by the assign- ment of special priorities* ' ‘ As for the results obtained under these new requisitioning procedures, the least satisfactory were those achieved in the dental laboratory truck project—the pro- ject in which the changebver from the old system to the new was first effected. Here, partly because of a failure to obtain necessary priorities and partly because of inadequate follow-up action by the central research authority on orders already placed, delays amounting in some instances to as much as nine months were encountered,. These omissions were not , . * however, repeated in the four succeeding projects,(the medical laboratory truck, the dental operating truck, the optical,, repair ■'truck, and the surgical operating truck), with the result that5ho serious delays in equipment deliveries were encountered in any-of these instances. In reviewing this section, several rather pro- nounced administrative trends are discernible. In the fiyst place, while liaison contacts with representatives of using : agencies were hot established in any of the minor projects . and were established in only two of the three vehicle pro- ■ • jects initiated during 1940 and 1941,.. close working relation- ships with on-the-spot liaison officers were maintained in four out of the five vehicle projects initiated after 1942, As for equipment selection, difficulties' were encountered only during 1940 and the early part of 1941* In the five projects initiated after that period, the preparation of equipment lists was well coordinated and promptly executed in every instance. Serious procurement delays occurred only in the two projects established prior to 1942, In all succeeding projects, improved., requisitioning procedures resulted in a uniformly high level of procurement performance* 3. Engineering and Service Testsi According to AB, 850-25. prior to standardi- zation all newly developed items of equipment should normally 617 "bo subjected to two types of tests. These are listed and defined in this regulation as followsi a. Engineering tests* - Engineering- test will ' ' ' it- comprise ' those.-examinations,. investigations, or other observations necessary to- the acquisition of scientifically acceptable data of an engineering character which will provide an adequate basis for the determination of^the , engineering satisfactoriness of the materiel ■ undergoing test* The tests will be conducted by the Army Air Forces or the respective technical services concerned, b* Service tests, - Sefvi ce tests are tests of development types of equipment conducted by the using arms and services under the supervision of the commanding general of the-forces 1 concerned ♦ , to determine the suitability of'It he equipment for service use* Service tests'will usually be per- formed by the using arms or services under the supervision of the commanding general of the forces concerned , * , in accordance with a pro- gram of tests prepared under the direction of • ~ the commanding general of the force concerned*^ Responsibility for the conduct of engineering tests of new items of medical field equipment rested primari- ly with the Medical Department Equipment Laboratory at Carlisle Barracks. However, for reasons which, will be sug- gested in the final section of this chapter,11 the Laboratory was unable to give adequate-.attention to these matters and, as a result,• -testing and .reporting procedures were on the handled cursorily or omitted altogether. .in the straight and'folding pole litter nro-- jeets, for example, although a total of' 33 experimental models were submitted for examination only four appear to have been' subjected to standard engineering tests. In none, of these * instances were .the tests performed by the Equipment Laboratory* Two were conducted by the.private manufacturers1 submitting these litters, while two were-performed by the Static Tes£, Branch of the Aero Medical, laboratory at Wright Field, All were static load tests and, in e'ach instance, copies of, the final statistical reports were promptly made available to the Medical Department* • ;v > In the case of - the snow and ice ambulances',, the ski litter adapter, the toboggan litter adapter, and the amphibian litter* stop, there-,is: no written indication that engineering tests were performed-Cither by .the-Equipment • 618 Laboratory or by an outside agency. A be.t-teh .record wafs achievedin the specialized vehicle projects* Two extensive road tests, of,-.the, medical laboratory trailer; yere made-, durxhg-wkiqlf detailed observa- tions of the:. mechanical functioning-of the'unit. were carefully recorded' on time charts* *;On the day followingrcompletion of these' tests, a complete statistical and analytical report was forwarded.by the Equipment Laboratory to The Surgeon General*s Office# . . : While this was "the only instance found in which an in—transit report on vehicle operation was prepared, on one occasion (the surgical operating truck) an inspection report was rendered on the condition of vehicle and contents after termination of a road trip*;" "In allvof the vehicle projects, however,.it is evident from the data that engineering road tests were performed. The surgical truck was driven.from Carlisle Barracks to Fort Knox, Kentucky; the dental operating truCkJ the dental laboratory truck, and the optical repair truck w,ere driven to Washington, D. C*, where they were closely inspected by representatives of The Surgeon General*s Office; and ,th,e. surgical operating truck was driven t o Lawson General Hospital in Atlanta, Georgia* and from, there to Fort Sam Houston,. Texas# The care with which these tests were conducted, the'type and scope of observations made, and the evaluations arrived at, are not known* Except as already noted,,no written reports of these 'operations,appear to have been'prepared. i: ; . Turning-now to the question of service testing, in only one instance (>the .toboggan litter adapter) ;does this activity appear to have been omitted entirely,, In.eight out of thirteen instances, moreover, field tests were, conducted, as prescribed in regulations,' by the appropriate using agency. ... • The .quality of these tests" and of the formal • reports which followed was, with one exception, uniformally high# Only in the case of the heavy gauge ski clamp—where, through oversight, tests had been conducted with non-standard equipment—was any deficiency of consequence apparent*. In all other instances, service testing was performed competently and thoroughly by the using agency, and test findings were reported in detailed and quantitative fashion. As for the promptness with "which testing and reporting procedures were accomplished hy the -designated using arms and services, the record was loss favorable* In only two instances (the amphibian litter stop and the surgical truck) was a final report of test findings received by the Medical Department as early as the month following submission of the initial test request* In.two projects (the medical laboratory trailer and the medical laboratory truck) this time lapse amounted to 6G and 90 days, respectively5 in four instances (the-lightweight ski clamp, the'heavy gauge .ski clamp, the snow and ice ambulance, and the'dental laboratory truck) approximately six months, wore required-for the accomplishment of these activities* This relatively wi$e variation in the amount of time required to complete essentially similar operations may be attributed, in part, to the differing methods by which service testing functions were administered at the various testing stations concerned. In the two instances in which testing and reporting procedures were most expeditiously handled, the experimental items in question were tested individually as soon as received. Since, under these con- ditions, a highly intensive type of test was possible, field trials*were completed within seven to fourteen days. Moreover, bccaiisc only one test item was involved in each case, but one to two days were required for the preparation of a final report of test findings. In the remaining six instances, however, a different procedure was followed by the testing agencies con- cerned. Here, instead of testing each item as received, testing activities were scheduled to coincide with maneuver periods, at. which time all experimental items on hand were subjected to test. From the standpoint of the Medical Department, the disadvantages of this system■of testing,aas it operated in World War II, were several. In the first place, unless a .'given experimental item was submitted to the designated testing station immedi- ately prior to the start of a maneuver period, there was certain to be some delay before testing activities began. This problem was encountered in the case of-the .lightweight ski litter adapters, which were shipped to the Experimental Board of the Alaskan Defense Command on 23 November 1943. Since the next mountain maneuvers were not scheduled to start*until 1 February 1944, a delay of more than two months occurred before field trails of this item were initiated. In the second place, the- -time required for the conduct of full field maneuvers was considerably greater than the time necessary for the satisfactory testing of an indivi- dual item of equipment. As previously mentioned,, individual service tests of the amphibian litter stop and the surgical truck were completed within a period of seven to fourteen days* The six items tested during maneuvers, however, wore not returned from test until after the maneuver in question had been completed. The losg.of-time that.this involved.was. considerable inasmuch as two of these maneuvers lasted thirty 620 days each, one lasted forty-two days, two lasted 60 days each, and one lasted 90 days. The third disadvantage of the maneuver type of service test was the difficulty of preparing promptly final test reports on a number of different expe’rimenth 1 items. This point is illustrated in the instances now under discussion by the relatively wide variation .in time Required for the preparation of written, of "test" findings., *. In .two instances this task,was. completed within tdree’days after the termination of maneuvers;' in’three, instances ,14 to ,17 days : . were required; and iu one instance 45 drfys elapsed before the., final test report whs completed,"' '■ ,• The degree of promptness with which testing and reporting procedures wore accomplished ,by‘designated using- arms or- services wa$ .not; of course, >xoiusite3Lyr.dopeddent upon the type of testing system employed* The. speed and efficiency with which purely administrative tasks were performed was an almost equally important factor. Serious delays could be, and often 'were encountered in the processing of initial test requests and test instructions and in the forwarding of final test reports through prescribed channels. In three instances (the amphibian litter stop, the lightweight ski clamp, and the medical laboratory trailer), only a few days were required for the accomplishment of these operations* In each of these projects, however, direct communication had been established between the Medical Department Equipment Laboratory and the particular testing station concerned* In the amphibian litter stop project, written permission for this direct liaision appears to have been sought and obtained from higher authority. In the remaining two instances, out-of-channels correspondence appears to have been instituted informally*. ‘ In five projects, correspondence was, for the most part, carried on through formal military channels. In those instances a number of delays were. encountered—attribu- table mainly to slow processing action by;' the using arm or service concerned—and, as a result, a Considerable amount of time wa.s consumed in the performance of'f'jSe administration task incident to actual testing and reporting* In the surgical truck project a total of 30 days was expended in clearing the; initial test request and test instructions with designated ' Army Ground Force agencies and in the forwarding of the final report through channels to the Medical Department* In the heavy gauge ski clamp and medical laboratory truck pro- jects, 50 and 70 days, respectively, were required for the completion of these tasks, while in the snow and ice ambu- lance and dental laboratory projects 90 and 96 days, respectively, were expended* 621 Considering finally those projects in which testing and reporting procedures were accomplished, not by the using arm or service concerned, but by the Medical Department itself, an entirely different performance pattern is presented* In those instances virtually no time.was lost in processing activities, testing periods were uniformly short and intensive-, and final reports of tost findings were ordinarily completed within a few days after conclusion of field trials. ••r:' Here, however, the quality of tho tost con- ducted and of the formal reports submitted varied widely* In the straight and folding pole litter projects, service testing and reporting activities were conducted at a high level of efficiency and thoroughness throughout 1941 and during tho early part of 1942* After this latter date, however, "a marked-decline occurred* Detailed test instructions were seldom prepared, field tests were as a rule summarily per- formed, and final test reports were brief and extremely general in nature. As for the three remaining projects in this category (the dental operating truck, the optical repair truck, and the surgical operating truckVtho service tests which were performed by the Medical Department, while inadequate in some respects, were on the whole of a higher quality than the post-1942 straight and folding pole litter tests* These testing activities involved little actual field usage or crosscountry movement; but within camp confines, the vehicles were subjected to regular professional use for periods ranging from four to fourteen days and interior truck facilities carefully evaluated for operational efficiency. Vith one exception (the dental operating truck report) final test reports were detailed arid comprehensive, comparing favorably with those prepared in other projects by designated'using agencies* 7 D, ■' Project Terplng-tioru' . 1 -• Standardization Procedures» The procedures to he followed" in handling requests for standardization of newly developed items of military equipment were clearly outlined in Army Regulations* Such requests .were to he cleared first through the technical committee of the technical service responsible for development of the item concerned, approved hy the chief of that technical service, and then submitted for final approval to’the Commanding'General, Army Service Forces, or, for items standardized prior to 10 March 1943, the Commanding General, Services of Supply* .• The need for, prompt.’-and efficient processing-.’ of standardization’ reguests was ■especially emphasized ;in ’i ?■ AR 85025: '-v'‘ 7' ... ; -v 4. .i' •The-, importance of avoiding delay :ih-the* .; process-/pf .standardization of items of equipment should-be realized by all concerned# The classification of an item as standard enables, the basis- -of .issue to be. determined and procurement planning for necessary production ...t'P bo inaugurated,’■ .. • . • • ' To what extent were these prescribed procedures adhered to in the projects, now under discussion? With what degree of speed and thoroughness was such processing executed? Of the 14 development items described in this study, 12 were subsequently adopted as standard by the.Medical Department* In nine of these twelve instances, standardization was accomplished in- strict accordance with the provisions of AH 85025* As soon as prepared by research and development personnel, standardization data was forwarded for'preliminary action to the Medical Department Technical Subcommittee.* ..The’ recommendations of the Subcommittee were reviewed’hy-; the parent body, the Medical Department Technical Committeei .and■ were ‘then submitted to The Surgeon General* After approval by The Surgeon General, standardization data were next sent to Headquarters, Army Service Forces* As soon as notification was received that the standardization request had been approved by this authority, appropriate action was taken to enter the new item in the Medical Supply Catalog* Typically, procurement action was also initiated at this time, although in two instances (the surgical truck and the surgical operating truck) in order to meet emergency requirements, production started prior to completion- of formal standardization* The tine required for processing this data through all prescribed channels ranged from two to five hut a year-by-year analysis discloses greater speed of per- formance in 1944 than in the preceding years. During 1942 and 1943* the average tine expended in the clearance of a single standardization request was approximately 32 days# In 1944, through a shift in the meeting schedule of the Medical Department Technical .’Committee from a monthly to a hi-weekly basis, processing time per item was reduced to an average of slightly more than 20 days. Clearance .of standardization data through Headquarters, Army Service Forces, accounted for approximately two-thirds of the total time expended. Standardization procedures were executed smoothly and efficiently in all but three instances. In the ski litter adapter project, because of difficulty in obtaining 623 adequate requirements data f rom'Afiiy Ground Forces, standardi- zation was- completed without this information. Little was accomplished by 'this action, however, as procurement could not he initiated until the quantity of adapters described had been decided upon. Thirteen weeks •lapsed before these data were finally secured. In the amphibian litter'stop project, in which standardization action was required both by the Medical Department Technical Committee and the Ordnance Department Technical Committee, clearance through the latter agency was delayed as a result of criticism ■■advanced by the Ta&k-Autnotive Center in Detroit, As mentioned in a previous chapter, the procedural difficulty in this- instance was a symptom rather than a cause. Incomplete, liaison between the Medical Department and the Tank-AutomatiVe Center during the earlier•stages of the project, had opened the way for this procedural - impasse which was not resolved for several months. The last- instance in which difficulty v/as encountered during the standardization stage was the dental operating- truck project. Here, processing action v/as accomplished in record time but with some sacrifice in factual accuracy. Errors in cost•computations and in the description of the basis of issue for the new item necessitated-re-processing several weeks later, - .. ■ ' ■1 • • ■In all other projects standardization data were complete in every -respect, no significant procedural delaysoccurred, and procurement action was initiated immedi- ately ’’upon completion of those activities. As for' the.substantivc contributions of each of the various agencies participating* in' the -s-tandardization process, the Field Equipment Branch of- the Plans Division of The Surgeon General!s: Office (after February,. 1944, the Development Branch of the Technical Division performed these duties) had the responsibility for the initial collection and assembly Of all necessary technical data. In mettings of the Subcommittee of the Medical Technical Committee, clearance of standardization data with all interested services and divisions of The Surgeon Generalfs Office was effected* Subcommittee recommendations were closely reviewed (modifications ’were made in five of the nine projects) by the Technical'Committee which also provided- coordination with all interested arms .and services. Only in the case of Headquarters, Army Service,Forces, does processing action appear to have been largely a procedural formality, Ho instance v/as found in which Medical 'Department recommendations were either rejected or amended by this office. All errors or omissions in*standardization data appear to have been discovered, and rectified solely on the initiative of Medical Department agencies. Turning now to those instances in which'pre- scribed standardization procedures appear-to have.been omitted altogether, in only three projects out of twelve did this occur. In the case of the straight steel litter, -the ■ straight wood litter, and the folding wood litter,-no- evidence was found which would indicate that these items were processed through the Technical Committee or that their classification-; as standard articles of equipment was formally.approved by :■ higher authority»outside the Medical'Department* However, no. serious'difficulties appear to haVe been encountered as a result;of these.omissions. Procurement action was initiated without'-delay by employing the same basis of issue and requirements estimates as had been previously applicable to-, the standard straight and folding pole aluminum litters. . While, as mentioned earlier in this study, failure to investigate fully the sources of supply for the straight pole laminated wood litter may have led to the standardization of an it erf‘"which was at that time procurable in only limited quantity the' sudden removal of aluminum tubing, from the t ... critical- list made further purchase of the. straight wood litter unnecessary. Whatever production problems might have existed, therefore, never became actual problems, . ; .. In conclusion it may he noted that Medical Department conformance with standardization regulations steadily improved with the passage of time* In 1941, only ojje item out of three was standardized in the manner pre*- scribed hy AH 850-25* In 1943, two out of the three items adopted were correctly processed* In 1944 a perfect record was achieved with six items out of six standardized in strict accordance with'Army Regulations*,... 