The New Zealand Dental Services
Reallocation of Personnel
Reallocation of Personnel
The Second Echelon being dentally fit, or virtually so, one dental officer to 2000 men was a fair allocation to maintain fitness for three to six months. Three or four officers would be required at this ratio. With the First Echelon developing dental troubles, however, the three executive officers at the ratio of one to 2000 were not enough. The suggestion, therefore, was to transfer three of the seven officers, at that time with the Second Echelon, to Egypt, page 148 increasing the ratio with the First Echelon to one to 1000. That would mean an allocation of six dental officers to the First Echelon and four to the second.
This reallocation was dependent on two factors:
That the disposition of the contingents remained static.
That the war situation allowed communication of men and equipment between England and the Middle East.
At the time, it appeared as if the Second Echelon could be considered as part of the Division in the field, with a long line of communication between it and the Base. When the Mediterranean was open, France our ally and airmail to England took only two days, this was so and the ADDS could have remained as mentor and ultimate controller of the service as part of his existing organisation. The precedent of his advocacy for autonomy of control could have been used in the scales to counterbalance the inexperience of his deputy. The unequal level of distribution of his forces would have been adjusted by the natural flow in a linked organisation dependent only on the patency of the channel of communication. The fortunes of war decreed otherwise. Communication with England became a lengthy matter and the two forces were virtually isolated. Apart from arming his deputy with full information on the organisation of the dental services in Egypt and directing him to work on those lines, the ADDS had to leave all administrative details to be decided in England. The result was not a success.
Although full instructions were sent to the Senior Dental Officer by the ADDS, he was not given the opportunity to implement them or to overcome opposition. The result was that matters were taken out of his hands and the dental services became subservient to the medical, whose preoccupation with their own affairs is reflected in the relegation of the importance of dental treatment to a lower level than that in any New Zealand Army force in this war.
The Second Echelon did not join the Middle East Force until early in March 1941 although two units, the Convalescent Depot and 1 General Hospital, were despatched in September and November 1940 respectively. These two units took their own dental sections with them, leaving five dental officers in England. With the standard of dental fitness attained in New Zealand for the troops, this number should have been ample to maintain dental health and this could well have been achieved under the organisation proposed by the ADDS. Equipment was available, as that originally ordered from the War Office for Egypt was still in England. After studying the files from the office of the Senior page 149 Dental Officer in England, the ADDS summed up the situation in his war diary of 18 March 1941:
A … scheme of dental attention was put forward by the Senior Dental Officer…. The NZMC Administrative Officers dismissed the scheme and the NZDC personnel were left in localities completely out of touch with the troops.
It was not until practically six months later that the dental sections were placed with the troops where they carried out yeoman service, worked strenuously and rendered Units reasonably fit. A good example of the lack of assistance given to the NZDC was the fact that during the whole time the troops were in England, dental officers operated without gowns and for the most part without towels and soap…. The following extract from a report on the Service in the United Kingdom by the Senior Dental Officer illustrates the atmosphere which prevailed.
The Army Dental Corps has extended to the NZDC every facility it could possibly offer us, has explained to us its system of operation and on many occasions their laboratory has done urgent repairs or vulcanisations for us.
Most units of the NZEF have done their best to assist us and have been very tolerant in the matter of having to carry their men considerable distances for treatment.
The attitude of certain officers of the NZMC however has been consistently hostile….
It is obvious that the dental officers were working under unhappy conditions and [that] one and all realised that given the necessary authority they could be of more service to the troops. Under conditions such as this, the service could only be efficient either by being separated from the NZMC or, if responsible to the NZMC, then only in the matters of policy affecting the health of the troops.
Despite the above remarks, it must be realised that, as far as their specialist duties were concerned, the officers worked to capacity and individually carried out a good deal of treatment under adverse conditions. In the United Kingdom, Units were dentally examined and made fit. On board transports, between the United Kingdom and Egypt, all Units were dentally examined and an appreciable amount of routine treatment was completed.
The original intention to attach dental sections to units in the United Kingdom was announced in June 1940 but was not approved by the ADMS until 23 September. Only makeshift surgeries were available, with poor lighting and primitive facilities for hot water and heating. Despite the assistance of the Army Dental Corps in the provision of mechanics, the transport of dentures to the laboratory was so cumbersome as to outweigh many of the advantages. Prosthetic cases, after being packed in makeshift containers, were sent to the laboratory by ration truck—supply point—supply depot—Field Post Office—Base Post Office, and back by the same channel. It is to the credit of all in this long chain of transport that only one model was broken in some hundred cases, but there was a needless waste of time. The Senior Dental Officer eventually page 150 managed to improve the position by instituting a daily service round the scattered sections and back to the laboratory.
