The War Effort of New Zealand
Chapter VIII. — New Zealand Dental Corps
New Zealand Dental Corps.
New Zealand holds the proud position of being the first to recognise the necessity of, and to arrange for, the systematic dental treatment of its expeditionary forces. The then Minister of Defence (the Hon. Sir. James Allen) is to be congratulated upon having taken the responsibility for such an innovation. It was a step without precedent, but the results proved beyond all doubt its value.
On the outbreak of war two dental officers were appointed to the Medical Corps, and accompanied the Samoan expedition. A dental officer attached to the Medical Corps was also detailed for duty on each of the ten transports which sailed with the troops forming the Main Body. Owing to the short interval between mobilisation and embarkation very little treatment could be given in New Zealand to these troops, and as the amount of work necessary was considerable, the dental officers were kept very busy during the voyage to Egypt. Civilian dentists in various parts of New Zealand, meanwhile, did a great deal of work for the troops in camp, and also prior to mobilisation, and they did it either gratis, or at reduced fees, which were paid by the recruits themselves.
But in spite of what was then being done, a large percentage of recruits who were otherwise fit were rejected on account of dental defects. In June 1915, therefore, the N.Z. Dental Association made a patriotic offer to the Government to treat all recruits free of charge as far as time permitted, between enlistment and being called into camp, provided the Government reimbursed members for the material used. The offer was accepted, and for over two years this arrangement materially assisted in making the majority of the men of the reinforcements dentally "fit."page 139
At a later period it was decided to undertake all treatment in the camps.
When Mr. T. A. Hunter and Dr. H. P. Pickerill were in Wellington in June 1915 in connection with the Association's offer, they were asked by the Government to inspect and report upon the dental treatment then being given in the camps in New Zealand. Their report indicated that if all the troops were to be sent away dentally fit it would be necessary to establish and maintain a large and properly organised military dental unit to operate both in New Zealand and over-seas. Decision was deferred pending the arrival from England of Surgeon-General Henderson, D.G.M.S.
General Henderson approved the scheme and it was at once inaugurated, and steps were taken to establish the New Zealand Dental Corps. It came into existence in the closing months of 1915. The dental officers attached to the N.Z.M.C. were transferred, and additional officers were appointed in New Zealand, the body being a separate unit with a director and two assistant directors. The Corps in its early days was greatly indebted to the valuable assistance and advice of General Henderson.
The Corps was established in a small way. It was impossible to determine even approximately the number of officers and mechanics that would be required to cope with the work in the camps in New Zealand. A lapse of time was necessary before anything like reliable data could be secured regarding the average amount of work being done for reinforcements by civilian dentists prior to the men proceeding to camps. But small as the corps was its aim from the first was to send away every member of the Expeditionary Force with an efficient set of teeth. It is interesting now to measure that task to ascertain the extent to which the Corps succeeded.
The 9th and 10th Reinforcements were in camp when the members of the N.Z.D.C. began their work. The principal dental officers at Featherston and Trentham were soon compelled to ask for more help and the personnel of the Corps was accordingly increased. But it was not merely a matter of sending in more dentists. Special buildings had to page 140be erected—surgeries, hutments, workrooms and so on; mechanics and orderlies had to be provided and equipment secured, while all the machinery of the new unit, had to be created as the Corps grew. Standing orders were compiled, systems of charting had to be devised, the calling-up of patients and necessary details for handling thousands of patients in accordance with full military discipline and with the least possible interference with the training of the men, were all matters to be attended to, and it was all new ground. However, all was accomplished satisfactorily and the Corps steadily grew; but it was not until the 17th Reinforcements entered camp that it could be said the organisation in New Zealand was coping satisfactorily with the work. The 17th reinforcements numbered 1,998 men, and the treatment given them by civilian dentists, and in camp by members of the Corps amounted to 6,335 fillings, 5,237 extractions, and 854 dentures; while 371 fillings 48 extractions and 32 dentures still remained to be done on board the transports.
The policy of the Defence authorities was to send away a reinforcement each month numbering approximately 2,000 officers and men. The difficulty of coping with the work may be understood from the fact that the number of teeth requiring treatment varied from 3,016 in one reinforcement to 13,517 in another.
As most of the deck space on the earlier transports was required for the carrying of horses, the dental officers had difficulty in securing necessary accommodation. Cabins on some of the transports, which originally were allotted as dental surgeries, had at the last moment to be taken for the use of officers. On the majority of the transports the accommodation generally was insufficient, but this was only to be expected from the hurried mobilisation of the Expeditionary Force and the limited time available for transforming passenger and cargo ships into transports.
To render the men dentally fit to take the line at once was the particular work of the dentists accompanying the Main Body.page 141
During the voyage to Egypt a dental examination was made of all ranks. It revealed a rather serious condition of things. Patients were called up systematically and according to the urgent nature of the requirements. Fortunately the weather was very good and the sea generally calm, and operator and patient readily adapted themselves to the novel experience of treating and receiving treatment to the roll of the transports.