2* Item Evaluation, Of the* 14 items discussed in this study, only two (the medical laboratory trailer and tho snow and ice ambulance) failed to be adopted by the United States Army as standard articles of military equipment* Even in the pro- jects in which these failures occurred, however, satisfactory end-items (the medical laboratory truck and the toboggan' litter adapter) were later developed and approved for standardization. Each project included in this monograph, therefore, yielded at least"one acceptable product. The straight pole litter project yielded twot the straight steel litter and the’straight wood litter. Comparing these 12 standard items with the equipment which had previously been used hy the Medical Department for the same or similar purposes, improvement., can he noted in each instance* Generally speaking, the now 625 litters and litter adapters represented the least radical departures in construction and design, since development work had been guided t-6 a considerable extent by earlier standard models* Even here, however, numerous -technical and mechani- cal advances were made* •In the straight and folding pole litter pro- jects, not only were suitable substitutes for aluminum side polos discovered (carbon steel and laminated wood) but a universal undercarriage adaptable to all Medical Department litters and constructed' entirely of pressed stool was also developed. In the case of the folding wood litter, basic design was- altered materially to provide for double-folding side poles'and channel hinges in place of the single- folding,' link-hinged poles of the earlier aluminum model. As for the new ‘ski litter adapter, this item too was superior to its predecessor, The.1935 ski clamp had been a permanent attachment ahd, as such, had required a specially prepared-set of skis,. The new clamp, on the other hand, was detachable, ' It -, could'thus be used, 'without previous prepa-* ration, with any type of standard ski or litter,. The toboggan litter adaptor and the amphibian litter stop were largely pioneer developments. Aside from certain relatively crude field improvisations, no previous experimentation appears to have been conducted along these lines by Army personnel,. ■ ’• Turning now to the vehicle projects, the. con- trast'between the new and the old was even more-marked,. In oily: one instance (the optical repair truck)- had any type of self-contained motorized unit previously existed, and in this •case 'the earlier vehicle was simply a stake-and-platform type of "open cargb truck,. tarpaulin-coyerod, and equipped with only a limited amount -of interior fittings. In all other ■' instances the:, new special!zed,medical vehicleswwefe litterally without precedent* . . ” Compared with'the earlier system of'packing equipment in .MMxcal.Department chests*,'loading these chests on general -cargo trucks, and then unloading.and unpacking :ail equipment upon arrival at the destination point—the simplified operation Hade possible-:by the levelopeont of self-contained •• medical vehicles was., a striking In place of ope apt- cargo trucks,'fully enclosed, hhd truck bodies were provided* ;-Built—fn cabinets' were available for, • the storage:-of equipment-and supplies, thus eliminating the necessity for repeated packing and-unpacking.6perations, • Pinally, the provision of heating, lighting., and plumbing facilities, made possible the performance- of laboratory, 626 clinical, or operating work within the body of the truck and on a twenty-four hour basis* Considering next the extent of wartime usage which each of the foregoing items- received, it will be seen that, on the whole, litters and litter adapters went into.-pro- duction earlier then the specialized .vehicles and consequently,- on the average, saw a greater amount of actual'field, service*; Excluding the ski litter adapter which was hot procured in quantity until after.the. war had ended, the average’time-span between the date of first;equipment deliveries*and;the date of official conclusion of the war VJ-day amounted to 2-7 monthsor litters and litter adapter as against 18 months for the specialized medical vehicles* In two of these latter instances, moreover,'(the dental operating truck and the medical laboratory truck) considerably less than a year’s over- seas service was attained* • " As for total procurement—a second index of the extent of wartime usage—the straight steel litter stands out;. • as the key item-in the Medical Department litter program* • • Over 470,000 of these items had been produced and delivered ifby " January, 1945, as against approximately 69,0Q0 folding wood litters, and slightly more than 5,000 straight wood litters* Erom these data it is evident that the straight steel litter served as the backbone of the system of medical evacuation in World War XI, However, the relatively 'high procurement of the folding wood litter indicates the large extent to which this item, which was designed mainly for Army Air Forces, was employed in air evacuation* The remaining items in this .cate-t gory were of progressively less procurement importance, . Approximately 2,500 amphibian, litter stop attachments and., slightly more than 300 toboggan litter adapters were produced and delivered during the war period. While over 1,000 ski ~ litter adapters wore ordered, none of.the.se appear to. have :■ been delivered before VJ-day, Of the six vehicle developments, first in- procurement importance and overseas urgency were the surgical and surgical operating trucks. More than 200..of bach of ’ these two vehicles were delivered during the war years, . Occupying a middle position were the dental■operating And dental laboratory trucks, with procurement totals of 138 and 107, respectively. Behind these was the medical laboratory truck of which 77 were produced during the period., ■ while in'.v last position was the optical repair truck withe a total of only 24 produced and delivered by:VJ-day, ■ • As for the first-hand evaluations by field personnel who actually used this: equipment during the war, no systematic method of ascertaining these* reactions appears to have been established by the designated using arms and services* Few references of.this nature were included in the Essential Technical Medical Data reports received each month from overseas, theaters and few direct comments on medical field-equipment developments ever reached the Medical Department through official correspondence channels. In view of data limitations, therefore, no conclusive answer to this question can ho given. It can only he said that a sampling of annual and quarterly historical reports submitted to The Surgeon General's Office hy medical units serving overseas and in the Zone of the Interior indi- cates a generally favorable reaction and interviews; with medical personnel recently returned from overseas tend- to’ confirm this positive impression. II* Analysis of Administrative Trends, A, Coordination and Direction of Research and Development« It has been noted in previous sections of this chapter how, from 1939 through 1944, highly decentralized and disorganized project direction was gradually succeeded hy a more and more centralized and efficient managerial system, • This steady improvement in project administration was ' evidenced in many ways* in the increasing precision and thoroughness with which military characteristics were formu— , latcd; in the closer liaison relationships that were establish- ed with participating manufacturers; in the more careful-' coordination of administrative action with interested Medical Department agencies and with-interested arms and services; and, finally, in the increasing'efficiency with which standardization action.was initiated and carried through to completion. Coinciding in point of time: with-these favorable administrative developments■were 'certain organizational changes which were taking place within The”'Surge on Generali From 1939,until 1942, research and'development functions were divided between the Planning and'Training Division, the Medical Department Research Coordinating Board, the Finance- and. Supply Division, and a number *f professional divisions,. each possessing a considerable degree of autonomy within its own special field, ,„Xn May, 1942, a Research and .Development,.Division was created and the major responsibility for- -the supervision and coordination of medical research and development transferred to this agency* However, certain research functions still in various branches of the Supply Service, Professional Service, and Operations Service, and it was not until February, 1944, with 628 the establishment of the Technical Division that the culmi- nation of the long trend toward centralization and unifi- cation of research and development activities was at last achieved. That improvement of. project administration was the underlying purpose; of these several organizational changes is clea.rly indicated in the investigation reports which pre-coded and led to both the 1942 and 1943 .reorganizations. It is equally evident that there was a. growing conviction on the part of key research and development personnel that centrali-s- zation of research responsibility.was the only answer to these administrative problems*- Centralization was the dominant theme of the special board report of 3 January 1944, of which the foil-owing..is. a sample excerpt: It is believed apparent that the approach to a solution of the problems outlined above must be along the lines of maximum centralization of responsi- bility for the several related activities. The present duplication, triplication and even quardruplication of interest and res- ponsibility in research and development matters is believed to have resulted in large part from the gradual but enormous-, expansion of this office without entirely adequate reorganization on a functional basis • « • • In contrast it should be noted that all technical services other . than the Medical Department concentrate; all research and development activities in a single u I, 1 On the "basis of the forcgoipgidata,. the . following general proposition is advanced: . -.The mbre centralized and integrated the organization foV research-and development. the; greater the degr.o.e .of.-• administrat.ive; -e f f i c 1 ency i n ■ t he' cohduct of these activities, : B# Technical Aspects of Research and Development. It has already-been pointed out that the items pro- duced under the Medical Department litter program were, on the whole, developed sooner and, consequently, saw a greater amount of actual field service during World.War II than those developed under the Medical Department vehicle program, ’There were, of course, a numbe’r of inherent differences between the two undertakings in costs, availability of materials, relative difficulty of the research problems involved, and degree of dependence upon other. arms and services for ..technical assistance. - One further factor emerges from the data, however, which :.would appear to he equally deserving of.-inclusion aS a-part of the total explanation for the differing,speed with which technical research and develop- ment was accomplished in these two major programs. This was the factor of. peacetime research and development. Paring the period between World War I and World War'* II, the funds available to the Medical Department for 'the con- duct of research and development wore.,unbelievably.small. ' During the 20*s, when*federal expenditures in all fields were being held to. a minimum figure, allotments for medical research and development were virtually non-existent.. Sven with the sharp rise in governmental appropriations following 1933, available research funds were minimal. In 1935, 1936, and 1937 only $1/500, $2,500 and $4,000, respectively, were allocated by the Medical Department for these purposes With these financial limitations in mind, it- is ,nbt difficult to see why, in the peacetime period, developments v in the field of litter construction and design far outstripped those in the vehicle field. In the former instance, since material costs were nominal and since the litter,' being a basic item of medical ..equipment, would be required in large quantity in the event of war, many manufacturers .were willing to engage in experimentation on a cost-free basis in the hope of developing new models., acceptable to the Medical Department, By thus farming out the major portion of this-experimental work, research and development personnel were able to conduct relatively large-scale investigations in this field with a minimum of expense. The results speak for themselves. During the middle 30*s new straight and folding aluminum litters were developed and .standardised which were Superior in virtually* every respect- to their World War I counterparts. Upon the outbreak of war,. ..therefore, the . only additional experimentation required in this field was the -discovery of suitable aluminum substitutes and the development of a small number of litter adapters; ■ Basic litter design had been established by peacetime research, . .’ "./. 'By Way of contrast-,--.vehicle.,experimentation during the pro—war period was seriously inhibited by lack of funds. Here, material costs were highland it was also'evident, that overL.in the ' event Of War the; number., ofspecialized medical vehicles, which would be required wpul4. t>e; relatively small. The noccssary xnduce'ffle’nts for manufact’urer-partici-pation did not, therefore, exist. The Medical Department'wad dependent upon its own funds, its own facilities, and its own personnel for whatever progress was tq b-e made. The sequel was dis- appointing but, under the clrduinhtances, hardly surprising. 630 As early as 1933,. the Medical Department established a formal development project'to'produce a self-contained mobile medical laboratory unit* Due to lack of fun.ds, this undertaking remained dormant until- 1939 when $500 was allo- cated to the project* A trailer type of vehicle was obtained, as had been the original plan in 1933, and two years-were spent in designing, construction, and service testing this model. Because of unsatisfactory field performance the trailer laboratory was rejected,, With the inadequacy', of the trailer,type, of vehicle now demonstrated, in October,.1941, a - now project was launched—the Armored Force surgical, truck project*—to,-investigate the possibilities of converting a prime^moyer type, of vehicle; into a self-contained mobile unit.: - A. year later this Undertaking was' successfully con-, eluded,.and the- Medical Department at last had a suitable basic mqdel for its 'specialized vehicle program, 1 . . It would appear’evident from the above account that inability.to conduct trailer experimentation in 1933 and learn, the lessons that were to be learned from thisi experience during, peacetime years had simply postponed these-preliminaries until wartime.. This latter period, it. will bo appreciated, was one in which -the Medical Department could least afford a - two—yea.r delay An a, major research program, - d In the light of these ddt>: the following general proposition is advanced! .There is a direct relationship between- the quantity and quality of .peacetime research and development, and the - speed, and effectiveness of wartime research and development,- . d ' ' ' : •' 7 'if y 0, The Conduct of .Engineering Tests,' * •' •’ ' Although-the Medical Department was responsible for the conduct of engineering tests of all new items of medical • field’equipment, the data have shown"that in only one instance (the medical laboratory trailer) were such tests satisfactorily performed and adequately reported upon* These omissions, how- ever, were attributable in only small part, if at all, to negligence on the part of medical research and development personnel,' In the case of litter projects, the Equipment Laboratory did not possess the necessary equipment to conduct static load tests and was hence dependent upon private manu- facturers or the Aero Medical Laboratory at Wright Field for such engineering tests as were performed. In the case of the vehicle projects, however, an entirely'different problem was presented. Here, no elaborate testing devices were required. All that was needed was sufficient trained personnel to con- duct extended road tests and to make and record during these tests appropriate technical observations regarding the mechani cal adequacy of the vehicle, and of interior packing,.arrange-' monts* - ;/ f;■ ■ That personnel was not available after 1941 for thd performance of these tasks is evident from the data. The reason for this,deficiency would appear to bo as follows. It will be recalled that approximately two to six months were required for the conduct and reporting of service tests by designated using arms and services. In the case of the dental laboratory truck, the dental operating truck, the optical repair truck, and the surgical operating truck, the need for those vehicles was too urgent to permit such an extensive time-lapse for service testing-. As a necessary expedient, therefore, these tests—though actually a using agency responsibility—were performed by the Medical Department, Under, these - circumstances, neither the time nor the personnel was, for the conduct of engineering tests which, though desirable, were regarded as less essential than ful-1 field trials. On the basis of the foregoing analysis, the follow- ing proposition is advanced: Except where suitable testing equipment was not available, the failure of the Medical Department to discharge satisfactorily its engineering: test responsibilities was largely due to failure on the part of using arms and services -to relieve the Medical Department of all service tost responsibility, • ;'r D* The Conduct' of Preliminary Research Investigations* It has been observed in earlier sections of this chapter that, on the whole, little preliminary research investigation was conducted in any of the projects with which this study has dealt*-"- • •” *' ~ On the basis of first-hand-study of the'‘research- procedures foilowed‘at'the Equipment Laboratory*at Carlisle' ■ Barracks and on the^basisrof considerable-day-to-day associa- tion with research and development personnel■i& The Surgeon1 : General*s Office, the following proposition is offered: Office procedures, funds. personnels and'equipment'necessary for the adequate performance of preliminary research'invdsti— gations were lacking at 'the start'of the war, and this deficiency was not remedied at any time during the'course of: thewar• * i-E« Establishment of Military Requirements..for Uew * ' Development Projects!' The' data..previously discussed have shown that,- in only two instances out -of eleven, did a using arm ,dr service submit.written evidence of the existence of a definite military; requirement for the development project,concerned, While the ; Medical. Department gradually developed certain informal pro- cedures' of its own for the. evaluation of requests for new items of equipment and for the assignment!, of research priori- ties, these efforts were at best half-measures as the Medical Department possessed no legal authority*and, hence, could build no adequate formal organization for the conduct of such overseas surveys. «. ■.The proposition is'therefore advanced that: Because of tho~failure of using arms and services to discharge satis- factorily- their responsibilities under Paragraphs 5, 6, and 8 of JUl~85Q-35;....adequate procedures'were lacking throughout the war for tne.-.e5.tablis;Ment.:;of sound, military requirements for new 'development- profleets, • III* Conclusion, ' Both' -from, avqualitative and quantitative standpoint, the achievements of Medical Department research, and development personnel in World War II were impressive’, Out 'of the 14 new items of medical field equipment described In. this study—and every effort was made to select a representative" sample—12 were of sufficient merit to warrant standardization and quantity procurement, and at least nine of these items saw extensive battle service* While the importance of these accomplishments is fully recognized, it is the belief of the authors of this monograph that an even better record can be achieved in the future by the Medical Department if equal attention is given to certain of the deficiencies disclosed by this study and appropriate action taken to prevent their recurrence. On the basis of the trend-analysis just, .presented and in the light of numerous discussions with research and develop- ment personnel during the,eighteen-month period When this study was being prepared, .the following specific recommen- dations are suggested:' < ' (l) that, however sharp the reduction in medical research and development activity during the peacetime period, all managerial functions con- tinue to he maintained in a single agency, even though that agency he of only branch status. 633 (2) that in future war plans prepared by the Medical Department, definite provision he made for the prompt establishment of.an adequately staffed and adequately financed independent; agency, responsible directly to The Surgeon General or his Deputy, to coordinate and supervened all, .types of wartime-, research and development'. ‘ • (3) that, whatever-t&e* size of’the annual''appropri- ations received by the Medical Department during . the post-war period, an appreciably'higherrpre- ccntagc of these funds be devoted to reseafchd-ahef development activities than was the ca.se during the years 1920-1940, (4) that the funds, personnel, and physical.facilities needed for the conduct of adequate perliminafy- # research investigations he immediately provided - . and that, to insure compliance with Army * 'd' „ Regulations, The Surgeon General require written evidence of the satisfactory accomplishment of, these procedures. as a routine pre-requisite, to approval of new development projects, ' ■ ■ ■* (5) that the appropriate provisions of AR 850-35 he revised to provide fdr the .establishment of cellular teams of overseas observers, organized preferably at the War Department level, whose ■ f*i -specific responsibilities will he? to investi- gate and .evaluate overseas* demands for new*. . items of equipment, and to recommend, when deemed necessary, the establishment of new development projects to produce these, items. (6) that the number of service testing stations-'. operated hy using arms and services he'material- ly increased to provide for year-round testing of all types of equipment; that of the testing period he shortened to the degree consistent with accuracy and reliability; and ' ’ that effective procedures he established’*#©; insure prompt processing of all .correspondence ' and-formal reports incident to such ’testing. ■ CHAPTER XI :850-25. Par, 8, See also Pars, 5 and’6; ' 2Ltf* to ‘Ghf,; Field Equipment Br,, Plans Div,, fr. Dir,, Research''and Development Div,, S.G-,0, ,10 Dec, 1942; subjectr “Medical Equipment for Mountain Troops“ (A,M,R# & D# 3d,) • « ‘ ■ • Z5upra. p. 232*. . ’ k ' 4AR-'850-25'. Par. 10, •, >: ■ 5 Supra, p, 226. 