The development of the production of medicines for the use of troops in the field was particularly notable. The important drug, salvarsan, used in the treatment of syphilis, was a patented formula and had been furnished formerly by a single German manufacturer. In this country we produced arsphenamine as a substitute, gradually increasing the supply and constantly improving the drug until at length its toxicity had been so reduced that it equaled or even excelled the German product.
The facilities of the American drug and tablet manufacturers were taxed to the utmost to supply the Army. For example, during the year 1918 a total of 46,000,000 quinine tablets was produced, while 172,000,000 aspirin tablets were manufactured during the same period, and 835,000 pounds of calomel ointment, 45,000,000 iodine swabs, 10,250,000 tins of foot powder, and 300,000,000 tubes of iodine-potassium. All other items of medicines, antiseptics, and disinfectants, required by the Medical Department, were increased in proportion. This production not only strained the facilities of the manufacturers of chemicals and drugs but also called upon the glassware manufacturers for the necessary bottles and tubes in which to pack these medicines satisfactorily. Here again was an effort that required close cooperation between the trade and the Medical Department in order to meet the demand.
When it became evident that a declaration of war against Germany was imminent, the Medical Department proceeded to analyze the country's resources of medical supplies. These resources were to a large extent limited. The Allied nations had been making heavy and constant demands for these materials, so much so that even the mobilization of such a relatively small number of troops as were centered along the Mexican Border put a severe burden upon the medical supply facilities of the country.
The Council of National Defense took up the medical supplies problem at the outset. The various manufacturers sent their representatives to consult with the Surgeon General, and committees on surgical instruments, surgical dressings, medicines, and other important supplies were formed. These committees allocated among the various manufacturers the first emergency orders for these materials. The result was that the base hospitals at the 32 mobilization camps in 1917 were equipped in an amazingly short time. The New York Medical Supply Depot, which was then the largest purchasing agent, was called upon to supply 500 hospital beds each to 22 of the camps. This work was handled so rapidly that in some cases the shipments had to be held back to wait for the completion of the hospital buildings.
Perhaps the most difficult task was to determine what quantities of medical supplies would be needed for a given period. It is a comparatively simple matter to estimate the quantity of clothing necessary for a certain number of troops, or to figure what food they will require; but it is not possible to forecast the number of men who will be sick at a given camp at a specified time, nor is it possible to foretell the nature of diseases or injuries. An epidemic of measles or mumps requires different treatment than an epidemic of influenza, and makes necessary the use of a different variety of medical supplies. Experience sheets of supplies actually used in the past formed the basis of our requirements schedules.
Eventually there was worked out a system of supply based on the initial requirements of the unit of 25,000 men in the Expeditionary Forces and the automatic supply of replenishment of this equipment. In this system use was made of the knowledge and experience obtained by the British and French medical forces during their nearly three years of warfare before America went in.
The following statement of estimated expenditures for the fiscal year 1920 illustrates the difference in the medical requirements of an army of 500,000 men under peace conditions and an army of 5,000,000 men in a war such as the recent one:
| Peace—500,000 men. | War—5,000,000 men. | |
|---|---|---|
| Surgical dressings | $3,059,525 | $121,230,924 |
| Textiles, hospital supplies | 880,124 | 70,682,673 |
| Miscellaneous hospital supplies | 230,477 | 12,626,848 |
| Medicines, etc | 1,969,901 | 18,431,614 |
| Hospital furniture and equipment | 500,000 | 16,600,184 |
| Surgical instruments | 200,000 | 34,727,863 |
| Dental instruments, equipment, and supplies | 150,000 | 6,256,482 |
| X-ray, equipment, and supplies | 200,000 | 5,004,900 |
| Field supplies | 300,000 | 3,604,695 |
| Veterinary | 701,692 | 6,656,894 |
| Laboratory | 852,673 | 7,858,004 |
| Stationery | 159,183 | 2,228,634 |
| Total | 9,203,575 | 305,909,715 |
Civilian experts in various lines of medical supplies were brought into the organization to supply the wide range of specialized knowledge required in such a universal buying program as the Medical Department was about to conduct. Before the war the Army's purchases of instruments for oral and brain surgery, orthopedic supplies, Dakin outfits, and other special apparatus were practically negligible. During the war period these purchases amounted to millions of dollars. It may be seen readily that the purchasing office had to possess more than a superficial understanding of the materials to be bought.