In Egypt dental officers were attached for duty to the various regiments, ambulances, (1st Field and Mounted) and details. As the Zeitoun camp was situated on the desert and timber and tents were at a premium, accommodation was necessarily very difficult to obtain, and the dental officers were relegated to a "bell" tent without flooring. But they got speedily to work and called up all ranks for examination and treatment. The establishment of the N.Z.E.F. did not provide for dental officers and great difficulty was experienced in obtaining recognition of our requirements. However, commanding officers quickly realised the importance of our work and soon did much to assist us.
The contrast between operating in one's own surgery fitted with modern appliances ensuring asceptic and hygienic conditions, and working in a "bell" tent without flooring, in the desert, can be imagined. The heat averaged between 110° and 120° in the shade, and a continuous plague of flies persistently irritated both operator and patient. Now and then violent sandstorms known as Khamsins swept over the camp and while they raged the tents perforce had to be laced up, thus shutting out the light so necessary. Yet no member of any unit had to be retained in Egypt as dentally unfit when the forces embarked for Gallipoli.
The Australian force, which had not been as fortunate as the New Zealand body in having dental surgeons attached to its medical service, soon realised the necessity for following suit. Although our own officers had more work than they could possibly undertake, the General Officer Commanding generously came to the Australians' assistance by temporarily transferring four Dominion dentists to the Australian hospital and ambulance sections.page 142
The British forces which were camped close to the New Zealand Mounted Brigade constantly reported to our clinics for dental treatment. These men's teeth for the most part were in a deplorable condition, and the gratitude of the "Tommy" after obtaining relief was no less marked than his astonishment at not having to pay for it. The invariable question was: "Is it true you take teeth out here for nothing"? Previous to our arrival the Egyptian dentists were making quite an income out, of the boys from Lancashire, who could ill afford to pay.
When the troops were ordered to Gallipoli the question arose of how many dental officers were to accompany them. Naturally all wanted to go. When it was announced that only four were to embark, two with our own forces and two with the Australians, speculation ran high as to who would be favoured. All doubt and anxiety were ended by the decision of the A.D.M.S. that a ballot should be taken. This, at least, was sporting.
No provision was made for dental transport, and the equipment allotted to each dental officer had to be considerably curtailed to such instruments and materials as were required only for the immediate alleviation of pain. The difficulty of transport was enormous. This applied to foodstuffs, and the troops were compelled to live mostly on hard biscuits and bully beef. It quickly played havoc with the men's teeth. A dental officer was detailed to Egypt to obtain further surgical equipment, trained mechanics and prosthetic equipment so that treatment of a permanent nature, and the making and repairing of dentures could be undertaken. Accommodation was provided at No. 2 Outpost, Anzac, for this purpose, and, after some months the staff was reinforced by five more officers. The hospital did splendid work considering the very adverse conditions that all ranks laboured under. The area was continually under fire, and, owing to the scarcity of fresh water, constant visits to the beach had to be made for sea water for use in the vulcanisers. The danger and difficulties of working under such circumstances can be imagined. But the clinic was the wonder and admiration of the British and Australian forces.page 143
Unfortunately a considerable amount of the Gallipoli equipment was lost during the subsequent evacuation, and this to some extent delayed operations at Moascar. However, with the assistance of the Commanding Officer of the 1st Field Ambulance, to whom we were attached, new outfit was soon purchased and a building erected, and a great deal of work was done during the four months training prior to the formation of the New Zealand Division.
When it was officially announced that the Division was to embark for France, General Godley ordered the re-organisation of the dental service. Capt. Finn, D.S.O. was appointed Administrative Dental Officer and sections were formed consisting of one officer, two mechanics and one orderly. Two sections were attached to each of the three field ambulances, and one to the Mounted Field Ambulance which remained in Egypt.
Soon after its arrival in France the Division took over the trenches east of the town of Armentieres. In order to centralise the dental work, a large building was secured and formed into a dental hospital, the personnel of which consisted of three dental officers, six mechanics, three orderlies, one cook and two fatigue orderlies. The greater proportion of the work at this institution consisted of extractions and the making and repairing of dentures. The surgical operations were carried out by the sections attached to the field ambulances. The dental hospital was established within 1¾ miles of the front line trenches, and this enabled all ranks to have treatment completed without being sent to the base.
At the New Zealand overseas base camp at Etaples two sections were stationed to treat all ex-patients from hospitals in France, and to do work which would accumulate amongst reinforcements waiting to reinforce the Division.
In September when the Division went to the Somme the dental personnel were ordered back to the base. They were disappointed, but the medical ambulance had only sufficient transport for their own requirementspage 144
In October 1916, the Division was withdrawn from the Somme. After a short rest we took over the old sector close to Armentieres, and the dental personnel were immediately recalled there. The dental work had accumulated considerably; but although working under adverse conditions, including frequent shelling by day, and bombing by night, considerable progress was made in reducing the accumulation. About this time the morning dental parades were considerably increased by an epidemic of Vincents angina, commonly called "trench mouth." This contagious disease was the cause of much anxiety to the regimental medical officers, whose morning sick parades contained numerous cases in an advanced stage. The ailment was a new experience to New Zealand soldiers. The treating of the patient near the front line by the dentists not only meant a saving in man-power and transport, but also prevented the men from becoming hospital casualties.