6AR 850-25. Par* 9c* . the authors (lit, Wilson) served as a member of the Supply Coordination Branch of the Technical Division, S.G-,0, from February,; 1945 to September/ 1945,’ The other author (Lt* Johnson) occupied desk space in the Research Coordination Branch of the Technical.Division, S,G,0, from December, 1944 through May, 1945,... • ‘ 8AR 850-25.- Par, 11b, °The;.-nStretaher—KotB submitted by the American Pressboard Company might be considered analogous HQ the military ski litter adapter, but it employed;.neither-a standard litter nor a standard ski* ... . .- --v; : •• • • • •••': 10Supra, up, 250-251, ... . . nSupra. p, 73, 12AR 850-25. Par* 12, 8Ibid*. Par, 16, 44See monograph by Chf,, Research Coordination Br,, Tech, Div*t S*G-,0,, History of World War No, II from 1 January 1939 to 30 June 1944. SECRET* (Hist, Div,t S,G-,0«,). Extracted in clear, 15 Medical Research and the Development and Classification of Medical Department Items of Supply and Equipment. 3 January 1944; included as Exhibit nAn in Five-Year History of Development Branch. Technical Division. Operations Service Tnist, Div,, S.G,0,)r ’ Army Medical Bulletin. No, 32, July, 1935, p* 75, APPENDICES Appendix A DECISIONS REACHED AT CONFERENCE HELD 6 JULY 1942 AT ERIE GBR PLANT BETWEEN REPRESENTATIVE OF MEDICAL DEPARTMENT EQUIPMENT LABORATORY AND ERIEGER COMPANY, CLARIFYING SPECIFICATIONS AND DRAWINGS OF SURGICAL TRUCK ”!• Water Tank to bo a standard 50 gallon Galvanized Tank, having approximate dimensions of - length 60”, diameter 16”. "2* Water Tank to be equipped with a Visual Reading Float type gauge similar to that manufactured by the Rochester Manufacturing Company. ”3. Rear Step to be standard \ ton Dodge Ambulance folding step as manufactured by the 'Wayne Works, Richmond, Indiana. ”4. Moulding - Exterior of Body moulding to be either solid or'snap—on type, ”5* A Rainproof Convenience Outlet wired into the truck electrical system to be provided at a convenient location on each side of the exterior of the body. ”6. Equipment Laboratory to furnish two (2) Floor Plates to Krieger Steel Sections, for the Pilot Model. ”7* Dome Lights as specified on Equipment Laboratory drawings to be any standard commercial car light. All wiring to be surface mounted on top of interior masonite lining and covered by a rectangular steel section; this steel section to be secured to the masonite by screws placed on approximate 12” centers,.. 636 n9* A Master Switch to 'be installed on the dash to control all interior "body lights. n10* Equipment Laboratory will furnish a color sample of the interior paint. Mll* In lieu of the double glass dehydrated windows speci- fied, single pans Safety Plate-Windows equipped with a pullman—type mechanized to be supplied on all windows and to be equipped with galvanized drip pans.11 Appendix B TEXT OF LETTER OF 8 JULY 1942 FROM MEDICAL DEPARTMENT EQUIPMENT LABORATORY SUPPLYING KRIEGSR STEEL SECTIONS, INCORPORATED, WITH SUPPLEMENTARY INFORMATION RELATIVE TO DRAWINGS AND SPECIFICATIONS AS REQUESTED BY TELEPHONE "In accordance with our conversation yesterday we are forward- ing you via railway express (one) 1 operating light and two (2) Carlisle model floor plates. These floor plates were obtained by us from The Aluminum and Brass Company, Lockport, New York, at a cost of $1,20 each. The brass floor plate has been superseded by cast iron and we do not know whether the Aluminum and Brass Company can supply these in this material. We are inclosing four (4) copies of our Drawing No, 1246 showing the design of this cast iron floor plate. The New York Medical Depot, Brooklyn, New York, has recently purchased a large quantity of these cast iron plates and we are writing them requesting that they inform you as to their source of supply; should you not hear from them within a few days please let us know. "A color sample of the paint for the interior finish is inclosed. This particular paint is made by the Beckwith- Chandler Company, Newark, N. J., and is their No, 630, light green semi-gloss industrial lacquer. We wish to mention that the paint you supply for the interior does not have to duplicate this sample exactly but should approximate the color; either lacquer or enamel may be used. n¥e contacted Mr. F, A, Keihn of the Evans Products Company this morning re the Evans heating unit, Mr Keihn just called back and informed us that he contacted his home office in Detroit and that every effort will be made to supply you with a heater, Mr, Keihn expects to visit you this afternoon or in 638 the morning. If he has not contacted you hy this time you receive this letter, please let us know hy phone. "Major Christie and myself wish to thank you personally ftr the many courtesies extended us while at your factory," 639 Appendix C_ NOTES OH CHANGES TO HS INCORPORATED INTO PRODUCTION ], MODELS OP SURGICAL TRUCKS AS AGREED UPON AT CONEERSNCE AMONG REPRESENTATIVES OE KRIEGSR STEEL SECTIONS, HOLA- 3IRD QUARTERMASTER DEPOT, AND MEDICAL DEPARTMENT EQUIP- MENT LABORATORY HELD AT CARLISLE BARRAGES 21„UULY 1942 nIn lieu of 50 gallon water tank and water heating coil as provided at present, a separate water heating svstem {-of a design to he supplied hy the Equipment Laboratory) to he. furnished hy contractor! A float level gauge is to he provided' on water tanks. Mixing faucet and sink to he as at present. n2. In lieu of the lighting system specified the following to he provided: ■ : :• ; • .. . The two 6 volt dome lights as at present to .he ..connected to electrical supply of.truck; cah switch required. Clear glass to he provided in dome lights..: So?-." A complete 110 volt lighting circuit including the following to he installed hy contractor^1 r > ■ . Operating light to he 110 volts installed as at present. Operating lights will he furnished hy the Medical Department Equipment Laboratory*to- the contractor.- A fused entrance switch mounted-inside the body shall he provided,'E’ .'I 640 All wiring to be surface mounted in conduit. The above to be in accordance with the wiring diagram to be supplied by the Medical Department Equipment Laboratory, n3* ' Rear doors to be equipped with two stage stops, one stage providing a door opening of approximately 170 degrees. Each door to be provided with a slam type locking mechanism with one locking handle. Door keys to be provided in triplicate, not Government coded. Handle to be provided for opening rear door from inside. **4, ' Six gooseneck lights of a design to be furnished by the Equipment Laboratory to be supplied by the contractor. Four saddlers loops (two on each Side of body) for fastening these lights to be supplied by the contractor. n5. Funnel ;for*-filling water tanks (of a type, .specified by the Medical Department Equipment Laboratory) to be provided by contractor,- ,'V ■THE. FOLLOWING- CHARGES AND MODIFICATIONS ROT INVOLVING ARY ADDITIONAL COST TO THE ERIE GSR STSETj SECTIONS, IRC. , ARE TO BE MADE ON ALL PRODUCTION MODELS: Water hefting coil to be eliminated from Evans heater. All heater fans to be operated from 110 volt, 60 cycle a,c. ”2, Skirting on body to be eliminated. M3# Spare tire^to be located on left hand'body side in accordance with blue print to be furnished by Holabird Quartermaster- Motor.,Base, . . ,T4* Filler neck on gasoline tank to bo located 'to provide casy.-.acce-e-s • - ”5* Install removable, service plate, for folding rear step mechanism on -each door. n6* Install shelf.on right, hand side of wood cabinet. ‘Install divider ,in .wood .cabinet. a8» ‘Close loft: end of wood .cabinet, n9* ‘Check roar windows for sufficient space to'install black- out curtain?;, if.necessary decrease size of window. n10# ‘Steel ladder to be installed on front of body ih accordance with original specifications. 641 ’’ll# Install parcel racks on each side in accordance with original specifications* ”12* Steel cabinets to be in accordance with latest revisions of Medical Department Equipment Laboratory Drawings ITos, 2258, 4259, 3260, 3261, 226o/d-295, D-296, D-297, and D-298.” 642 Appendix D REPORT OF ARMORED FORCE BOARD, FORT KNOX, KENTUCKY,' ON PROJECT NUMBER 291: TEST OF SURGICAL TRUCK AND TENT, DATED 26 AUGUST 1942 • THE ARMORED EORCB BOARD Fort Knox, Kentucky SJB/mvm AFB P—291 August 26,194Rf-' TEST OF SURGICAL TRUCK - AND TENT . ‘ , 1. PROJECT: Tost,- of Surgical Truck and Tent. : =n :-:'- , * a. Authority.—Letter, Armored Force Board, - Fort .Knox,- Kentucky* August- 18,. 1942, file AFB 451,8 and 1st Indorsement, Headquarters Armored, Force, August 18, 1942, file 451.2-112, GNOHD (8-15-42). b. Purpose.—To determine the suitability of the surgical truck and tent for the Armored Force, 2. Discussion: * - - a* Description: (l) Surgical Truck.—The surgical truck con- sists of a van type body mounted on a standard, 6 x 6, 2-|—ton truck. Mounted within the van body were' the following facilities: 644 (a) Water tank - 50 gallon capacity, (5) Air circulating fan, (c) Sink with hot and cold water outlet, (d) Cabinets for equipment, supplies and accessories, (e) Two dome lights - 6 volt, (f) One dome light (operating) - 6 volt, (g) Cabinets for the stowage of equipment and supplies. Outside of the van body were the. following fapilities:, ;. (a) Combined air-water heater on left front body, (b) Fuel tank, gasoline, 6-gallon capacity for air—water heater, located above and to right of cab, (c) Electrical connections for homelite or other source- of current, ■ The interior of the van body was wired for 6 volt current only. The weight of the body and all equipment was estimated to be 1800 pounds.,;,. -For -further,; details see photographs No, 3860 to 3864, inclusive, (2) Surgical Truck Tent.—The surgical truck tent was fabricated,rat the Jeffersonville Quartermaster Repot according to the design presented by the Armored Force Board Report, AFB P-224, f,Tent for Operating Room Truck,” May 29, 1942,' Certain changes t we re necessary in ordo-f. to ■„ conform to the design of the surgical truck. These involved essentially the following: . y..; • - - -(a) Greater height_where -the tent pasqes over the van body, ; *• ■; • •. t ‘-.xi r Two side ventilators in place of one the cab* , (c) Straps to fasten the canvas to the front and top of the surgical truck, ;.i) v. • • : The tent is constructed of. heavyycanyasyr ,n, r-:' treated for blackout characteristics. The tent weight:-1 O’ on approximately four hundred (400)m pounds• The tent dimensions are as follows? • ' Length - 22% feet Width • - 25% feet ’ •** •" ’ •• Height - 11 feet (approximately) -at the top of the van body, 5 feet and 6 inches' at the side walls, ■ Entrance to the tent is from the rear through *iV a hanging flap, A canvas fly extending at an angle of 45° from the left side of the entrance prevents the escape of - light during night operations, For further details see photographs No, 3860 to 3864, inclusive, ■ ' • ‘ . '■ \ h. Details of Tests.—-The surgical truck and tent were subjected to test as follows: 4 (1) Cross-country operation, (2) Pitching and striking of tent* (3) Blackout characteristics* 4. . . ,) .. ,. ;1 . •• (4) Inspection by Armored Force Medical’ : Officers and demonstration to Medical personnel,- c. Results of Tests : ' ■ (l) Surgical truck, 2%-ton, 6 x 6, with van type body* ’ ; (a) Cross-country characteristics,—The tests indicate that the truck has excellent cross-»country ability, equal to that of the standard 2-%-ton,- 6x6 truck. The added height of the -van body (approximately one and one- half (*1 %) feet)' will ■cause some difficulty when traveling -■ through wooded areas* The load of the surgical truck is estimated to” be as : follows-: • •■‘•T •" Van type body ’ ’ ■ - 1000 pounds Tent — 400 pounds :- Equipment & Supplies - 1000 pounds Total - - 2400 pounds It is evident that the truck is well under its-payload capacity*• - • - (b) Accessories, Equipment and Facilities on or within the Truck.Body*—The pilot model surgical —' truck was not complete nor fully equipped. The following discussion will consider the desired.features. 1, External sources of electricity (as frota' a- Homelite cr similar generating' system) must bo made available* This is neco'ssary in order to conserve the battery and provide ample power for fans, sterilizers, and operating lights. A portable 1500 watt, 110 volt generator is being considered. Since this unit”generates current at 110 volts'V it is necessary that the ‘interior, of , the truck be wired and/-fitted with accessories for such current. It is suggested--that’this generator be suitably mounted on the front of the truck body, above the cab and between the air—water heater and fuel tank fox the same. It is v t \ m believed a; type of mounting can be utilized to prevent vibration, and that an adequate muffler (possibly using a 6x6 truck muffler) would reduce, noise satisfactorily. The tyoe of mounting should be such as to make the gener- ator easy to dismount and place on the ground outside the tent.for'operation. » 2. The truck must be wired for current available from the truck power supply as well as from ext ernal s our ces. 3. Four brackets on the outside of the truck body (two brackets- on- each side) are required for light purposes within the tent. 4* Outlets within the body are required as called for by drawings No* ,SK 51, Wiring Diagram, Surgical-'. Truck, . ... ■ 5. An additional ventilating fan should be provided fof the adequate ventilation of the truck body. This fan could be located at the front, of the van body and just above- the sink, J The circulating fan. connected to the air-water heater provides only hot air for the truck body. As an alternative, separate air and water heaters are suggested. The fan on the Air heater could then be used for circulation of warm or air’as’-required. The air ‘heater can be installed on 1'He, body to the right of the 'cab. 6* CabihOts No, 19,, Drawing -.No. -3360, and Cabinets No. 20, Drawing No, 3261’,’ have drawers • which are too small. Compartments fitted sliding doors and haying dimensionslofiappf oximateljriSl”: .x. 19-t?^16m are more desirable. Two rows of small drawers:-IG—fx 9/i6n at the top of the cabinets are ample. 647 7, Drawer latches must be more substantial and more readily operated,. The- latches failed to hold the 'drawers- in position in many cases during cross-country operation and in .other, cases would not’ permit the drawers to be pulled out, * \ V .8. The wing nut method of holding the burner lighting door in place on the air-water heater, is unsatisfactory. During long cross-country operations the wing nuts will loosen and the door will be lost. Provisions be made to prevent this, . 9, The spring operated door of the heater through which regulation of the burner draft is accomplished is’ unsatisfactory. The door and door springs are light weight material and the springs will fail after a short time* A heavier hinged door with positive locking device ib suggested. 10, The fuel metering valve assembly is susceptible to damage when operating through brush or timber* The assembly should be more rugged- and amply protected against damage. 11* Brackets around the,front sides and top of the truck for attachment of tent straps should be factory installed* 12* The ,'sink drain pipe discharges upon the muffler and thence on the ground within the tent. The sink drain should be carried to.the front of the truck and discharged into a soakage pit prepared for that purpose* (2) Tent Surgical Truck, ... (a).. No difficulties were.'experienced in pitching or striking the tent provided that the. tent was folded in such a manner that it may be hoisted over the drivers cab and to the 'front top of the van body and then unfolded from the top of the van body. 0>) Blackout Characteristics *—In general the tent has good blackout characteristics. Ho light was observed to pass through the material or through the rear entrance when the movement of casualties was simulated. Some reflected light did escape from the front of the truck at the junction of the canvas and the truck body* This was due' to poor contact of the inner canvas flap to the body of the truck. This contact may be improved by providing a grommet and rope over the truck body and fastening down tightly on the opposite side* A strip of canvas is stretched under the truck chassis just below the 648 front of the truck .bb'dy* ~ This^canvas'prevents the'esbapfe bf light except Vhen light, rays are directly under»the body of the truck*- Such light is-visibly only when observers.lie. on the ground,' A very small amount of reflected or even direct light escapes from the front tent ventilators. The escape may he prevented entirely hy lowering the ventilator covers* • • • L .(c) Largo amounts of- dust;, mud,. and*.:; j... dirt are introduce’d into the tody of the truck when the folded tent is carried therein. It i-s suggested that the folded cover in a baggage rack on top of the drivers; .cab and held down by means of a tarpaulin and ropea. The tarpaulin could be used to prevent reflection from the windshield-when the truck is in use as an operating-room • . truck* „ .V. h'-ri 3* CONCLUSIONS: The Armored Force Board conclpded-r that: a* The truck, surgical, 2—|-tbn, 6 x . 6, has the- re quire d cross-country mobility for Armored Force use#;.; b. The accessories, equipment and facilities are adequate except as indicated under 2c (l) (b)* c. The tent for the surgical truck is satisfactory except for improvement in blackout features as stated under 2c (2) (b),. ■ , d* The folded tent should be carried on top of the drivers cab in a suitable rack and held .down by means of a tarpaulin and ropes* 4*; IffiCOM^BNDATIONS: The Armored Force Board recommends that 5 a.- ' • ') . a* The truck, surgical, ton, 6 x 6, he standardized for issue to the Armored Force after modifi- cations as indicated abovb have been-made, • b* The tent, surgical truck.be standardized for issue to the Armored Force after modifications as indicated above have been made'* ' ~ i: .v».... ... 649 c* Provisions "be made for carrying the folded tent on the top of the driver's cat), /s / G, B. DEVORE G, B. DEVORE Colonel, Armored Force President 1 InclS Photographs* /.Stamped^/ Headquarters Armored Force Fort Knox, Kentucky Approved Sep 7 1942 For the Commanding General: /s/ LEO S. SCHDLTSN, JR. Major, A* G* D*, Asst* Adjutant General* 650 Appendix E TEAT OE MEDICAL DEPARTMENT LABORATORY REPORT ON-ROAD TEST OE TRAILER LABORATORY, DATED 25 APRIL' l941: ”1* The semi-traitor unit left the'Laboratory at-1 i03 P.M, , April 24, 1941,* Th,e equipment carried'in the trailer con- sisted of glassware, microscopes, etc. ,r2* The attached chart is a log of the1 trip. j The total mileage of the trip was 60 miles of which 9 miles were traveled on concrete roads, 40 miles on macadam' roads? and 11 mile6 on dirt roads. The gas used on the'60 mile trip was 13 gallons. • ; : • ff3* The power unit controlled the trailer vbry well, except that a pushing-pulling motion could he felt in the cab, ■Thiscould have been caused hy a worn coupling of the power unit* When the brakes were applied suddenly, the trailer would push the power unit* This could probably be taken care of by adjusting the brakes oh the trailer* . The trailer unit rode very well; it had a gentle up and down motion, and a side motion on macadam roads, and the same motion but more severe’ bn rough “dirt"- roads which made it difficult for the, rider to keep on his feet during the time he was..riding Jin. the -trailer* "The average speed traveled on macadam roads was 2.5 -m.plli*,;;‘and on dirt roads, 25 mvp.h. and at these speeds the trailer rounded curves without excessive leaning or*swaying. The height of the trailer being 1L feet (plus or minus), low hanging branches of trees on the dirt roads would strike the front and. top portions of- the vehicle, and at times fairly large branches would strike the windows in the front of the trailer, . The windows having no protective curtains could easily have been broken* The’ driver took a wrong turn and, entered a small park with a narrow winding road bordered with trees. Upon finding his mistake, the possibility of backing out was examined but rejected as there were a number of trees with low branches which would surely be broken in maneuvering so large a vehicle. This made it necessary to continue through the park which was difficult due to light wires, tree branches and trees that had to be avoided. H4-« The following is a list of the equipment that needs adjustment in the trailers Sterilizer has a chafing noise in wa,ter holder. Metal strap on sterilizer door needs tightening. Sterilizer frame could be cross braced. Top rear drawers on the right side cannot bo opened when vehicle door is closed. Fuse box door is hard to close, Center light, left side, needs tightening, Windows do not fit tight at top.,... Generator and motor bouncing around, 'heed , fastening, Soard under-,-motor cracked. w5. The couple te unit shows good roadability, over - all types of roads. ,It exhibits comparatively easy handling, and the power unit can pull the trailer without effort notwithstanding the: fact that it is necessary to use low gear on long - hills.* ; V- . Project IT-5 (Cont’d) Road Tost. Laboratory. Serai—trailer * Total MilpagP 16P-,;^irGs■ > 8 Gas used4 _on0t ‘ - 12 ;:gal. Road.' Test. “ April 24. 1941c. .. .r» CX * *■ )■<*' .. •"* lino Speedometer Reading ; ’ Start- Finish 'Mile s' |Type ■ of Road • i .Condition ' Remarks - P.M, ,* f'Macadan . . r“—• : ,• IS 03 30058 | 30060 2 good ‘‘ y- Recorder--riding in • \ 1 ; , cah' on past’ - driving ~ - >■■ - • -» -4- - . . j i '• *•* T •f* ' , -r¥ * ‘ • * h Concrete _ _ > Driving- at 30 to 35 . 1:07 300601: 30066 ■ 6 good ’• - nph, ‘ Some- feeling of hack ‘and f orth move— | , v -■ v .. ,. *»*4 nent (.may he caused i - ; V,-n •T; . . ■"*"* * . h.y worn coupling'-on . ...power unit) ? -j* ! 4'- * j * * : •■■•h M v d . hpafe s, vs-'ud- i v> - J -A ' . **• , •dehlyt'sped :CbUld feel ■ 5 ■■■"' \ i j Si . pushing action of - f I i ■ i t 1. . i .trailer.on power unit 653 Time Speedometer Heading Start Finish Miles M * Type of Road Remarks , Condition i . . 4 , ■ (this, action may he stopped Uy adjustment — of_brake_§_ pnj_trailer) • -: • ■ 1:3.9; 30066 ; 30069 3 Dirt rough Recorder in trailer. Driving at 20 MPH. •v : . ' Chafing noise in sterilizer. Top right rear drawers of cabinet cannot he opened when rear door 1 ■ ■ i ‘ is closed. Generator and motor bouncing around in cabinet. • 1531; 30069 30071 i ! i : * 2 Macadam j jDriving at 30 mph, | Riding fairly smooth* ’] Chafing' in sterilizer. jv (j. Gene rat or. motor h ounc— " ”* ha ing• d\5Sise;;hf>% hard J _ J. 30071 !30073 ” - • 1— , — — IS 39 2 Dirt Driving” at *30 mph, rough j Trailer taking 90^ r f v . ■ . ►>. v- £ <; * I. * i • ■ : Vi - • • ! . • . t I 1 turns with out lean- ing more than could be expected. On small country road, branches of trees, some fairly large, striking bus in front windows; danger of breaking as windows r- ! L - are unprotected. j Macadam Driving at 35 mph. 1:45 30073 |30075 u. 2 ■ Recorder in cab. i Dirt Driving at 25 mph. 1:60 30.075 , 30076 1 poor Short steep hills. " \ ' . I’■■ . ■ Unit taking curves without affecting i ' L _) the driving. I ‘ ! Macadam Driving at 30 mph. 1:55 30076 i30079 h- 3 good Dirt _ Rnproycd_ _ • 2:00 r I J30079J 30081 _ _ 2 _ 654 Tine Speedometer Reading Start Finish Miles *.. Type of.Road Condition —*■“ Remarks —.—■—7 • • * Macadam TTook wrong..road 2X07 30Q81 30090 j 9 through park. \ , • : . ; : . * ; ’ Trouble,, get t ing un- * 1 ' * ’ | dor wire and low • ' branches of trees. • ; . .. Road winding; im- - * ' ' - - * possible to back out. Left park and w continued at 30 r mph around curves • without side sway. ' Riding at 35 mph.on - ' '.1 •_ ‘ ••I:"'- ■ straight road, ... — trailer riding — ■ s i7 r _smopthly* 1. Dirt Rower unit pulling 2i40 30090. 10092. j. _ p. Ip^rpye^d^ Jiard pn^stccp_hil 1.s^ 2:50130093.^ 30094 : h;i * -Macadam ... .. . -■ 2552l30P94_ 30097 r >'-rj . -13 Concrete .. - 1 r ” Tc rr ■ -■ , Macadam Recorder riding in' 2*56 30097 SOUS l .. good trailer. Trailer ' ' ■ i. ■ • unit holding road, t -1.- very little side • * •r* . sway; constant up ♦ and down rhythmic 0 .V1-- ; motion. Center . light, left side; ■ /■. - i * loose. Climbing .. ’ Sterretts Gap slow ■ j. • ; • ■ .. but stoady.Upower >' ..... -y ■ • •. - ■ - v unit pulling hard... f. „ , f • •• ■■ ■* •*-' . J • •.' ' . - - * * • V in' low gear.*,.. •- "" "!! 0 • ' - r: ■ ■■ ... - • this"speed trailer,. 4 n ‘riding quite smooth. "111-- ■ 1 ••• .-. ?• '• 'Glassware joggling ' in drawers, not • ■ ' V • - . . hard enough to cause . y. t ■ damage. Microscope 0.. * front left not firm • *• * t _ on floor. Door ... — • ...... , :strap on sterilizer v 1 mm* •mm — — T* p* is. _nee ds_a dj us tme . .. - "■ 'Returned to 4*00130X18 ***“ - Equipment Laboratory Glassware checked; - -- nothing broken. 655 ,fl* The Amy labdrat'ory• semi-trailer was taken on a road test of 81 miles ' of rodds on April 25, 1941, as follows* na» Thirty—two (32) miles of concrete roads, State Highway type. n_h* Thirty—four (34) miles of macadam roads, nine (9) miles of which were mountain roads. "£• Fifteen (15) miles of gravel covered dirt roads. . u2* Speed varied from 5 miles per hour over the mountain roads to 35 miles per hour over concrete roads.' Average speed for entire 81 miles was 23.1 miles per hour* ”3* Weather and road conditions were ideal. n4* The road test was uneventful* Inspection at end of road test did not disclose any apparent damage or "breakage of the equipment carried in the laboratory,n nl. The Army laboratory trailer was driven a total of 73 miles over all types of roads, this morning, as follows: Dirt and stone 15 miles Macadam 36 miles Concrete — 22 miles ,f2* The dirt and stone roads were very rough and could not be traversed at a speed greater than 15 miles per hour; Approximately 11 miles of the macadam roads were rough, necessitating reduced speed (15 to 25 miles per hour); The balance of the mileage permitted a speed of 30 to 40 miles per hour* u3. An inspection of the equipment in the trailer at the end of the run disclosed that nothing had been broken and everything appeared to be in the same position and condi- tion as at the time of starting on the trip.” nl* A total of 39 miles was covered on the following types of roads; Dirt, rough, 14 miles* Macadam, crowned, 22 miles* Concrete, smooth, 3 miles'* H2« During all operating the writer rode in the trailer and observed the equipment* Operation over all roads was at fairly high rates of speed (20 - 45 mph). 656 n3» Comment si The equipment and supplies rode well over all types of terrain; no changes in installation are recommended*w Appendix 3T TEXT OF SECOND MEDICAL LABORATORY* S REPORT ON FIELD TEST OF TRAILER LABORATORY, DATED 15 OCTOBER 1941 nl» With reference to the W.D. Letter, Office of The Surgeon General., dated August 16, 1941, the following report of observations and suggestions concerning the mobile laboratory trailer operated by the Second Medical Laboratory at Lake Charles, Louisiana, during the Third Army Maneuvers, September 3, 1941 to September 30, .1941 is' submitted.’' n2m Laboratory work accomplished by the trailer Laboratory! f,A. Clinical Pathology; . ' . . , Malaria e'xaminati on (31 ood spreads) *****......... -5 Darkfield (f or Treponema' pallidum .. *. , * * .15 UrothTal Smears* (for gonococci)...'. ..10 n3'* Bacteriology1; • • Nasopharyngeal cultures (for meningococci*.......88 Feces for Typhoid-dysentery group • (Bacteriological).••••••«**«*••••***•. 9 Water analyses (Bacteriological) .... «72 Babbit inoculation (for typhoid *' agglutination Sera)....•.,*....*. 1 Crand total........... 200 n3« Comments and conclusions?, nA. The' Trailer itself; (l) It is the concensus of opinion among our officer personnel that;the trailer as now‘constructed is too bulky for the purpose contemplated? that is, mobile laboratory facilities for a Field Army, * *J '-(2) ' The ceiling‘appears “■tod* for its top-heavy appearance and increased bulk* The trail- maneuverability is therefore limited to hard surfaced roads and parking areas, thereby defeating one of the prime purposes of a mobile laboratory trailer* (3) The present windows are difficult to raise and are easily broken by road jarring# windows nor door arc provided with screening. It seems desirable to have these facilities particularly with the summer months* (4) While stationary, the trailer exhibits consider- able notion due to movement of personnel# This movement causes considerable interference, at times, with the microscopic work and use of the prescrip- tion balance, (5) When the. prime mover is attached to the trailer the front end of the trailer is slightly elevated* (6) The trailer’s tires as compared to these of the prime mover are a different size and no spare t.ires axe carried# (?) The air for the trailer is drawn out with an :- electric fan# It would be.better to have the exhaust fan converted into an intake fan'equipped with,a ... dust filter for providing dust free air* v- (8) There is no heating system provided for the unit, in the cold weather,#.. . * v , .-. * nB„- Equipmentt -, '' : . * (l) So far as this \imited observation permitted, it is believed that •facilities-;for .packing are...adequate, . However, 'suggested changes in. the size, arid- number ;‘vV of''certain items of glassware wouldv'necessitate , , '’ adjustment s>v, There was inconsequential breakage ’ enroute.'frbm Washington to Lake Charles and 'thence 1 ..fcpt;J*prt Sam Houston, Texas# 't ’■ * (2) It js* felt-that., a certain amount of shelf space- wquld'be, dc’sipable while the unit is stationary#% , Hope* is .provided# Likewise, there is poor utiliza- tion 'O'f drawer and cabinet space#- (3) The laboratory is not equipped with fire extin- guishers . This deficiency is serious as the steam pressure sterilti.5fe‘r js-heated by a gasoline stove and all the*bunsen’burners.are of the alcohol type* The hazardp. Of fire consequently.are very great* ; (4) There’ is no facility for, .either draining, or 4 defrosting the‘re frige pat'or*. The water (from the melting .tec* about,the’coils when the current, is shut off) coJLl'Octs in the bottom of the box caus- ing a very disagreeable state, • • , 1 ■ .* (5) There is no adequate heating unit- provided for ’, , the heating of -air‘ ster'?ilze.r‘V'''' that the heatth|g element -.of ’ the. -st'andard Q,. M# C, kitchenunit;’ type' generated. shificient heat, for dry air gnsp.line heating elements nov present' in; t|ih.. or totally non-functlo'iiahie,r/'“ !’/. . " ’ ‘ . " . (6) There, is .at present included in .the trailer laboratory two how 'binocular one ■, nqw|ri _T. binocular, dissecting microscope, one now. monocular-g microscope, and’ one field (folding). miscyps,c!qpe,.;r It is felt that, for the work done in this .unft, - -. j this equipment is too^elaborate and in.excess of • vfi the actual needs• The' prism arrangements in - the . .:o\0 binocular microscopes are delicate apjd. the j a rr i ng-» ?■ j incident to the movements of the* trailer will - causer, the prisms to become disarranged. .*0 j, { (?) The present dark field equipment-leaks light and- gives unsatisfactory .dark fields, -The..absence,.of. a set screw makes’it’ impossible.to.properly secure the. dark field apparatus to. the microscope .-proper ... nC, Laboratory supplies: Certain items of supply .are- in excess of the ordinary .needs and other.items are far too deficient. Specifically, the foilowing.are .0 - offered’in brief: ... - (1) There is'a marked insufficiency of 10 c,c, pij>* ettes which are necessary in .water .examinations ... too many "1 'c.c, pipettes* ’ *1. . • . . *s.< (2) There are tap few fermentation (aeration} tubes;* for water examinations, " (3) There _is an excess qf .dropping,bottles^ (4) Thefe "is' a marked deficiency in,’,the..precaant • • number (.two) of one litter .flasks, whereas.-there -are; too many’;’smaller ’ijasks.r' "particularly 250 .c,c, and s mall at*« The' larger' flasks’ are needed . in the - ; preparation of media, (5) The selection of dehydrated, media is unsatis- factory in that, certain .items are in excess and- • others are insufficientTjjr.t her more.,’, /there. is:n-<. total lack of differentialisugars*, r : (6) There is' at” present no agglutinating sera .-for- spot diagnoses and .culture, confirmation*.,. . .... ;r. ”4* Recommendations s _ ; A, The present trailer, as., a Koi'iXer.llhit. of. an Army Medical,"Xah’b'ratoiyr ’ ' i ,r (1) That the ceiling of similar trailers he made about six inches lower than the present trailer. This would afford sufficient clearance ...for any average person and do away with-a considerable amount of hulk* (2) That the windows of the npush-out” type he utilized, allowing greater ease of manipulation and equal ventilation. It would he desirable to have 660 the,windows so made that they will he airtight when closed and the present exhaust fan converted into an intake fan with a dust filter for air-conditioning the laboratory. That the windows and door he screened, • (3) That the motion of the trailer incident to move- ment of the personnel he eliminated hy the installa- tion, of, a springlock mechanism :which will he used when the trailer is in a stationary position, (4) That the trailer he provided with the same-sized tires as the prime mover or vice versa•and that spare tires he carried with the trailer. (5) That the trailer he-provided with some heating mechanism for cold weather work. (6) That shelf space he provided, and sinking dead spaces in the suggested shelfing will prevent spilling of materials. Drawer and cabinet space is poorly utilized at present# .Built-in spaces for miscroscopes could he provided beneath the present utility or hook cabinet, leaving some of the resulting space beneath the work benches-for.the installation of a self-contained, electrically operated’ oven or,' if adequately .insulated,-, a gaso- line operated oven. The "beer pump” could he removed and the space utilized for other purposes* The pressure of the running water would he, attained by . means of a suitable pump* , The wall space in front of the present autoclave could: he utilized for a peg hoard for drying-of glassware. The present drawers are. so constructed' that during their opening, "shavings" are cut from their bottoms* If■not corrected, 'this will-in time cause the drawers to loosen* .The use of steel bottoms and steel tracks will eliminate this defect* . ; (7) That the unit he equipped with two fire, .extinguishers* V • - ; . i 0 .. ,- ;■ • - (8) .That some drainage facilities he incorporated into the refrige rat or 1 1 .• r,: * (9) That the two new binocular instruments, and the one new, binocular dissecting instrument he.removed. In their stead, substitute one more,monocular microscope* (10) That the collar arrangement holding; the.dark field unit he equipped-with a set screw or-other appropriate arrangement to obviate,this defect. If.this'is ndt possible,- then a new dark field apparatus should- he provided, . (11) That at least fifty to sixty 10 c*c, pipettes he included* ... (12) -That the number of fermentation (large aera- tion) tubes for water analyses he increased hy 100 -tubes* . ■ 1 . (13) that the number of dropping staining bottles be decreased and.other useful items of glassware such as volumetric flasks be substituted therefor, (14) That at least six (6) large, one liter flasks be included in the trailer unit and the number of smaller flasks be reduced, particularly, small flasks below the 250 c,c, capacity. Those one liter flasks arc particularly needed in the preparation of media and other materials in quantity, (15) Large amounts of dehydrated Lactose Broth (DIEGO) are necessary to carry on any degree of water analysis. The present supply of such media is inadequate ferr this purpose. On: the other hand, the amounts of certain other items of dehydrated media for example Bacto-Proteose are in- excess. It is recommended that 2—3- pounds of DIFCO Lactose Broth be included as an item.. It is further recommended that a sufficient quantity of differential sugars be added, (is) That agglutinating sera for spot diagnoses and culture confirmation be included. nB, Its use as a Stationary Laboratory Section; (1) That the present trailer or its equivalent together with three other similar units he. used to make up the Stationary or Base Section of the Army Medical Laboratory, instead of the present set-up whereby each trailer is used as one mobile section of the Army Laboratory, One trailer will be equipped for Bacteriology, one for Pathology and Chemistry, the third for Serology and Pood Analyses and the fourth trailer equipped for dish- washing, preparation of media and supplies. All four trailers will act as one Base or Stationary Unit, - (2) That each of the Mobile Sections of the Army Medical faboratory be equipped with one small house trailer type unit similar to that used by the United States Public Health Service to procure and test various water sample, (See PUBLIC HEALTH REPORTS Vol. 56, Ho, 15, April 11, 1941, pages 754-760 for detailed description)-. These house trailers are small, light, inexpensive, very mobile, and can operate closer to the front within the Corps and Division areas than the present large type trailer. These house trailers are well equipped with work benches, drawers, electrically operated incubators and laboratory supplies sufficient for six months' work. Each completely equipped trailer cost the United States Public Health Service $3*615,50, 662 (3) That each of these trailers be hauled by a ton cargo truck and that they be so equipped that they may operate independently of the Stationary Section for at least two weeks. The \ ton cargo trucks can carry.the personnel’of the mobile section, can be utilized to replenish supplies from the Stationary Section while the house trailer is parked in the forward area performing its mission, to carry me.scages, reports and transport officers to various .-areas for sanitary surveys, water reconnaisances, thereby speeding up the laboratory service to a more efficient level. nC* It has been suggested by Lt. Col. Harvey R. Livesay, MG* that the Stationary Laboratory Section be equipped with four mobile units constructed along the lines of the General Electric Corporation Century of Progress Unit. The four units thus constructed could be placed together and can be made into one large laboratory which cah perform practical- ly any test which it may be called upon to do. All the supplies and equipment would be carried in these trucks in drawers and cabinets ready for instant Use. „ • nD. That whatever the decision made as jto what type mobile mit to he furnished the Army Medical Laboratories, the equipment and supplies he not stored in chests'of crates, hut that ample space in the form of drawers and cabinets he utilized to the fullest extent for their transportation. This pan not he- top deeply emphasized, for by actual experience, it took five.inOn a total of ten hours to pack and load the medical supplies of the Stationary Laboratory Section prior to one tactical move during the recent Third Army Maneuvers, whereas *. the;:Laboratory’Trailer was ready to move'within a •few minutes after the. order was received.* Appendix G TEST OF FINAL TEST REPORT ON THE TRUCK, 2? TON, LABORATORY, MEDICAL, ARMY, POP PERIOD 13 FEBRUARY 1944 TO 15 MARCH 1944, INCLUSIVE ’’Sumbitted herewith is the final test report on the Truck Ton, Laboratory Medical, Army, for period 13 February 1944 to 15 March 1944, inclusive* , •• • nl* Personnel, Consisted of one (l) Major,’ MC, four (4)-. laboratory technicians, one, (l) truck driver, 2\ ton, qualified-,-' Equipment, Glassware, Supplies, Reagents* a. Items’ listed on Enclosure #1 and #2 of preliminary report arc confirmed as being a necessary part of:the equipment except for the following: (l) Items in Excess Unit Quantity Desired* 1X92060, Oxgall, Bacto i Id None 20040, Bandage, gauze, rolled, 2 inch 1 doz .None 405.62, Bottle, -screw :neck. 9 cc ea None « 43800, Pipette, Volumetric, i 25 cc ea None 44000, spoon metal ctn • • ;• ■ 1 •• • •" 44710,;:Vial, 2 dram ea 100 (3) Items Deficient Unit Quantity Desired 10160, Acid, Hydrochloric lb 1 10200, Acid, Nitric lb 1 10340, Acid, Sulfuric lb 1 13660, Potassium Hydroxide 4 it 1 14490, Sodium Thiosulfate (to neutralize Chlorine in water analysis) \ lh 1 43010, Jar, Coplin (Por use with G-iemsa stain) ea 2 70620, Lamp desk, flexible (for use in Bacteriology) arm ea 1 (3) Items Deficient in Quantity Unit Quantity Desired 44364, Test Tube Kahn ea 250 44405, Test Tube Support Kahn ea' • 8 b, In comparison with equipment ordinarily used in station- ary laboratories, serviceability is satisfactory, except for Item 94320, Incubator, which requires.-considerable amount of obsorvati fn to prevent .temperature f 1 uctuatio.hkV, c, The manner of packing allows safety in transport and the items are satisfactorily accessible.for operation. At present, it takes 90 minutes to pack fof'movihg'and 2 hours to set up for ope rat Ion i, .. , d, , We have made use of the vacuum principle' on which the windshield wipers fuheticn.*. -By connecting-rubber tubing to •the yacuum and a series of Vacoliter bottles *to prevent Sthef and other chemical solutions -from being carried to the motor, an efficient suction apparatus for thd cleaning of pipettes is obtainable; Use:of- such suction may possibly be of use in Surgical trucks to obtain blood transfusions more quickly, suctioning material'.from the- chest or abdominal cavity,, etc, v‘"' 113* Apparatus: The apparatus provided is generally satisfactory with the following qualifications* a* Item N S 7 - Oven, hot air 0° C - 180° C, as noted in the preliminary report has too small a capacity for the amount of glassware to he dried ancL.sterilized. A larger unit, if adopted would decrease the amount of work bench space availa- ble, would,necessitate the elimination of one side wall rack; both' fact ors making it more:feasible to operate in a tent* The' amount of heat radiated,- would be an additional factor to indicate operation in a tent *as a more feasible procedure. The apparatus has been run approximately 200 hours. b, Item US 7 - Refrigerator electric, (Jennet &'Sons, Model 3- has some limitations* (1) The enamel outside finish has ,,scayr.Gdn. easily and in places the enamel has peeled off, .'