The New Zealand Stationary Hospital in France, although attached to a British army corps, also had its dental section the staff of which treated not only the British troops but the French and American. In addition they attended to French and Belgian civilians in districts where the dentists were absent on active service. The French soldiers and civilians were greatly surprised, when in answer to the invariable question "Combien s'il vous plaît, Capitaine"?, they were informed there was no fee.
Equipment and expendable material were obtained through the British medical depots in accordance with the contract which was made between the War Office and the New Zealand Government. Although at times, owing to the interruption of transport from the United Kingdom to France, material was delayed, this arrangement on the whole proved satisfactory.
At the Sling depot, on the Salisbury Plain, three dental officers and six mechanics were detailed for duty to complete as far as possible, in the short time at their disposal, treatment required before the drafts proceeded to France. During this period five extra dental clinics were established in the United Kingdom, one at headquarters, London (to attend to the staff and all ranks on leave from France), and one each at the hospitals at Brockenhurst, Walton-on-Thames, Hornchurch and Codford, where treatment as far as possible was completed during the stages of hospital attention, convalescence and light training prior to marching into Sling Camp. The remainder of the work necessary to make the men dentally "A" was done at Sling before they were included in drafts for the front.page 146
In November, 1916 the D.D.S., Lt.-Col. T. A. Hunter, left New Zealand to visit Egypt, England and France to inspect and report upon the work and organisation of the Dental Corps abroad. He found that the establishment was quite inadequate to cope with the work requiring attention. Steps were at once taken to remedy this by sending an officer and mechanic on each transport leaving New Zealand, who were to be retained for duty on arrival in the United Kingdom. As a further result of this visit better co-ordination was obtained between the work of the Corps in New Zealand and abroad.
In December, 1916, Major Pickerill arrived in England from New Zealand to take over the jaw fracture cases, of which there were now quite a number in the United Kingdom. These distressing cases were first treated at the Walton Hospital, to which a dental section was attached to assist Major Pickerill. In January, 1918, it was decided to remove this section to the British "Jaw Hospital" at Sidcup, and a dental section was attached to assist with dental treatment and the making and fitting of splints and appliances essential page 147to this branch of special surgery. The combination of oral and plastic surgery with prosthetic devices was one of the features of war surgery. The specimens now in New Zealand of cases treated at Sidcup, show the progress of recovery through the various stages, and form, indeed, a very interesting collection.
During 1917 several additional depots were established in England, viz.—at Grantham, where the Machine Gun Corps were located; at Brocton, the New Zealand Rifle Brigade Camp; at Boscombe (New Zealand Engineers); at Ewshott (New Zealand Field Artillery); and at Torquay (the evacuation camp). The N.Z.D.C establishment had also to be considerably increased. In April, 1918, the Deputy-Director of Dental Services was recalled to New Zealand under the exchange system then in progress, and Major Rishworth, who at that time was attached to the Jaw Section at Sidcup, was placed in charge. Under him the whole establishment was reconstructed and increased, providing one lieut.-colonel (Deputy Director of Dental Services), two majors, 41 captains and lieutenants, one quartermaster (W.O. Class II.), two staff-sergeants, 38 sergeants, 14 corporals, 53 privates—a total of 152 of all ranks.
Early in December 1918, Lieut.-Col. Rishworth was relieved to allow him to visit America to inspect and report later in New Zealand upon school dental schemes in operation there and his duties were undertaken by the Senior Dental Officer.
In the meantime the Director of Dental Services, Lieut.-Col. Hunter, had embarked for England, and on his arrival there he took over the administration of the corps. Nine other officers, who had been sent from New Zealand on his advice, arrived shortly after to assist in the final treatment of the men prior to embarkation, in accordance with demoblisation orders, and also to reinforce the Corps, which at this time was diminishing in numbers on account of dental personnel being sent on duty on transports returning to New Zealand.
There were difficulties even in repatriation. Men longest on service were transported first. This was particularly page 148unfortunate for them as the earlier classes had not had the same opportunity for dental treatment, and consequently, required more. However, as a dental officer accompanied each returning transport, the difficulty was to a great extent minimised. By the time the 1916-17 classes were due for repatriation the labour strikes, which were then general throughout the United Kingdom, delayed the departure of transports for about six weeks. This, though very hard on the men, was a blessing to the dentists for it enabled them to attend to all cases. It was hoped that the whole of the troops thus remaining in England would arrive in New Zealand dentally fit, and this subsequently proved to be the case.
There is little doubt that the dental treatment afforded the New Zealand soldiers was on a more generous scale and of a higher standard than in the case of any of our allies. The standard of treatment was a high one. This not only helped the efficiency of the soldier, but also the professional skill of the officers of the corps. The result, it is believed, has been that the people of New Zealand not only have a more efficient dental service, but the standard of the general health of a considerable number of the male population of the Dominion has been raised. It has, indeed, been stated by the Director General of Medical Services that the dental treatment of the New Zealand troops contributed in no small degree towards the reduction of disease and epidemics in the camps, and in making the soldiers more efficient as a fighting unit, and that it also ensured a more speedy recovery from disease and wounds.