.This'was probably the result of heat, humidity and/qr other local factors. (2) The cold of the compartment is dependent on electric power, hence in hot climates, Unit, Power, electric would have to be operated 24 hour$ daily. The latter, we believe has functioned so well,- because it has been operated on an average of 12 hours per day with frequent rest periods. For this, reason a kerosene operated refrigerator may be preferable. (3) The size and shape of the item for the purpose intended, i.e. .storage of antigens, sera, and . enrichment bacteriological media (40 plates) has been adequate. If an occasion demands the storage of whole' blood for transfusion, asfc may occur if the -■-unit was 'part of an Evacuation Hospital, the item * would.necessarily have’to be larger. c; •':Ttcm 94320, Incubator, 1920 ModelThe air-jacket type manufactured by the Precision Scientific Company and shipped from the Carlisle-Medical; School was received two weeks prior to this date, '' The item is too small for use since only a total of 30 culture plates of 15 water analyses tests can be accomodated. The maintenance of a uniform temperature, however was as ‘constant with this air-jacket type as the water- jacket type which we have used since the start of the testing program. Both, however,, require frequent observations especially during the night, to prevent of the temperature as a result- of outside and inside temperature changes"; An air jacket type of the height (36 inches, includ- ing thermometer level) and volume (90-100 culture plates) of water—jacket type-would be equally suitable for use. In either instance permanent fixation during movement is desirable; likewise, fixation in the center of the work bench on the’left necesslates division in the center of the overhead- rar.ck" and each-half placed adjacent to the incubator. . .id#*'- Item' 94010; Autoclave , Laboratory .Field — Because of its size .and 'amount' "of 'radiating heat,; the apparatus is operated best i’n- the laboratory 'tent, Forty runs totaling 50 hours ,, were oadev'10 ;; " * A * ’ ■ e* N S Item 9 Autoclave, small (aluminum cooker)* * 4 4»«oS & • ‘ < ’..’ X a) This item was received 10 days prior to this.,, date. Eight ..runs totaling 5 hours time were-made* 7)«:*(sJ - The advantages of this instrument over 94010 are v -‘as follows. • * - ; ■ a. It is lighter (less than 25 pounds) and c-on- sequently easier to handle.. ' h* It can he operated over an open fire ' . C. -Complete autoclaving is accomplished in 30 minutes while with item 94010, 50 70 ’' minutes is necessary depending.on the external temperature, * . (3) The disadvantages ares a* There is a leakage of steanj from, the steam joint, the escape value,, and .the safety vale, -•When a pressure of 10 to 30 Ihs Is obtained. ■Hence, constant pressure could he maintained only tyr removing the source of the heat thus necessitating constant supervis,on.v -Tteia • 94010 has a .regulated automatic safety^valvS, there is “no'* steam leakage, and after reaching the desired pressure nee4 not hQ.supervised; h. Its total capacity limits the amount of material one may.autoclave which‘is not true of item 94010. • * ■ v (4) ¥& conclude . that the Aluminum Cooker-is a-Xisefui adjunct , espe cially. if, Coleman burners are not ' functioniAg''’properly,, hut-should-not .replace-.item ” 94010. ■ V;:‘ 1 ‘ ■ V .-'-r •' ■ •*, f, Coleman-Burners'- .Model.’522 (10,000 BTU) - This item heats our--hot water tahk item .94010 autoclave-, -No extra generators (vaporizers) accompany these burners and none-are stocked af’the local Medical .Depots, Since their proper function and length of service varies danectly with the- qualjbty:-of -the white' gas' used (we have found the quality quite variable) extra generators should adoompany the truck. g# ¥e have found the followii^vitems‘vtb be very satisfactory and necessary! (l) 99555, stove, two burner, gasoline (extra generators 667 ■5,000 3TU, are supplied). (2) ITS 4, Water bath. (3) 41390, centrifuge, electric, small. h* Item 94070, "burner, gasoline "blast could not "be made to function successfully* ”4* Laboratory Tests. -a* Enclosure #1 lists the type of tests which were .. . available and the number of actual tests performed. •• The source of oUr-material was a Provisional'Evacuation..Hospital supporting two to three divisions, numerous Corps and-Army Units* b. The- season of the year dictated the type of laboratory requests yet trial runs of other tests not requested were performed in an effort to more fully estimate the efficiency of the truck’. . re.: •.;»;; • c* The following technical observations are noted (l) Bacteriology. (a) Sxcspt in the case of media which may he tubed and then autoclaves, considerable difficulty in preparing uncontaiminated media was noted. This applfes mainly to, enrichment medias such ‘as blood and chocolate agar while 55 Agar gave us no difficulties. The problem is not impossible because by observation of good I'-- technique followed by immediate refrigeration, our media would remain sterile 3 4. days, ■(b)* because of the tendency for ..the-incubator temperature to fluctuate* due to external temperature changes, technicians must, coh-r tinualfly nute'the'temperature readings. The fluctuations noted during our testing made the Culture *of the' gonococcus difficult. The above two factors do not appreciably affect stool bacteriology which will constitute most of our work, ■ (2) Hematology --A1 though Hemoglobin requests were infrequent* nevertheless, Item 42840 is inaccurate and should he replaced hy a suitable Hemo-globin6m~\ eter,. • '' ‘ d. In addition to the tests recorded, bacteriological- studies of old latrines, and coliform indices-of local water* points jrere conducted* . , " ”5, Adaptability of Truck as Vehicle for a. Laboratory* a# Frequentr movements during the; six weo&s of maneuver activities has proven that equipment damage is negligible. Item 99600,. Unit, Poyrer, Electric should however, be transported in a suitable carrying case, ' • ‘ b# Maneuverability is excellent as noted during this period of testing, * ' c# A tent is .necessary to supplement, the truck for the • • collecting and,recording of specimens, autoclaving and possible sterilising of equipment. For convenience of opera- tion, protection against inclement weather, and blackout conditions, it would be most suitable to use a surgical operating .tent of .the, type used in Armored Divisions so that direct, attachment to the rear of the truck would be possible. d, The water tank is filled from the roof at present by passing 5 gallon cans to a man on the roof. This is neces- sary because the water hose leading from the water trailer is too short. It is recommended that 25 feet of hose accompany the truck for the purpose of filling the water tank. To reach the roof, it is necessary to st6p on the canvas-hood protecting the front seats * It may be desirable to have this roof over the seats made of steel because of the wear involved in filling the tank, ’ : ' 116, Adaptability of. Truck Body as Working Area, a« For the size of Ihe truck and its design, head room and aisle space is adequate. The space available accomodates two technicians and one assistant (glassware) without confusion. b, A few of the facilities, are unsatisfactory from an operational standpoint. The' following are" recommended changes}. ‘ ‘V*';, ‘ . * ’ . ”J ■; Cl) t>JVis:ipii of the present. into;,Jtwo compartments ..VijtH separate drains to facilitate Proper cleaning of the. glassware* , . (2) The end of the drainage pipe should extend over open space to permit drainage directly' into a soakage pit# , Tho present arrangement won’t allow such; instead wastes now drain onto the underckrriage parts* (3) Considerable difficulty. In the- preparation of bacteriological media in petri dishes is encountered when the truck is not parked on a level area* It may ...therefore be desirable to use blocks, and a jack .#i 6 .level the truck, ; ; ■ : 669 (4) The racks located on both sides of the truck are unsatisfactory. It is recommended that an enclosed shelf of similar size and length be substituted, (5) The drawer latche.s are unsatisfactory. It is suggested that a single iron bar, extending through the drawer handle spaces, from floor to work bench be substituted, (6) (a) The drawer with partitions for holding petri ... dishes in vertical position is highly unsatis- --- factory because! 1_, In movement, the solid media is loosened from its base and slips into the lower edge. 2• Water of condensation collects at the lower edge and on righting the- plate, the water runs over the media to promote the growth of "spreading” rather than ”discreet” colonies of bacteria, •’ • • ’ (b) It is suggested that a similarly; partitioned rack with door, holding the petri dishes in a hori- zontal position, be placed on the right side of the wall, over the work,bench and near the exit. (?) To prevent unnecessary opening of-the doors with resultant drafts (affects incubator temperature) and entrances of contaminated dust (contaminates media) it is suggested that a. sliding port: be. made for the exchange of reports and specimens. c* Ventilation is fairly adequate, depending on the follow- ing factors* ' (l.) .1900. to 0700 (Lights and Incubator in.Ude - doors * ’ .and windows closed), ... ‘il ~ t : • • .bUT.SILE I ITS IDS 65° E 78° E 41° E 65° E 30° E 59° E I'f the interior temperature falls l)elow 65° E,- the . Evans air Heater must be used to maintain a normal ' incubator temperature, i,e, above 35° C, (2) .0700 - 1900 (Hot Air ©ven - Stove burner, incubator, water bath lights in use),’.. -Vv -ra- , . s • ) . ; - i * ■* * . . (a) Without circulating fan — doors- and windows’, : closed, ' ■’ ’. •; . • . - A • ‘ . . ■’/ 670 . ; . • y • :- OUTSIDE ■ ■ 'INSIDE . 55°- F ' , ■ ■ ' 68° F 64° F . ■ ' ■ .. • .!• •. r - ' 82° F 66° F 90° F (b) With the doors open and the •outside temperature 64° F the inside temperature is 76° F, (c) With the circulating fan. in. use the temperature is lowered 4-6° F* :(d) With the doors and windows opeh and the outside temperature 64° F, the inside t'emperature is 68° F. - Cthe amount of bacteriology to be' 'done is great, .,c;..the' windows and doors must remain closed because of the danger of contaminating.culture' media. The time necessary to keep such ports closed would not be .. more than two hours at any one time, hence the work- ing conditions of the personnel would not be appreciably affected, - f*) (4) Buring the present testing, temperatures‘between 35° and 75° F only have been encountered. We may assured- ly stats that working quarters would be satisfactory at outside temperatures of 30.- 80° F, We may state that they probably.would be satisfactory at 0°, Further testing would be necessary to determine, the . same if the outside temperature was. above 10p'°• - - (5) Ho obnoxious, fumes exist to affect the personnel. ”7* General Information, From our experience with this mobile laboratory, as-well as other mobile units of an Medical -Laboratory-" :"we "'' envision the present unit functioning best as a Bacterio- logical and'Serological Laboratoiy attached to an Evacuation Hospital,’ During epidemics it could function unattached for as long a s'1-tan days to two weeks, without additional supplies depending on the volume of work. In the case of an outbreak of dysentery, the unit would be adequate to perform the neces- sary laboratory work for 100.‘.cases,' Again, depending pn the volume of work, this unit, could function as. a 250 bed hospital laboratory except that no biological Chemistry could beeper- formed* We do not feel the unit is adequate to function as a central laboratory for a groupr.'of‘ small hospitals* The' only conditions under which this unit would be considered. pf,.less value than similar equipment packed in chests,' would jungle areas. If the.unit.was to act as a small laboratory for three to four weeks, additional transportation would be needed for carrying the personnel and to secure supplies.” 671 Appendix H TEXT OF SERtlCE'TEST REPORT. OH MOBILE .40.T.t truck chassis which operating under actual-field conditions, has proven to be very satisfactory, ffb* Hot water system, (1) Hot water heater, located' right: front of truck, works with complete efficiency if-'white gasoline can .. be obtained and used, (2) Hot water storage tank, 10 gallon, located inside Laboratory on right anterior wall is adequate,- nc*. Laboratory Heater, (1) Evanair Yehicle Heater, located left front’ of truck works very efficiently if white gasoline'!is used, (2) An electric circulating fan' for heater, located inside laboratory in the left anterior wall has proven satisfactory. nd, Cold water system* . ■ / a (l) Supply tank, located across anterior'wall of laboratory has a capacity of 60 gallon, which is . : adequate under present field conditions,-for about . „• • one'.;(l) day, .(See Paragraph 5 b, re change in location of gague) ne, Electrical system* . • ■ (1) Intake supply, , (a) Power line, if available very satisfactory. (b) Onan Electric Eield Plant (AC, 115 V, 1500W) very satisfactory,,.. (2) Outlets in” laboratory consist of scven-(?) double outlet plugs wel'L placed and adequate, (3) Illumination in laboratory,. • (a) Six 6n ceiling lamps, two of which receive power from truck'battery very satisfactory; .. . , -.(b): Four flexible* arm lamps'well placed and adequate, (4) Dental engine, Weber desk type, well placed,, satisfactory*/ ■ * u- • • •• (fe) Electric boil-’but and processing unity consisting of two (2) hot plates and two (2) processing pots inclosed in covered well in left work bench proven satisfactory but are slow in heating up. Requires about two (2) hours to bring water to a boil* It is believed that the raised letters on bottom of the two processing pots prevents full contact with surface of hot plates and thus reduces transmission * of heat to pots. Also recommend the placing of a small groove •J” from periphery of processing pots, around the inclosed top# of well to prevent water, from running down into hot plates, ”f* Supply Storage Space, (1) BSnch Drawers I (a) Five 23” x 24” x 8’*psufficient and well placed, (bl Five 18” x 35-|” x sufficient and well placed* (c) Eight 23” x 18n x 6n sufficient and well placed. (2) Closet beneath sink, 3 shelved, 4! x 3j§-! x 2^*, is quite adequate for larger supplies, (3) Filing cabinets, located at right and left rear of laboratory is quite adequate for records, gowns and ' small supplies, contains following: (a) Sixteen 23n x 9” x 6” (b) Two 23” x 9” x 4n ; (c) Two 5f x 1T x 18° f,g* Miscellaneous* (1) Acetylene tanks* (a) Two 250 lbs tanks are adequate if used only for casting, soldering and vulcanizing* (b) No pressure,.regulator received with acetylene * ; ''tanks. , This quite, vital for efficient • operation." • ♦ (2) Plaster bin divided into four compartmentsS (a) Two *f or plaster paris. Sufficient. (b) One for art if i cal stone. Sufficient* (c) One for investment. Sufficient. Os)-sink;- y: V"*'. ■■; .W-V'v (a) Porcelain sink with hot and cold water faucets, > satisfactory, . . • • ’ “ ’ < ’ X r # ... * (4) Work bendheS, except .fpr cha,nges recommended in ■■■ "paragraph‘6 a, very’,.'sati'sfactoiy.f (•5) - Windows, four (4), ‘ complete with blackout curtains, vary satisfactory, V " ,''• : ; . (6): Hecommend that ■linoleum on floor, of laboratory be cemented to prevent its warping and cracking*1*. 675 Appendix: _I TEXT OR LETTER: CONTAINING -.INSTRUCTIONS GOVERNING, CAPTAIN MANGOLD’S TESTING OS PILOT: MODEL TRUCK, 6X6, OPTICAL REPAIR UNIT 27 November 1943 Subjects Operational Test of* Mobile Optical Repair Unit as Leveloped by•Carlisle•Barracks, To* -The, Commanding. General . 'Carlisle Barracks,'Pennsylvania Attention: Col, E* D, Quinhell, Director, Medical'Dept. Equipment Laboratory* 1* The new inclosed type Mobile Optical Repair Unit as developed by your office was demonstrated to:the members of the Optical Advisory Board, and was accepted with considerable enthusiasm by all of the members of said board* It was the consensus of opinion of the Board that since parctically the same equipment; was being included that had been previously used in other mobile units, a lengthy field operational test would not be required. However, a limited operational test should be made in order that any minor deficiencies might be corrected before final specifications- are written. 2. Therefore, in accordance with-the decision of this Board authorizing such a test, arrangements will be completed by this office whereby Captain A. E. Mangold, Sanitary Corps, who has--had actual overseas experience in the operation of such unitswill be made available to conduct the operational test under the supervision of your office. In addition, six 676 enlisted men who have recently'•■copplo ted the training course for opticians at the Medical Supply Services School, St* Louis, Missouri, will he transferred to Carlisle Barracks for this temporary duty* The orders for Captain Mangold and the above enlisted men will provide for their arriving at Carlisle Barracks in sufficient time to start the operational test 30 November 1943, and such orders will be for a period of approximately ten days* It is recommended that these operational tests be made over a consecutive period of approximately seven days* 3* The following is set out as a guide in the operational test during this period. a. Purpose - To determine practicability of com- pleted unit as pertains to equipment and location with- in the unit* in relation to productive capacity obtainable in actual field operation. (l) On basis of stationary operation* (a) Using regular electrical current (available at location) (b) With use of generator. (2) On basis of mobile run under field con- ditions* (it is recommended that this incorporate movement to certain field’"- installations setting up unit to operate and actually performing prescription service - no doubt the several points located near Carlisle Barracks as discussed can be included on this run,). *. b* Points to be covered .and‘decision made based on result of these tests* • : (1) Total daily productive capacity of unit* (2) Number of men required ,to man unit. (a) , - To, reach maximum capacity of unit._ (b) .The maximum. number of personnel ■ required f 'operation of the ■unit -arriving, at average,, maximum • capacity* - t ,-<-v - (3) Determine excess,equipment to carry.with■ unit as, jemergency, replacement';factor. (4).5:y Determine if additional equipment required. 677 such.as tent, flashlights, towels, soap, ad s cellaneous, .etc* (5) Determine a&ditional conveyances'.required^ to carry pers6hnel:;and their baggdge, ” ‘ " :o tent,, (if required); generator, efc. ’-i (6) Determine size generator required to operate the unit. ‘ ’ *•’ • • * ■ (?). Determine’ :if - heating and. .hot water supply -is sufficient-. ■ - * •’ ' (8)- Determine if unit can he properly operated : •••••under blackout conditions (with and without :tent). ••••■; . ' • '(9) ; Determine the feasibility of making special • space .available to carry surfacing laps, .equipment, tools, etc., so that all’petal cabinet space can be utilized for stack and supplies, also giving proper con- s.ideration to reserve, drawer space that should be carried for emergency additions of supplies. (10) Determine whether-or: not, any. of the present quantities :of original stock of supplies as furnished are.-.excessive. (11) Determine if present stocks should be- supplemented with additional quantities of , / certain items* to, insure maximum utilization .of. carrying capacity of such unit, and giving proper consideration of reserve • cabinet drawer space required (paragraph 9). (12) Determine proper protection screens for windows as guards against bomb fragments, etc. c. Equipment and proper placement within unit. d. Stock and supplies (based on quantities to be carried, the location and distribution of such stock within unit as pertains to cabinet drawers properly marked, etc. 4* It is requested that when the operational test has been completed, determination be* made of the additional 678 supplies, that. will. "be. required to properly stock this unit in accordance’with the inaximum stocks that will he carried as sot; out above. Such quantities' will ho requisitioned from this office andNwill he., .shipped, for inclusion with this unit so that "Pilot Model" will then he complete as to equipment and stock for the. purpo.se of using 'as a basis of procurement on quantities required’, in accordance with completed tentative specifications.,,.; fr .. /.* 5# It is anticipated that due'to the limited production facilities, that...are available, that., it may he necessary to grant certain concessions to the' manufacturers to insure expeditious delivery of complete*! 'Mobile Optical Units con- structed in. accordance with the specifications written on the Pilot Model. 'To give these'suppliers ah opportunity of making any recommendations ‘that would aid. in the overall procurement objective, it is requested that at some time- during the operational tost, or before the final, specifications are written, this office be advised so that arrangements can be completed with the supplier for one of their engineers to make "inspection of such unit; Your‘cooperation in this con- nection will aid in elimination of delivery delays of com- pleted units from suppliers on an item which is urgently needed for overseas theaters of operation* . .' 6, Captain Mangold has, in‘view of his broad optical experience as. pertains to operation of mobile units over- seas, proved a very valuable aid to this office through recommendations made for improvement- of the overall optical program* *It is therefore, requested that your office give every consideration, to any recommended changes he.might make as result.of"this operational.test; as it is 'believed that this will.result in the final approved Pilot Model meeting all the requirements' that'will be necessary under actual field operating' conditions* . ; ' 7** In the" event this ' Office canv’ be of’ any aid during this operational test, please do not hesitate to call on us. By .order of" The ' Surge Oh* General,: . ; JOHN 3, KLOPP, Lt.rColonel, Medical Corps, Chief, Pieid1 Equipment Bevelopmeht Branch* CONCURRENCE: PAUL I, '*;• ’•* : Colonel, Medical Corps, Director, Supply Planning Division. Appendix J COPY OP GAPTAIN MANGOLD’S REPORT OR OPERATIONAL TESTING OP TRUCK, 2J-T0R, 6 X 6., OPTICAL REPAIR UNIT ASM/eh SARLISL3 BARRACKS MEDICAL DEPARTMENT EQUIPMENT LABORATORY UNITED STATES ARMY In Reply Refere To: Carlisle Barracks, Pa*, - 8 December 1943 SUBJECT: Operational" Test-of' the Mobile .Optical Repair Unit developed hy the MedicpX Department Equipment Laboratory* TO : Colonel Paul I, Robinson, M. C*, Director, Supply and Planning Division,rOffice of The Surgeon General, 1818 H* Street, N*W*., Washington, 25, D, C* Attention: Captain K. A* Short* 1* The new inclosed type- Mobile Optical Repair Unit was' given a limited operational test; by Captain A, E. *Ma;ngol.d ...and' six 'enlisted me,n. , 2« Length of test v/as for’one week, not consecutive days, due to difficulties listed in*this report* 3# In answer to the guide request by your office the following is reported: 680 a. It was found.that the unit, operated in a ware- house using electric means, was satisfactory in all respects. For the use of the generator a 2-1/2 KVA gasoline motor generator was used, A test run was made in the field and it was found that five minutes were required to set up the optical equipment for operation and 15 minutes were required to service and start operation of the generator. b. In answer to the following, points were covered and a decision made as follows: (1) Total daily productive,capacity of tho unit — 75 jots* (2) Number of men required to man unit — 6 men. (a) To reach maximum capacity of unit — 6 men* (b) Maximum number of personnel required •for service operation of the unit to arrive at average maximum capacity — 6 men (one driver), (3) Excels equipment 1— 1 cutter, (4) See additional list. (Letter to S*0,0. , 8 December 1943)'* (5) Additional conveyance — 1 staff car, (6) Si»e generator’2-ly(2 EVAjj ,■' (7) .Heating and Hot Water — Sufficient and adequate, . y * (8) Operating under Blackout — A piece of canvas tent fly or tarpaulin drawn f;rom . the Quartermaster* or'Ordnance to act -as* light-trap. * (9) Arranging special space for equipment, etc*. Alterations are being made by the Equipment Laboratory which will be incorporated in the final specifications; •• ov i and-drawings * . -r ••• *1 - * * ” *‘ ■' * (10) Excess materials and supplies such as ‘ • ■ polishing’pads, blacking pitch, Calipers-*** pads, cement, files, reject lenses, pliers*, 681 etc* — corrections made in new specifications, (ll) Supplementing present stocks -**- See separate list* (l2) Protection for windows — Equipment Laboratory reports this is not feasible £* Placing of equipment within unit — Changes made in final specifications and drawings* d* Location and distribution of materials Sec blueprint for suggested stock arrangement* 4* • See Pinal Specifications. 5* Medical Department Equipment Laboratory reports that they will be happy to cooperate with manufacturers or suppliers. 6. Captain Mangold was given complete cooperation by the Medical Department Equipment Laboratory while testing this unit. The following is suggested! a. All Optical Equipment after being installed in in truck should be run for twelve consecutive hours to make sure that mechanically they are in good working order. b, Cutting wheels or diamonds for cutter should be checked carefully to make sure that they are efficient. £. Edging stones should have a metal cover to protect them in transit. d. An attachment should be made to hold head of M840 away from stone while truck is in transit e. A test of a blue edging stone should be made at the factory to ascertain whether or not it would be feasible to include one of these in the unit. / s/ 4»urel E. Mangold /t/ Aurel E, Mangold Captain, Sanitary Corps 682 Appendix K COPY OE REPORT OE INSPECTION OE TRUCKS MES* AT ARMY ME I CAL PURCHASING OFFICE BY'REPRESENTATIVE JOE MEDICAL DEPARTMENT EQUIPMENT LABORATORY ' > W3C/mh ARMY SERVICE FORCES' MEDICAL DEPARTMENT EQUIPMENT LABORATORY ' CARLISLE BARRACKS ,• PA. SPMES 451,2/2500 Project F 32 , • " In Reply Refere To; ’ . . 6 January -1945 SUGJECT: Inspection-of Truck, 'Ton, 6x6, Optical'Repair ’Unit, TO; 'The Surgeon Gcnoral, U, S, Array,. Washington 25, D, C, Attention: Director,’ Technical Division, (Thru: "The Commanding General,-Carlisle Barracks, Penna,) • , ■ • • 1,.At the request of Lt, Col.'Howard.F.-Baer, Director,'Materiel Standards■Division, Army Medical. Purchasing Office, New York,. N. Y, , an officer from the Equipment Laboratory was sent to New York ...to examine a pro- duction model Truck, ,--6x6, Optical Repair -Unit with particular reference to certain.changes in the truck interior equipment which were accepted by the Optical Branch of the Army Medical Purchasing Office, New York, and which were at variance with the applicable Medical Department Equipment Laboratory Drawings, "f 2. The changes found hy the Laboratory Officer are as follows*' a,. The truck was not one made under the Basic Truck contract as the black-out shades were surface mounted and interfered with the cabinets being placed in their proper position. By moving the rear shades slightly forward, the cabinets were placed as close'as possible to the required position. b. Vertical Storage Compartment doors have boon cut into two sections and’ a immovable shelf has been pla.eed in the cabinet. The M.D.E.L, drawing shows a single door and no shelf. .: V-' "c.” The Table-'Top has been made of -plywood covered with a har'd pressed structural 'fi.ber-boaror sheet, and has a front working edge made of oak. The; table top is painted with a clear resin paint. The M.D.B.L, drawing calls for an acid.proof finish on the table and has no separate front edge specified. d. Holes approximately l/4 inch diameter have been drilled in the lower end of the cabinet locking bars for the insertion of keys or pins to prevent,.the jpunping out of the locking bar, M.DJB.L*. drawings do npl(show.'t'hfe. hole mentioned, ’ • ‘, V. ” x ’ ■ ‘ e,’ The two, rear, flush, electric, receptacles on the left side of the vehicle have been covered by a cabinet 44 indies wide which made it necessary to place exterior wire molding. Vi,t&;two surface - type receptacle boxes over the rear left window. The wiring to the surface receptacle was run from the left, rear, flush,’receptacle. The M#D*E,L. .drawings, show tlje flush receptacles as being 41 inches apart and the- cabinet-.38 inches wide. The dimensions shown in the drawings wouli.permlt::thS cabinet to fit in between the flush receptacles and the-additional surface wiring would not be required. f, -Lensl Surfacer has been .reversed t'P have the handle to left of-.T&Swl,: Handle- shown- to right on M.'D.E.L, drawing. • ■ ' :>■ cV •• ' g. Cutters-have been removed from the sink cabinet at the front;rl0ft-.of truck as shown in ; drawings and stored, one in .a box fastened to the wall of the truck and one with, other,; material. in., a general storage h, Hot water tank has "been” moved to a"' new position and counter-sunk into the sink cabinet top. The hot water tank was too high to fit under the cold water supply 685 tank and was moved toward the center of the truck to leave room for the nEdgerTT motor. The M.D.B.L. drawing shows the hot water tank against the front and right side wall of the truck* i. Axis Marker and Lensometer have "been reversed to opposite sides of truck. J. Certain drawers and inserts have had dimensions changed to make drawers larger or to fit new equipment. k. Eootman Loops have been mounted on the floor instead of the wall as shown on the M.D.E.L. drawing. 1, Edgers have the switches mounted under the table top lip instead of on the motor housing as shown on M«D,E,L. drawing* m. Auxiliary piping arrangement has had the pipe mounted with collars to fit over studs on the "Edger” housings. M.D.B.L* drawings show the pipe fastened to the housing with self tapping screws. n. Sink drain pipe has been turned to drain toward the front of the truck running through the floor between the cabinets-* The M.D.E.L. drawing shows the drain turned to the left side of the truck and the cabinets close together* o. Metal channel and angle sections have been added to the cabinets under the sink to permit easier removal for opening into the storage space to the right of the cabinet* 3* Additions added to the interior equipment of the truck consisted of two drawers in the sink cabinet, bolt and block for securing the lens surfacer bowl, box for storage of lens cutter and a fitted box for general storage. 4. As the Medical Department Equipment Laboratory Drawings applicable to the Truck, 2-J- Ton, 6x6, Optical Repair Unit have been standardized as now drawn, disposition of this project is requested. E* D. Qplnnell Colonel, Medical Corps Director 686 Appendix 1 TEXT OF LETTER IN WHICH CAPTAIN MANGOLD JUSTIFIED AS DESIRABLE CERTAIN DEPARTURES FROM APPLICABLE SPECIFICATIONS ACCEPTED BY ARMY MEDICAL PURCHASING OFFICE- IN THE TRUCK, 2-g—TON, 63c6v OPTICAL REPAIR-UNIT . . r \. • , • ■ V ' 1, Reference is made to Project F-32 and communication:of 6 January 1945 from Medical, Department Equipment Laboratory, Carlisle Barracks, Pennsylvania, 2* Inclosed herewith are blueprints/1Q0,058: and 100,098 from Krieger Steel Sections, Inc*:)- lill, 34th Avenue, Long Island City, New York, showing the changes. (circled' in 'red* pencil) that are to be made in • the. basic, truck*:- If I* 3* Reference is made to the communication from Medical Department Equipment Laboratory, Carlisle Barracks, * Pennsylvania dated 6 January 1945, changes noted as follows! a* Due to the new construction in the basic truck, this change noted in communication will not be necessary, • bf This change will allow separation of’various types of working materials, • - ‘ '■ *• c, . -This change is to be made -so that opticians■may use table tops in edging, more, efficiently in their optical work. d, This change- is to''Be made so as locking bar will not work out when truck is driven. Note; See letter from this office dated 1 March 1945, Subject; Stock No, 9958900, Truck Optical Repair Unit, and Yawman and Brhe Drawings 246 and 247 attached therewith. 688 e* As this change was made to enable us to use cabinets that had already been delivered, this alteration was neces- sary# It is requested that new blueprints be made for a cabinet which will fit between the two outlets which will eliminate any change in basic body* See Medical Department Equipment Laboratory Drawing C539, fm This change should be made so that handle of surfacer is in correct working position, ... g# This change should be made for more efficient operation of optical equipment. h# This change should be made to allow edger motor to fit between water tank and truck wall enabling us to use the space for edger motor. Sec Kriegcr Steel blueprints 100*068, Section AA bind" 100’,G'9'8. • _ - i# This change should be made for* the more efficient operation of the optical equipment. This changei should be made so* that’special'optical equipment will-fit in drawers, ‘ k# This change should be made so that stools remain, in position when-truck is being driven, 1. This Change should be made for the more' efficient operation of optical equipment. m* This change' should be made for the more efficient operation of optical equipment. ....... n. This change should be made to allow working space on front table. . . . ... o« This change should be made to allow for easy removal of front cabinet. 4# Additions that were added*t0.the'interior of the truck are necessary for more efficient ppcration.VOf unit as a whole# 5* It is suggested that "before the new blueprints of "basic truck and equipment for the mobile optical repair unit be standardized that this office have the opportunity of checking them. Appendix M COPY "OF’ REPORT WITH LISTS OP RECOMMENDED EQUIPMENT SUBMITTED 22 ■ -OCTOBER 1943 BY’ LIEUTENANT COLONEL -DONALD -McNEIL ,. M.C. , AND SECOND' LIEUTENANT MARGARET E.* GAYNOR, A. N. C. RELATIVE-TO EXPERIMENTAL PACKING- OP SURGICAL OPERATING TJIUCK -s i .'* ■ •P-35 22 October 1943 SUBJECT! Surgical Truck, Operating. TO* - Director, Medical, Department-Equipment.Laboratory, : ‘Carlisle4 Barbacks. Pa,. • .-i.' *r.. • - * • • * .... 1. Surgical* packs" for.' surgical unit. a. Surgical packs were made by Lieutenant Gaynor, ANC, as requested, and.furnished for samples. These packs consisted of Major and Minor packs as per attached list (see Inclosure l). b. -Major pack§.are act intended for use in every - operation’as it ,is conceivable that, the. operators ' may go from one' ease to the next' simply byrinsing or changing their . gloves using the same . gowns. , , , I. ; If it is necessary to change drapes, these can he taken from a Minor pack :wi,th,out contaminating other gowns or breaking open a Major This is done by-using the original sheet wrapper of the Major pack which is already on the instrument table and covering the table with one towel; two may bo necessary. This renders the table relatively sterile. The Minor pack may than be opened, its contents 690 placed on the table and the next case prepared. Extra sterile gowns or dressings are available from sterilized drums without opening Major or Minor packs. • c. Towels. Bight .towels were put in the packs so throe persons scrubbed could each use' 'one to dry their hands before donning gloves. These three used towels with one more towel can bo used for draping the operative field which later Will be covered-by- two.sterile sheets. One towel goes on the .adjustable instrument•table which is fifst -covered with a'sterile pillow case,.. The three remaining towels are then used as the occasion'demands, ■ M'- d, Sheets, Sheets are fan folded in order to permit easy and fast draping without contamination,. Sach sheet is first placed at the site of operation and then ope nod di s t al ly . • '■ '■: e_.■ Tape sponges. Due to the probable shortage of sponges moistened abdominal tape sponges may be used for sponging during operation. If necessary they can be rinsed in sterile water and wrung'out. Six tape sponges were : hi7V-'; included; these may be washed subsequent to operation, steri- lized and reused.' •'7 f.- Dressings. The dressings included in each Major and Minor pack are in bur opinion the minimum.. is fel't that these may have to be augmented by extra dressings from sterilizer’ drums, however, every effort should be made to conserve .’their use, and the abdominal tapes should- be stituted for sponging whenever possible.. ■ • f. Outside wrappers of Major and Minor packs. One hundred and fifty .yards' bf ,.iaUslin were included.. This amount is only necessary”in equipping the truck'-initially;as this muslin is used f or wrapping packsbasins, -pitchers’, gowns, dressings and other sterile supplies. When the con-, tents of such packages are exhausted these covers may be employed similarly many times 2.- Review of equipment o’f 'surgical unit with suggested additions and deletions. " ; a* A separate list has been prepared (see Inclosure 2) showing the additions and deletions from the original list presented. Those proposed changes with the original list, we feel, will give a basic supply of sterile goods and instruments which can be varied depending on the nature of the work the unit may be called upon to do*' (l) Stockinet, Stockinet cut on the hias, divided into 5-yard lengths and rolled makes an excellent 691 compression bandage. The six-inch size is used for the extremeties; the nine-inch for the thorax or abdomen. In our experience this bandage has proved so useful that we think it should be included here. The bandage may be sterile or unsterile as the occasion demands. (2) Basins and pitchers. Basins and pitchers were wrapped in sets to conserve space. The addition to the previous list of pitchers allows two sterile and two unsterile as they have many uses. (3) Vaseline gauze. Continuous vaseline gauze in two—inch widths should be prepared and kept sterile pre- ferably in unbreakable containers. This can be made from materials already included. (4) Instruments. (a) Two basic instrument sets would seem sufficient for only one team. We believe two teams should have three sets so one may be sterilized while the others are in use# This, of course, implies sterilization by boiling for conservation of time. (b) The Genito urinary injuries, Supplementa- ry Instrument Set, has been added as it takes little room and most of the items in the set will be needed. (c) One Amputations and Fractures, Supplementary Instrument Set 1942, is already on the list. If the purpose of this surgical unit is abdominal work, this is enough. Should the unit, however, be called upon to take care of general casualties, at least another set should be added# For such general work, in addition, there should be added the Extension Apparatus, Kirschner and Extension Apparatus Steinman, with at least twelve (12) Steinman pins; each in 5, 6-l/2 and 8-inch sizes. In that case also larger quantities of plaster, splints, sheet wadding, and felt would have to be added, and also a small portable fracture table. (d) For -units handling compound fractures, a few Roger Anderson pins with the external fixation bars would he of great value in cases where for one reason or another plaster fixation was thought inadvisable. We do not feel that valuable time should be spent in obtaining accurate reduction, but in certain cases there is no quicker way in which to obtain immobilization and still have easy access to the wound than by the use of these pins. (e) Sharps and needles should be kept in eresol solution, full strength when the truck is stationary. 692 '■* :: (.£) iki. tubes might either he •‘boiled or kept An - alcohol depending1 rbrtfofche urgency of- their hoed*- ••-• Silk,* cotton .hhd dermal-;-can-be:./boiled, > ; sonoi*. > • -■ •• ' r.’t . ■' r I: :jjo :ir. :: 3* Possiditty of -use of, surgical unit .with'surgical teams and evacuation hospitals, * ' Q l" t Z:' ' ■ ■ j ' ; [ y " % < v..- ■ a,;' in general the impression gained. £atom.* the surgical truck ;and tent is that it is the best thing'.of its. - kind that we have seen to date. The idea of, the truck ‘being, able to move and leave the operating tent standing is very good*. The;, possibility of having tje move suddenly and leave the. tpn.tr -hut still carry away most of the equipmonfeis- airs0:i very ..ap-pealing, Prom previous experience we have- found-,that, an inner lining in an operating tent keeps the dust nuisance, to a minimum and also makes a difference in temperatures in hot climates of 15 to 20 degrees,- The construction of the present tent without poles in the center is a very real advantage and is one of its best features. Blackout features are obvious and require no comment* : • .v ■). /. £..v b* The disadvantages that we have nqt.pd in .using a trailer as an operating room is the Jack of space-.and loss of time setting up for the next case in the same trailer. Using a tent ;fdr,an‘operating room without a truck has a great disadvantage.;in having no provision for storage of sterile goods and supplies*■ To be sure boxes may be constructed, but our experience to date in setting up showed us lumber was impossible to obtain for such-purposes*'. •J . c* The greatest .advantage we.noted in.use of the. trailers .was the space to store sterile goods, the.ease ofr„: operation :of.the.sterilizers, the , abundance,-, of sterile, water, hot and cold, ..and. the ability to .use , eachoperatinghtrailer , for certain types of .cases Operative infections': we re at,; a minimum. In over eight'hundred-and f if ty/,(,850);; procedure a, only one. infection of any consCquency~ensued\:ahd’ .was:: - undoubtedly due to improperly,preparing;the patient’s skin«; * . . * " i.r.; .[ ; V . ■ - f • d* From the use of these trailers we learned a few things which might-be, correctedlin further construction ■and-might be motioned here*. The ventilation- in the:stori-, lizer trailer was. i the lights -9 i fans * -and /..<:/ ■electrical equipment,were:not standard* It was-f ound very- difficult to , obtain parts for. replacement*., In the ■ X-ray •. /,-■ trailer the file for storing films should not be .in the. darkroom* A homemade desert code r. .-on the - A-r.ay trailer dropped the temperature 20, degrees- in- the.. darkroom'. ,:;The j ■ developing tank was only 2-1/2 gallons permitting the development of only two films at;, a time; it; was replaced by a 6-gallon tank which fitted easily - in* the-.same.’ spape.The., pass box going to the darkroom was not large enough to take a 14 x 17 cassette. We, cannot comment on mobility as these were used as fixed units. e. In the present surgical truck it would he a distinct advantage especially if the sterilizer should he permanently placed inside, to make some provision for a desert cooler, A small fan is already in place; this might he enlarged or at least an outlet sufficiently large might he constructed so such a cooler could he improvised if the need arose. f. If a man trained in the running and repair of all the mechanical and electrical features of the truck could go with it, he could train the personnel which would he attached to the truck. This would have been a distinct advantage with the Carlisle trailers. The question has been raised as to the use of fixed space for storage rather than movable cases. Any accident that would damage the truck body would probably render useless the supplies contained therein whether boxed or in stationary cupboards. The fact that the truck is standard and the body can be lifted off the chassis onto another would minimize the possibility of not using it because of mechanical breakdown. There is also a very decided advantage in being able to take goods out of a cupboard, rather than boxes, which would have to be spread out over a considerable area in order to get at their contents. The boxes, of course, might be constructed like cupboards but then would come the problem of fastening them securely with the truck in motion. h. Whether the autoclave is to be in or out of the truck is not yet decided. Its use outside of the truck would §ermit sterilization of supplies in the absence of the truck, his would also keep to a minimum the number of people work- ing inside the truck. Autoclaving inside the truck would also add to its heat. 4. Conclusion, We believe this unit is a very definite advance over previous units. We also believe that it opens up many possibilities for use with small surgical teams and also surgical and evacuation hospitals. In fact from the rather limited experience the writers already have had with an-evacu- ation hospital conditions, they would thipk it a privilege if they had the opportunity of setting up with several of these units in their authorized equipment. /s/ Donald McNeil It/ Donald McNeil Lt, Col,, Medical Corps 'Chief, Surgical Service' /s/ 'Margaret S, Gavnor ft/ Margaret 3. Gaynor 2nd Lt., Army Nurse Corps Asst, Chief Surgical Nurse 51st Evacuation Hospital A.P.0, 180 c/o Postmaster Los Angeles, Calif* 2 Incls - Incl 1 List of Packs Incl 2 - List of Equipment SURGICAL;PACKS FOR SURGICAL-UNIT- Based on 80 Major Operations MAJOR PACKS 20 3 Gowns 3 Sheets; - . 2 Fan folded -<•*.. T * * J , 1 Folded in square used as inside wrapper and instrument table cover, . 8 Towels'' 1 Pillow case 6 Abdominal tape sponges • ;; 25 Surgical sponges, 4" x 4" 25 Surgical sponges, 4" x 8" 1 Abdominal pad, 8" x 10" 1 Abdominal pad, 12" x 16" This pack is wrapped in 2 yards, double thickness muslin. MINOR PACKS 50 2 Sheets (fan folded) 8 Towels 1 Pillow case 6 Abdominal tape sponges; 25 Surgical sponges, 4" x 4" 25 Surgical sponges*, 4" x 8" 1 Abdominal pad, 8" x 10" 1 Abdominal pad, 12" x 16" This pack was wrapped in 1-1/2 yards, double thickness muslin» EXTRA'STERILE SUPPLIES 36 G-owns (May be packed in 5 - 14" sterilizer drums or wrapped separately in muslin*) 500 (l bag) Surgical sponges, 4" x 4" (J4ay be packed in 1 -9" sterilizer drum,) 70 Surgical pads, 8" x 10" ) May be packed in 4 - 9" 80 '"Surgical pads, 12" x 16")sterilizer drums. ENAMBLWABE POP STERILIZATION 12 Basin, hand - Wrapped in sets of 2 with muslin double thickness - making 6 sets, 12 Basin, sponge - Wrapped in set of 2 with muslin double ' thickness - making 6 sets, 4 Pitchers -r - Wrap 2 in muslih for sterile use, Keep 2 unsterile. 695 EQUIPMENT FOR SURGICAL TRUCK Items to t)e Increased to Original List • Original List,*./,"- 71720 71780 75900 76640 78800 92125 92127 Sheets 180 Towel, hand 640 Oil, typewriter, 2 oz, bottle 2 Twine, Jute, coarse 3- ■ Pitcher, 5 - quart 4 Sponge, surgical, 4M x 4" 5 Sponge, surgical, 4" x 8M 5 96 500 1 1 2 ■ • 2 - 2 93770 Silk, suture braided 15 5 99575 Table, instrument, » folding 4 3 Items to be Removed from Original List : 34990 Sound, 18F ea. 1 35010 Sound, 22 F ea. 1 97642 Items to M,D, Chest, surgical A be Added to Original Lists ea. 2 11590 Cresol, Saponated Sol, qt, 6 (for steri- lization of sharps & needles) 14700 Talc, purified lb. 2 1K20605 Nikethamide (Coramine) 25 ea . 4 20270 Muslin yd. 150 (for initial wrapping of sterile supplies) 20400 Stockinette, 6n roll 3 ) To be cut on 20410 Stockinette, 9” l! ) # A ' t * • roll 3 )the bias ))and made )int.o com- pression )bandages of )of 5 yds . )each. 20420 Wadding, Sheet roll 50 34920 37615 37764 Shears, Plaster Paris Splint, accessory, asbestos felt, soft gray Suture catgut, chromic, size 00 with half-circle, non-traumatic needle ea, yd, tube 1 1 200- 696 Items to be Added to Original List 38750 Tube, stomach, 30E ea. 1 38755 Tubing, drainage, 5/8n Penrose 36" ea . 6 38757 Tubing, drainage, 7/8” Penrose 36" ea . 6 38760 Tabing, rubber, l/8” (Dakin) ft. 25 70880 Stool, revolving ea. 3 70950 Table, ins trument, adjustable ea. 2 78770 Pins, safety, large card 6 79110 Sterilizer, controls box 3 79120 Sterilizer drum 9” ea. 5 (to pack extra surgical dressings) 79140 Sterilizer, drum, 14” ea. 5 (to pack 35 extra gowns) 92119 Pad, surgical, 8” x 10” bag 3 92121 Pad, surgical, 12” x 16” bag 5 93320 Supplementary instrument, ea. 1 sot (Genito Uninary injuries) Items to be Added Depending on Type of WorkJ 31800 Drill, Bone, extra drill sets ea. 3 31955 Extension apparatus, Kirschner (hand drill type) ea. 1 31960 Extension apparatus, Steinman ea. 1 31965 Extension apparatus, Steinman Pin 5” ea. 12 Extension apparatus, Steinman Pin 6^w ea. 12 Extension apparatus, \ Steinman Pin 8” ea, 12 697 Appendix N FINAL LIST OP EQUIPMENT, AS OF 29 JANUARY 1944, FOR TRUCK, 2-g-TON, 6X6, SURGICAL, OPERATING /Penciled Note_T7 Pinal 29 Jan 44 TRUCK, 2 1/2 TON, 6 16, SURGICAL, OPERATING CLASS I Item STo. Item Unit Quantity 10122 Acid, Boric, Ointment, USP: 4 oz 24 10480 Alcohol, USP: Quart 12 11105 Caffeine, With Sodium Benzoate, 7,5, Or Amp! Dozen 2 11590 ■» Cresol, Saponated Solution?; Quart 6 11646 Dextrose, 5$ In Sterile Distelled Water. 1000 cc 24 11650 Dextrose, 5’jo in Physiological Sodium CBloride'Solution! 1000 cc 24 11747 Ephedrine Sulfate, NF VI, ICC Amp,, 3/4 Or! Dozen 6 11790 Ether (For Anesthesia); 1/4 lh 1Q0 698 Item iia*_ Item Unit Ouantitv 12725 Mercuric Cyanide Tablet; 100 5 13020 Normal Saline Solution Tab; 100 2 13340 Petrolatum, USP: Pound 10 13390 Phenol, USP; Pound 1 13806 Procaine Hydrochloride, USP, 150 MG* Ampit- 10 10 13830 Procaine Hydrochloride, USP, 3 Or r Hypo Tab;. - ■ 10 .. 24 14120 Soapiji Soft? Pound 3 14306 Sodium Citrate, 4$ Sterile Solution, 50 CC In Vial? 12 1 .14622 Sulfadiazine, USP, 0%5 Cm (7*7 Or) Tab? 1000 1 14623 Sulfadiazine Sodium, USP', 5 Om Vial? 6 15 14636 Sulfanilamide', ' Crystalline, USP, 5 Orams In Sterile Individual Doubl Envelope; Pkg 25 14640 Sulfathiazole, ..Ophthalmic Ointment, 5$ ’ " i • • Dozen 2 14700 Talc, Purified, USP; * :c Po^kid 2 ,14910 Wa£er, distilled, Free? OH I 1000 < 3C 6 14917 Water, Distliied,"Sterile,'P^fo^en ...I .V„.; .... . . 25 2 14920 Wax, Bone, Sterile;, 2 gm 6 14940 Xfj'j i' :.'i 1*0 f v,'-'cr .••• ' Whisty, us?;" . Qpart 2 16088 Serum-,. Normal Human Plasma, Dried;. Pkg 48 Item Ho. Item Unit Quantity 1X01075 CLASS IX Adherent, For Skin Traction? 4 oz 3 1X00600 Epinephrine (Adrenalin) Hydrochloride, MR, U1000 Solution : Dozen 2 1X35605 Merthiolate, Tincture, MR, 1:1000: Pint 12 1X20605 Nikethamide (Coramine): 25 1 1X56700 Pentothal Sodium With Sterile Distilled Water: 25 7 20024 CLASS 2 Bandage, Elastic, All Cotton: Dozen 2 20130 Cotton, Absorbent, Compressed: Ounce 25 20140 Cotton, Absorbent, Roll: Pound 2 20150 Cotton Batting: Pound 5 20254 Mask, Race, Surgical, Improved: 120 1 20290 Muslin; Yard 200 20340 Plaster, Adhesive, 1-Inch: Spool 24 20350 Plaster, Adhesive, 3-Inch: Spool 24 20390 Stockinet, 3-Inch: Roll 3 20400 Stockinet, 6—Inch: Roll 3 20410 Stockinet, 9-Inch: Roll 1 20420 Wadding, Sheet: Roll 200 31130 CLASS III Catheter, Urethral, Rubber, Self** Retaining: Each 12 :31133 Catheter, Urethral, Rubber, Self- Retaining, 4-Wing, Malecot, 32R: Each 12 31790 Drill, Bone: Set 1 700 Item'' 1'! 0 * _ f 'Item ~ rtf f i- Unit .Quantity* . 3180G Drill, Bone, Extra Drills'* * Set 4 31955 Extension Apparatus, Kirschner’"Hand Drill Type! • . . 1 ■■ ••--C, ;/v t Each ■■ 1 31960*10 Extension Apparatus, Steinmann! ’ Hew Type’ 5 ; i 31965-04 Extension Apparatus, Steinmann, Pin! "S-Inch Each -e j ;c-K Bhch ■ . f 1 - I2r 31965-06 Extension Apparatus, Steinmann, Pin! 6 1/3^Inch Each 12 31965-08 Extension Apparatus, Steinmann, Pin! 8-Inch Each 12 33620 Needle, Spinal Puncture, Corrosion Resisting Steel, 20 Gage! •Each 12 33623 Needle.., Abdominal, 1 3/4-1 nches, Straight! 6 6 •* ’•I*1 r 33791 Needle"', Intestinal,■Size 2, ■ Half-Circle; Pkg 6 .33796 Needle, Intestinal, Size 3, Half-Circle! ; . V \ Pkg • - i 6 33802 Needle, IntestinalSize 4, Half-Circle: * ■ • ■ Pkg: 6 * 33805 Needle, Intestinal, Size 3, »• Half-Circle, Pine! 6 6 33807 Needle, Intestinal, Size 4,#. Half-Circle, Pine! *6 “ * * 6 33809 Needle, Intestinal, Size 6, Half-Circle, Pine! : 6 6 33845 Needle, Skin Suture, 3 l/2—Inches! .2kg 2 33865 Needle, Skin Suture, 2 l/2-Inches! " ■Pkg 3 33950 Needle; :'Surgeon,s Regular., Size ;l'2,'r-; . 3/8-Gircle! 'c:> USiXS :Pkg 6 33961 *' r . - • Needle, Surgeons Regular, Siz'd 3/8-Circle! ’ OCT Oii< f;.- Pkg 5 Item Ho. Item Unit Quantity 33965 Heedle, Surgeon*s Regular, Size 18f 3/8-Circle• Keg 6 34930 Shears, Plaster Paris: Each 1 36030 Adapter, Eor Tubing: Each 12 36215 Battery Box! Each 1 36624 Cotton Thread, Ho. 80; Spool 6 35626 Cotton Thread, Ho. 40; Spool 6 36680 Depressor, Tongue: Cart on 2 36810 Cloves, Medium, Size 6 l/2: Pair 24 36830 Cloves, Medium, Size 7 l/2! Pair 24 36840 Cloves, Medium, Size 8: Pair 24 37050 Irrigator Tubing! Bach 4 37055 Kit, Suction! Each 1 37275-08 Rheostat, Lamp Socket Type: 110V, 60C, SP, AC Each 1 37615 * Splint, Accessory, Asbestos-Belt, Soft, Gray: Yard 2 37750-08 Suction Apparatus, Portable, Electric! llQV, 600 SP, AC Each 1 37762 Suture, Catgut, Chromic, Size 00, With 1 3/4-Inch Straight, Hon- Traumatice Heedle Affixed: Keg 10 37764 Suture, Catgut, Chromic, Size 00, With 1 l/8-Inch Half-Circle, Hon- Traumatic Heedle Affixed! Keg 10 37770 Suture, Catgut, Chromic, Size 00: Tube 100 37780 Suture, Catgut, Chromic, Size 0: Tube 100 37790 Suture, Catgut, Chromic, Size l: Tube 100 37840 Suture, Catgut, Plain, Size 00! Tube 100 - Item Item Unit Quantity •37971 * • < * * ** * - , % - , . Suture, Silk, Braided, Non- Capillary, Size 00: ... _ . Spool 4 37975 Suture, Silk, Braided., Non- Capillary,* Size -IS' Spool 2 37988 Suture, Silk, Braid’ed,'Non- Capillary, Size 31, ,, . , , i.yt-.: ■Spool 2 :37995 Suture, Silk, Dermal, Coarses.r. ;:Pkg 50 38510 • '• * # ' • < Syringe, Luer, Needle, 19 13/4 Ind£‘ Canulas’- • A’ * '' Dozen 1 38705-09 Tubeduodenal,* I>evin!sS ‘15B Each 12 ; 38720 •3 .;<■ ; Tube,; Mujrphy Drip: Each 12 38750 Tube, Stomach: Each 1 38755. Tubing, Drainagd, 5/8-Inch: Each 12 38757 Tubing, Drainage, 7/8-InchS * Bach 12 38780 Tubing, Rubber-, 1/4*Inch: Boot 24 38792 Tubing, Rubber, Latex, 3/l6-Inchl Boot 48 38793 tubing, Rubber, Latex:, ; Boot 60 38900 Wire, G0rr0sion-rResistirtg 0#0l4rinI-CAL.- QPESATING- This truck was received at this station on- 20 December, 1943, having been driven from Carlisle Barracks, Pennsylvania, fully loaded, with trailer attached. At the time of arrival, the contents were checked for breakage and it was noted not a single bot.tle was broken and so far as could be determined, none of the items were damaged by the trip. It was noted, however, that, due to inadequate drainage, the faucets in the rear of the truck,"the condensation float on the sterilizer and the foot pedal under the sink were frozen. These were thawed out and for the remainder of the test period the truck was kept in a garage-whenever the weather was cold and the truck was not actually in use. The unit, was set up between two wards of Lawson General Hospital and twelve operations were performed. These included! (l) Ligation of varicose veins, leg, right; (2) Hemorrhoidectomy (3) Incision and drainage of pilonidal abscess; (4) Seques- tectoray, thumb; (5) Excision of pilondial cyst; (6) Revision of plaster cast, leg; (?) Chamge arm cast, surgical dressing; (8) Application of body*cast; (9) Application of leg cast; (10) Sequestectomy, femurr with saucerization(11) • Bron choe- copyjidp) Bronchoscopy.-, .Thru-out ■' these operationsonly the equipment carried ‘in the truck was used. Instruments were found to be adequate in both number and type. For the most part, the;-\ini-t-''ftnictioned in an excellent manner. The largest defect and one which chused almost con- 708 stant trouble was the steam sterilizer* Upon arrival the tank in the burner was found to have two small holes which made it impossible to maintain pressure within the tank. These were repaired, but other small leaks appeared from time to time. Inasmuch as Colonel Quinnell has informed us that this type combination steam sterilizer and water heater will not be used on future models, it is not believed necessary to go into details as to its defects. The following list is offered and a more detailed report on them can be submitted if required? 1. Steam is not produced rapidly enough or in sufficient quantity to enable the sterilizing unit to meet the demands of early operation and frequent operation# 2» Unit is incapable of safe mechanical opera- tion while the truck is in motion, 3« Heating unit -is .unstable in its mechanical operation and- requires constant attention. :to . prevent breakdown# If door to burner is not kept open there is danger of overheating pnd if it is open the burner is subject to gusts of wind*..materially reducing its efficiency. 4» Boiler capacity is inadequate "By the time sufficient steam has•been created for ade- quate* sterilization and hot water,- the water, in the boiler has been used, and;,’ads the feed is of the gravity type, it is necessary -to- lose the head of steam in order'to refill the tank# This makes it necessary to'start over again with .consequent loss Hof time.- 5# Present unit has .an exposed‘and vulnerable glass water gauge without. any protection.. 6, Condensation float is the length of the;.- . sterilizer from the thermometer and con** . nect.ed by inch pipe., Thus, the temp- erature ;at-the float is at variance with the thermometer -and allows steam to escape*- 7# Due' to the drop in steam pressure when the.., ' jacket is—filled and again when the chamber ■ is f ille d,: •-cons'lderably steam -condenses on... ’ inside of •• the.-.stenilizen with .consequent soaking' of the surgical packs. - For this•. reason,* no -pack/ qfin.be' alibied to- touch the' sides,* whi^h; greatly, rejucear the- capacity of . . the sterilizer of any 6he'unruhfV'• y ••• 8# At present hot water is obtained by passing steam thru a small tank under the main supply tank. If this is done while steam line from boiler to jacket and chamber is open, care must be taken not to draw off too much steam, or the pressure in boiler, jacket and chamber . will fall below the 17 lbs. sterilizing pressure. If ‘steam supply valve to steriH- zer Is .closed when steam is drawn into the ■ /;: water tank there is the chance that the' .pressure will, drop to a point where it is not possible to build it up fast enough*to prevent chamber condensation from dropping f: . the chamber’pressure below the .17 lbs . sterilizing pressure. This would-1 become a real problem if large quantities of hot v/ater were used, and requires constant attention, at all times. ■ The use.of. a separate steam sterilising unit apart from the,'heating unit, such as is being planned, should solve these difficulties... ' ' 4~ " The hot air heater and fan gave no trouble and was quite efficient, _ „ The.small generator (Signal Corps, RE- 75—T) ran constantly for several- days at a time without any difficulty, and supplied sufficient power for all needs. There was, however, no heavy- duty cable t.o connect the generator to the truck. One was borrowed ..locally for this test,' but should be‘included as part of the standard equipment, A length of 50 feet is recommended* '.Operating'wastdone in the tent supplied for the purpose,;-; which was found.to supply adequate space to allow two -teams to work without crowding, ’’’ The. tent is not difficult to erectV but the white canvas flooring is difficult: to keep-Clean. ■ It is recommended that the eyelets used to raise the white inner tent be fastened, to. the,. tent poles; in" such a;manher that- they cannot be lost. Several, were missing, wben: the -truck was' - - ■ ’ delivered and were made locally.' It is ru cumin ended that ‘a six- foot vestibule be added to the tent eB.tTrah.ee to form a light trap# This would enable, litters .to be carried in and out of the.tent and maintain blackout pfepautions, ‘The remainder of the truck and tent can.be made light-proof without- added-. ' equipment, ‘ . x The lamps, field, operating ('Item 99316) supplied - suf- ficient light for operating and, together with the lamps fixed to the rear of the truck, made the illumination within-the tent adequate for all purposes! The adapters on these lamps, used to--accomodate 6-volt ,bulbs , require an extension oh;thC;; center 710 contact in order to complete the circuit. This difficulty was overcome here by the addition of a drop of solder. These lamps were used with current supplied from the generator and from the truck battery, '..As no batteries were available, we were unable to try these lights with this source of durrent• It is noted that the original list of- equipment calls for three of those lamps. Inasmuch as -they-are a large and bulky item and packing space is at a.premium, it Is suggested this number be reduced to two*. Only -two were used in this test and this number was found to be sufficient. . u ' The'-Titter supports .v/ere satisfactory and firm enough for operating purposes. It. is suggested that the cross boards of these 'supports, be notched to accomodate the curvature of occupied litter.\ It was noted during the operations that the bfoss boards were, about. at-the level of the patient's shoulders arid after a time: caused,, considerable discomfort* Within the truck, it was found that-the door catches on the cabinets were unsatisfactory in several respects, and it is recommended that, these be replaced by simple flat catches similar,to those used to keep the drawers closed. The ones on the' cabinet’s at present are too weak to hold unless they are in perfect-^coMition. Furthermore, they protrude into the narrow aisle of the truck and there is considerable danger of them being damaged,by-passing personnel as well as, during the packing and unpacking'of the truck, being broken by equipment pabitedJLn:'the’"aisle. During the test period here, none of thbse were broken, but several .of'the men received minor skin abrasions caused, by- striking them in the aisle* Window screens on the.-Jbw#imndowq .would he a distinct advantage if the. functioning within an arqa-whbre- insccts. are plentiful.* -' The' blackout screens oh these ■■■windows are Quite ■ /r/, . 'Thb ggose-neck on the sink, is :too narrow for safe' scrub- bing, and,:,-if possible:, Would suggest this be bent outwards , to allow more-clearance between ..the lip of the pipe and.t'he upright section, thus eliminating the danger of contaminating the hands by contact with; the- unsterile piping. , y , While, •using the ,;tr\ick'here: we.; attached a simple flexible extension -on the sink:drainage .pipe,; At' th© present, time, the. sink drainage pipe drains-Cn the spare; tire under the,truck , - body? hence,: soapy water; -hHemic^ls'-'f:icr whatever is. discarded’ • in-the sink .hits the., tire-and spatters. By means' of, this - ‘ extension,- -drainage -dffect’ed cveV the tire and could: be collected .in buckets’ or-directed into • a suitable drainage ditch and darried .off.: 1 ’ -v'f ob *• The ppwer 'inlet plug on the left side of the truck jbody is at present exposed* This should, he’ covered by a metal cover for protection when not in use. TKe water-tank is filled-thru an opening in the top of the truck* At present, in order to fill .thertank it is necessary to climh over the engine hood,%up over the windshield and step across the top of the combat cab, Inasmuch as it is understood steel cahs will pot he available, recommend that either a ladder be placed against the side, of the truck or hand and too holds so placed in the side that access to the tank inlet can be gained in this way* A similar situation exists for the gas tank supplying the hot air heater. Dpring the test period, considerable rainy weather was experienced. This caused a softening of the ground and the rear of the truck sunk slightly. Either for this reason or because of the natural slope of the truck,- the rain from the truck roof drained into the eaves trough and,,hence, over the*: electric outlet plugs and into the tent itself. The unit as now constructed is not suitable for work in cold climatesi The water pipes are outside and not insulated, .During the test-.period.these pipes forze at a temperature of 26° E* while the truck was in use. It is understood that later trucks will have inside plumbing and it is suggested that .on the present models these exposed pipes be insulated to afford some protection from the bold. In this regard, no trouble was experienced-from freezing Of;water or watery solutions inside the truck itself.*--. ,, . - • Despite weatherrbelow freezing during a considerable part of the actual operating time, -no. trouble was encountered in maintaining a comfortable temperature within the tent. The gasoline heaters-,.- sterilizer .and hbt air heater on the truck kept the tent sufficiently warm thruo.ut this 'period. Inasmuch as all available space is utilized in packing the truck, a considerable quantity of material 'ie placed above the cabinets* Fixed roof straps, .buckling-to the outer edge of the cabinets, would aid in securing these, supplies, especially during travel ever rough terrain* Considerable attention was-;.given, to the equipment and supplies forwarded with the truck and trailer,■including those supplies not available at Carlisle at time of ishipment, but which we re secured from lo-oal sources, Forking on the assumption that the truck was to handle general surgical cases and the anticipation that enough supplies for 100 such cases were to be carried,, but also bearing in mind the problems of storing these in transit-,--the tentative list of equipment was revised and the suggested list enclosed herewith. 712 The following explains the major changes which were made* _ Chloroform was de 1 e te.d tp cause it was found that it was used .so rarely and adequate substituted were already included. ' ' Epinephrine hydrochloride, item 11750* was deleted and epinephrine hydrochloride, item 1 E 0060, substituted. This was for greater ease in handlirig arid administration, ; . The quantity of ether,'--g-lbr cans, was reduced* : .. from 150 to 100, Due to'.quantity of sodium pentothal ■ supplied, it was believed" 100 cans of ether to be sufficient. This item, should not be hard to ■replenish and 100 cans is believed ample for one dajedoptrrating, The quantity of pentothal sodium was also reduced* This is a bulky item and, although it was felt desirable to carry as much as possible, the space limitation had to- be. considered. In conduction with other forms of anaesthesia available (ether','' local, and spinal) it.'is believed that 7 units of 25 ampules each would be sufficient* •It is recommended that sulfathiazole opthalmic ointment be substituted for yellow oxide of mercury ointment, - . . D;* , Item 13806,. procaine hydrochloride150 mgra amp, was increased from 5 units.-to-10.units*. Th.ib* wash- done because of the. redhotipn in'sodi.um'pehtothal/and but little extra space was -involved, ... . ■ - ‘ •/•" Item 13830, procaine hydrochloride, -.3-gr,' hypo tab, wag increased to 24 units .for the same'reason. •• 5 ‘A v* * , ; , -Item 1463.6,-V;sulfan-ilamide,' £rys t alii he, 5 gms . in sterile’ihdividual double,wrapped envelopes with shaker top was reduced from 200'units to 25 units. EaOh of 'the§q units contains 12 envelopes which gives a total of-300,■ envelopes* which is believed adequate for 100 caVes. It is also,' believed,this- item is , ‘ , ( •' * 4 ’ jS * ' • ■ easily replenished and hence there'-is little necessity of carrying .too..large a.Supply initially# * .* * ■ * i,, Item-14523,. sulfadiazine sddium, 5 gm. vial, was •'■increased fr.om: 3 units of 5 vials to 15 units bf 6 vials. This increase believed necessary to handle the cases'where either vomiting or the presence of stomach 713 or intestinal wounds would render the administration of sulfa drugs by .mouth undesirable, • Item 1491Q, .water, distilled,, sterile, 1000 cc., was reduced from 24 bottles to 6 bottles. .This was done to save packing .space and; was . compensated by the suggested addition of item 14917, water, distilled, Sterile, 50. cc. units of 25 ampules-'each. It is anticipated that this, water would be used, for the most partin the preparation of local anaesthetics. 3Tor this,the> smaller size unit is believed more economical and easier to handle. Item 14940, whiskey, was reduced from 6 quarts to 2 quarts. This item, while in some respects desirable, is space consuming and probably, not used to any great extent for medicinal purposes* Items ,20130, 20140 and 20150 were all reduced These items, (cotton and cotton batting) while not heavy are bulky and, hence, space con- suming and it is believed the quantities recommended in the revised list’would be adequate for general surgical tehmSfbr 100 cases. If considerable orthopedic work was contemplated, these items might be increased. Item 20390,'stockinet, Scinch-, was .added and item 20410, stockinet, 9-.inch, reduced to* 1 rool* *’ Item 20430, wadding, .sheet, was increased to 200 rolls, : This packs well and was. believed advisable with the reduction of cotton battipg, *. Item 31790, drill, done, was proposed as an addition. While,one is present in-the fracture kit, 'another was believed advisable as a spare. ■ Item 31133, catheter, urethral, rubber, self- retaining, Male cot, 32-E, was increased for use in chest wounds* The needles were not materially changed as there was little space involved. It is recommended, however, that some small cutting needles be included* Item 36990, intravenous solution, reservoir, was deleted. These are difficult to pack and not believed necessary. Other items already included can be used wherever this item was necessary. 714 Items 37780, 37790, -57840 and 37995 (sutures) were materially reduced and the amount left believed more than adequate for 100 operations, Item 38705, tube, duodenal, drainage, levin1s, 16—Et was increased to 12, Little...space is. involved with the packing of the additional 6 tubes and with the contemplated‘set-up for this unit, a tube placed during the operation would leave with the patient and probably not be recovered, t * - w . V - Items 38900 aqd.;;38910, .wire, corrosion resisting steel,-were deleted; as., sufficient wire of this type, is present in the ins.t.rp©,ent.. kits,' ' - •?-•••• ' v ■■ z4yu Item 44020,: sterilizer, hot" 'air, -large, was not supplied with ifcrhe .truck, . From tlib’'description, this ., item would occupy considerable 'space in. packing anct is not believed to -be of sufficient use to justify its inclusion* - • *.*.. . . Items-71600, 71690 and 71.720-, gowns, pillow cases and sheets, were, all reduced; ‘ The.-numbers % recommended on. the revised list take care, -of the* 1',.. packs and leave some, excess, This-’s'pace saved by t’his reduction can be better utilised'for other supplies,' Item 77010, aprons, rubber, operating, were increased to 6--to supply one to each of the two scrub nurses, -r ’. • ? , ... 7 • • ; . > , * Item 79000, rubber sheeting, 2 yards suggested as' addition to equipment list to be- used in,.connect.ion " ' with wound irrigation, " b. - a -. ... y. 7,7' ’ Also suggested addition of item 74590, brush, scrub, 2 to be u§ed for scrubbing*the 'canvas flooring .. of the operating tent. ' * , *: ? A Item 91155, morphine tartrate,fgr. solution, has been recommended cut from 200 'unit.s::te 80 units'.,, Each of these contains*5 syrettes for a total of 300 doses, which is believed adequate* Item 92030, bandage, plaster of paris, 6-inch, ; has been cut to 20 units Of onebdozen each' Instead 1 ' of 40 units. This item is both bulky and heavy and 20 units is believed adequate for 100 general .surgical cases. It is recognized’thaVsOme^case^•:will, in addition to such wounds as render them general, surgical cases,- also have fractures which it is desirable to ‘ • ‘ ‘ *. i **'• - •y t . treat at'the same time If is belie ved,- / however, that 715 20 units of plaster "bandage is sufficient for this pur- pose* Should the truck "be used for any considerable number of orthopedic cases, this probably-would not suffice, but it is our understanding that’shch is not the purpose ■of. this particular operating unit* Item 92040, bandage, triangular, compressed, was reduced from. 9.6 to_ 50. • . This is believed sufficient for the proposed number of cases to be handled. . Item 92127, sponge, surgical,'4x8, was,increased to 12 bags and" item 92125, sponge,- surgical, 4x4, 5 bags added. This will care for those in’.the' packs and leave an extra supply, easily ‘packed in ’the'* sterilizer drums. These “are extremely useful and packed in thusterilijzer* drums will not. require additional space* Each bag of 4x8’s contains 180 sponges, henCie, the 5. bags oh’'-the .‘original list would supply 900 spongesj, , The 80 surgical packs as shipped made up contain 25 sponges .;(4x8)■■ or a total of 2000 sponges. » Hence.,, the 5 bags of item 92127" are entire- ly inadequate.*. ..." * It is recommended that item 97639, chest, plasma, complete, be. deleted and that item 16088," serum," normal, human plasma, be substituted. It is further recommended that this be packed in export packages of 12 units’ to each package* It is believed that by this substitution, an adequate supply, of plasma could be. carried in a much smaller space. Would recommended 48 packages of this unit be included...... . . Item 97758, gas casualty case.was deleted and Item 97764, kit, first; aid, gas casulaty, Substituted. :Xtem 97758 is bulky and.heavy, and its use would probably not be sufficient to, Justify its inclusion' in the list of equipment, * •. . .. . * The‘: number of units of item 99415, pad, heating,-.- refill, ,;has. been reduced from 36 to 12*; This allows one refill for. each of the 12 pads,, which is believed sufficient*' * ‘ ’ : ' . Item 70880, stool, revolving, 3, was deleted;;:-.?- r Although "-this is,ja- desirable item to carry if* space;., would-permit, the limitation of such space makes it necessary to recommend its exclusion. These stools ■ are awkward to pack and can not be broken down, Ther- equipment already contains 6 folding chairs which are easily packed and, ..are. .satisfactory. During the test . period, none of these revolving .stools were used and no serious discomfort resulted* • In additioh, the following’items are recommended as additions, -to the table of equipment I f ♦ ••. Item • * *" ■* ' -‘i ■ . ... , Unit Amount 13CQ1075 Adherent for Skin 4 6z 3 ' ‘ ■75040 ' ' Bag,.:paper, 5-lbs, 500 1 78250': ’■; • •' Jar, 8-bz, ea. .2' 20020 V Bandage, Elastic ■ - doz. : „• 2. 44630.:"': ■ Tubing,. Rubber, Pressure ft. & .. 99530 ';. :i/rj ‘ '-Sterilizer, Instrument, /■s , ‘ i •>-; ** 14-in-ch ea. 1 .099540:. ' Sterilizer, Instrument,' '** - .L • ea. . 2 93707 : ’ '■'•■-.Shock Team Set, Complete ea. 1 3Tor ecohbmy un packing space and ease in" handling, it is recommended that item 97455, "blanket set, large, he delated and that two units of item 97465, ‘’"blanket set, • smallr* he Substituted. While this would result'- in a tot ai: • re dueti on Of several blankets, it is believed sufficient ,blankets-,would remain to fulfill-all . The -supplemental chest, thoracic set, was supplied without either battery box - or ,b&tte7le8v'--She&;? must be included in order to use the bronchoscope, •-In-this connection, it was noted that the supply catalog contains an item 37275, rheostat, lamp ‘socket ,type. If this could be used in con- nection, with the generator, of the’^surgical,.truck and connected to the. bronsphoVcope.,-it-.would be;.-fpt* better than the packing of a battery" box'bind batteries; . One .-pr the" other should, be supplied, however* 0 + ;• ■ -, _ •■‘■ 'If a syringe* holder f.or administration* Of sodium pentothal is available.,'~it *is heartily reccirtmendjed, that two of these items be added. The. anaesthetists, in-thist^oupnCbel that the administration of sodium peht’othal is much;mpre-satisfactory with.these holders. ”* ~ r-l: , ';It is. also suggested that a-'small, portable, ether- oxygen ma chi he -or portable resuscita-tor., capable, of adminis- tering, either'oxygen or. air 'under, -3jOw pressure.,;„be added, if available, ’ • • • .. ! ’ The truck and•.traile'r were packed with the.-items on the revised list and it was found that, there is adequate space available and still leave, room within, the.truck;'for two people to work while the truck is in' transit, . SuOh perspnnel could be preparing surgical packs or, with the proposed type of inside sterilizer and..hcating unit, actually be sterilizing equipment while the‘"'truck, was in motion. 717 The unit as a whole was considered to he quite satis- factory. With the exception of the steam sterilizer, all defects reported above may he considered minor. The pro- posed list of equipment will undoubtedly have to he altered, depending upon the peculiar conditions existing in the particular theatre where this operating unit is functioning, hut is is believed that this list, as suggested, is fairly complete for a basic unit. 1'feather conditions during the days when operations were actually performed were anything but ideal, consisting of rain, wind and, at times, sub-freezing temperatures. Throut this period, however, the operating tent was both warm and dry so that neither the patients nor the surgeons suffered any discomfort. /s / A* Kind /t/ H. A. KIND Lt Col, MC Appendix P REPORT ON TRUCK, SURGICAL, OPERATING, 2j TON, 6x6, SUBMITTED ON 25 MAY 1944 BY. .HEADQUARTERS ‘ PI PTH AUXILARY SURGICAL GROUP, PORT SAM HOUSTONTEXAS REPORT ON TRUCK, SURGICAL, OPERATING, 2\ Ton, 6x6 This .'truck-was received at this station on the 8th of March 1944, having Been driven from Lawson General Hospital, fully loaded with the Trailer attached. The truck ran well enroute, no mechanical difficulties, being-encountered. It was found that the attachment of the cabinets on the inside of the truck were.inadequate and worked loose during the trip. This has bopn corrected to some extent by bracing the cabinets with a b'oard placed at the rear of the truck between the ends of the cabinets. It is recommended that in the final models of the truck the cabinets be given stronger attachments to the wall of the truck and that a brace be placed between the ends of the cabinets just above the rear door. The truck has been used continously since its arrival here both in the performance of animal surgery and in ASP demonstrations. The unit has functioned well and the defects found are essentially the same as those noted by, the I’ourth Auxiliary Surgical Group, A copy of their report is enclosed, ¥g concur with their-report-with the following additions and exceptions, • :” The steam sterilizer as previously reported was inadequate. The following corrections were made: 1 "Tne burner supplied was replaced-by a Plumbers 720 Furnace, Clayton and Lambert, Stock No, 22, obtained from the Rost Engineers, 'This unit was found to be.«adequate once steam was generated although it required fourty-five''('45),, minutes to develop an adequate head of steam, * 2* The steam inlet to the jacket was changed from the top of the autoclave to the posterior inferior jacked opening, With the previous inlet to the jacket the water of condensation accumulated in the jacket and at no time previous to this change was there adequate temperature developed in the jacket. Further there was no way to drain the accumulated water of condensation from the jacket until the new connection was installed. 3* The pipe line from the boiler to the jacket was changed to make it as short as possible, * The previous pipe- line was too long and in an exposed position, thus wasting a large amount of heat. ‘ • ■ 4* A vacuum attachment was run off the former opening to the jacket and attached-to^the■chamber exhaust pipe. With the above changes the autoclave Was- ‘fbund to run in a very satisfactory manner. The addition of th.e the drying of the autoclaved material and should-.'be- installed y in all the new models. The autoclave may now be "run-con-., • **.V (; stantly without the former great loss of water. Once stchma.f - is generated it functions almost as rapidly as any of the standard small commercial models. It can now function continuously for four'(4) complete-loads without the addition of water. It can operate staisfactorily while in transit. The use of the-' steam from ,the autoclave to heat the hot water has not- been corrected,; • ¥c adyise that a separate water heating unit bp iris tailed to avoid the loss 'of, steam from the autocalveIt is also recommended that the.-heating units he place<1 further away from the gasoline tank. Cliibtof orni should not.be deleted as-it is believed that it will be required as a" substitute for ether in c.ases in „which the latter,;,while being the annesthetic of'choice, is ;cohtrpvindicated because of- its inflammability. x J{. Item 92030, bandage, plaster of paris, 6 inch,' should be 'retained at 40 units instead of the recommended'cut to 20 units. We.have found that this item is rapidly expended when 'h,-large number of fractures were simulated and believe'that it should not be reduced. The advisability using plaster in many cases of extensive wounds without fractures, and the fact (that the unit vd 11 ■; be'preparing its. cases; for evacu- ation vre believe further warrants the retention of 40 units of 721 the plaster of paris. The addition of a portable fracture table is believed to be very necessary* The application of plaster casts with the patient on the present operating tables is most satisfactory* Item 70994, Table, Orthopedic, Portable, with arm traction bar, complete with carrying case, is recommended* The recommended addition of the syringe holders for the administration of sodium pentathol and the portable ether- oxygen machine we believe to be very important and strongly advise their inclusion into the equipment. The windows of the tent should be enlarged to give better lighting and mosquito netting should be supplied so that when the walls are rolled up for operating in hot weather, the tent could still be flyproofed. The litter supports should be higher so that the litter is supported at the level of an operating table* The present Mayo stands, although adequate, would be more satisfactory if larger and more stable. The addition of four small collapsible tables, one for a splash basin, and one for an additional utility table to each theater is recommended. A ceiling ventilator with a fan should be placed in the roof of the truck as the autoclave makes the inside of the truck very hot when it is running. An extension cord with multiple outlets should be supplied so that the electric generator could be used when the truck is not attached to the tent* An increase in the volume of water that the truck can carry would he desirable. The supply of needles is adequate, hut small needles are lacking and should he added. Double rear view mirrors should he installed chiefly for use in hacking the truck into the tent opening. Larger fire extinguishers should be provided, especially a carbon dioxide extinguisher for gasoline fires. Eor the Commanding OPEICER, DUGALD S. MacINTYEB Lt. Col., MC Executive Officer 722 Appendix £ COPY OF MEMORANDUM PROM HEADQUARTERS; ARMY SERVICE FORCE'S , - • DIRECTING CHIEFS. OF TECHNICAL SERVICES TO PREPARE INDIVIDUAL HISTORIES OF WARTIME RESEARCH AND DEVELOPMENT WAR DEPARTMENT HEADQUARTERS ARMY SERVICE FORCES WASHINGTON SPROD 31 July 1944 RMO/ah 4513 MEMORANDUM FOR THE CHIEF, CHEMICAL WARFARE SERVICE THE CHIEF OF ENGINEERS • THE CHIEF OF ORDNANCE THE CHIEF OF TRANSPORTATION ... • THE CHIEF SZONAL OFFICER THE QUARTERMASTER GENERAL THE SURGEON GENERAL Subject! History•of Wartime Research and Development# 1# It is desired that each Chief of Technical Service initiate at this time a continuing project, t*o he completed, within six months of the termination of hostilities, to pre- pare a complete.illustrated history of wartime research-and development for his respective technical service. This pro- ject should -he .undertaken with the objective of furnishing!. • • • . * : ' e# A guide to future research and development per- sonnel to prevent or discourage repetition of unsuccessful investigations. h.v .A;ready reference text or source ho6k for research and development personnel to indicate a line of research and development to he followed or avoided# Cj, A source of information for personnel charged with the preparation of military characteristics* d, A source of information to those responsible for the initiation or approval of development projects to he used as a background for approving or disapproving project initi- ation* e, A factual text for historians and others requiring correct information on the many varieties of research and development projects undertaken during the war# f, A reference manual, for -staff planners. ,to assist them in the preparation of future war plansV 2* As a minimum the documentary evidence prepared by each technical service should be objective and factual and should include; ' ■>,, a* A table of contents. b. For each item or program descussed (1) The purpose objective of the program or project. ' * ■ •’■■■ (2) A brief description of the item or program* (3) A cross reference.to related items or programs. (4) A brief residue of results attained. ■ (5) Illustrations of the item or program where applicable* . : • .; jy r c, Index* 3* The finished document, will bey-bla-ssif ie.d not lower than secret and each item' or,,.-.program contained-- therein will be given an individual security classification* 'Distribution will be held .to the minimum:•within the technical service, and distribution outside the technical sbrvibe will be as follows; '• V* ;a.doint Chiefs of Staff ••*■’2-A-y- • b_. Assistant Chief' of ’StaffedG—4, War Department General Staff — 2 725 .c, Commanding General, Army Air Forces ~ 2 d.* Commanding General, Army Ground Forces - 2 e* Commanding General, Army Service Forces — 2 f. Commander in Chief, U* S* Navy — 1 Commandant, U* S, Marine Corps - 1 h* The Adjutant General - 1 For the Commanding Generals LUCIUS D* CLAY, Major General,•General Staff Corps, Director of Material* 726 Appendix R OUTLIiTB USED IN PREPARATION OE INDIVIDUAL DEVELOPMENT PROJECT HISTORIES INCLUDED IN MONOGRAPH ON WARTIME RESEARCH AND DEVELOPMENT OE MEDICAL FIELD EQUIPMENT ' ■ . I* Historcial Background* A* Description of earlier models* B* Advantages and disadvantages of each* C* Discussion of technical ftp tails (where relevant to present project)*. II* Project’Initiation* ♦ ;. 1 A* Original project proposal. ” , M 1* Purpose or objective. 2m Existence of a firm military requirement. 3* Military characteristics.* 4* Punds requested* 5* Research plan* • hi - ■ B* Processing the proposal. 1, Procedural steps followed* € a. Medical Department Equipment Laboratory. 728 b, Research and development agency* Surgeon General’s Office. c* Medical Department Technical Subcommittee. d. Medical Department Technical Committee. e. The Surgeon General. f. Headquarters, Army Service Forces, (or other higher echelons. - * * • n v . 2• Substantive changes introduced. Ill* Development Phasdll' A* ■'v P'rbll mi nary survey-of research possibilities (scientific literature, trade catalogues, related projects, etc,). 1* Foreign (civilian and military). 2. Domestic (civilian'and military). B» Actual development work* 1. Agencies participating. a. Medical Department Squipment Laboratory, * ’" b. Private industry, c. The Surgeon General * s Office, ■ * •*'.!’> * * * • . • - *< ;• V * , . v > C; ' .i V' d* Other agencies, ' t »:v:. . ♦ 2. Major, structural• problems. V.!'‘ ■ .. ■* • 3. Construction progress; • • *. « 6* Testing stage. , * * 1. Preparations for field testing, 2. Analysis of tests conducted* ( y **' .• O • 3. Summary of findings and recommendations, D* Modifications-prior to standardization. 729 IV, Standardization Phase. A, Procedural steps followed, ‘ • I ( »(•* • ■*•••■ ■■ .... I f 1* Medical Department Bouipment Laboratory,- .' 2, Research and development agepey, Surgeon General’s Office, > ' % . % - - ' .; . ... • • • ; • 3, Medical Department-TcGhhlcal,Subcommittee, 4, Medical Department Technical Committee, 5, The Surgeon General, 6, Headquarters, Army Service Forces, (or other higher echelons), B, Standardization data (especially the following), 1, Nomenclature, 2, Unit, 3, Basis of issue, 4, Quantity to be procured (including estimated cost), G, Major controversies at any of the above stages, "■ 1, Changes made, 2* Suggested changes overroiled. V, Procurement Phase* A, Data from Army Medical Purchasing Office, # 1, Initial production contract (date, quantity, unit cost), 2, Deliveries on initial contract (dates; quantities)# 3, Total procurement to date (quantity; unit cost changes, if any), 4, Total deliveries to date (quantity). VI* , Evaluation of Project* A. The item opinion*1} present catalogue classifications overseas reactions, etc*)* 3* Administration of the project (especially inter- agency' coordination)* 0« Procedural aspects (see ~AR 850-25)* 3* Other aspects of project meriting attention* Illustration 2. Interior View of Truck, 2j-Ton 6x6, Optical Repair Chit. Source: Medical Department Equipment Laboratory Photo S-368. (Chapter IV, Truck, 2j-Ton, 6x6, Optical Repair Unit.)