The delay in implementing a satisfactory dental service was fatal to the hopes of landing a ‘dentally fit’ force in Egypt. Even when the echelon was on the transport from England to Egypt, a journey of over nine weeks, the leeway was too great to be overcome under the difficult conditions on board. Excerpts from Captain Hefford's report on the voyage give some idea of the conditions of work and the dental state of the force:
The ship carried approximately 2,800 troops. There were three dental officers with three outfits and a kerosene vulcaniser. Accommodation was provided in two cabins with one porthole in each. The light was supplemented by extension electric lights. Being close to the side of the ship, the deck in these cabins had a considerable slope on it, making work in the field chairs difficult when the ship rolled, as it did in fairly moderate seas, being built with a flat bottom for the St. Lawrence River.
As no cards were available, the findings at examination were added on the side of specially prepared nominal company rolls. The amount of work required for each man was noted. Also whether he had artificial denture or dentures.
In addition natural dentures were classified as:
Teeth with a reasonable prospect of being retained for some years.
Mouths which, generally because of advancing ‘Gum’ degeneration, would probably require total extractions in the next two years.
Those cases where immediate extractions were indicated.
The examination was carried out on deck. It was not considered necessary to ‘Mop up’ those men who were not examined on the original days as the prospect of getting all the work done was never entertained.
The filling work showed a preponderance of interproximal fillings largely in lower premolars and upper molars.
|Number requiring treatment||1087|
|Number of fillings||1127 (Add 250 which will be found on treatment)|
|Number of scalings||460|
|Number of extractions||99|
|Number of new dentures||34|
|Number of remodels||199 (Not all very urgent)|
|Number of repairs||87 (Not sufficiently urgent to warrant immediate work)|
|Number made fit||252|
|Number of fillings||456|
|Number of scalings||163|
|Number of extractions||109|
|Number of denture repairs||41|
Taking into consideration that the force was dentally fit on embarkation from New Zealand and had never been without a generous proportion of dental officers, the dental condition should have been better. It emphasises the danger of allowing work to accumulate. With the large number of artificial dentures, in this case 2185 single dentures in 2265 men examined, there will always be repairs and remodels as well as replacements of those lost. A soldier dependent on artificial dentures will obviously be less efficient without them and any delay in remedying that loss must react on the efficiency of the force as a whole. Dental caries is a progressive disease and the preponderance of interproximal cavities in the mouths of those examined above shows that the progression had advanced to a stage when a proportion of those teeth might have to be extracted. The ground was being prepared for more denture-wearers.
It is now necessary to return to the Egyptian scene of May 1940, when the diversion of the Second Echelon to England forced a reconsideration of all plans of the 2 NZEF. There was a feeling of anti-climax; an enforced respite due to uncertainty as to the future and, in the Dental Corps, a strangely coincidental abatement in the flow of work. The time was opportune to look searchingly into the organisation, to test its efficacy for every imagined contingency, to shore up its weaknesses and prune its dead wood.
At the beginning of June the troops were still in Maadi Camp, so the arrangement that all dental personnel remain with the Camp Dental Hospital was eminently satisfactory. Should movement orders be received, it was simple to attach a section to a field ambulance as transport was available for that purpose. There was one weakness here regarding the equipment of a dental mechanic. In the British field ambulance a mechanic was not included and the only mechanics' outfits supplied were on the basis of a field laboratory, where two mechanics would be working together. These outfits could only be divided into two by the addition of quite a number of essential items of equipment. Arrangements were therefore made with the Field Park Company to reinforce three packing cases, converting them into temporary prosthetic panniers. These were to contain equipment and one month's supplies to enable denture work in the field to be begun at a moment's notice. The field mechanics' outfit for two mechanics, with the addition of supplies and equipment purchased locally and items such as hammer, nails, small saw and scrubbing brush, would equip two such panniers. Should they be required in the field, the camp dental hospital could draw another page 152 field mechanics' outfit from the medical stores for use in the meantime. The principle of pooling equipment and re-issuing according to changing circumstances was ready for testing.
The ADDS was anxious to try out the field organisation as soon as possible, and when two battalions and other troops moved to the region of Mersa Matruh in late June 1940 he immediately suggested that a dental officer should accompany them. At this stage, however, the AA & QMG would not agree, as the troops were being relieved every two or three weeks and could be treated each time they returned to Base. It was nearly two months before the opportunity occurred.
A certain amount of confusion was evident between Egypt and New Zealand regarding the amount and nature of equipment received from England, as well as of the number and status of reinforcement personnel required. There were several factors responsible for this. The exact nature of the War Office issue of equipment was not understood by the DDS, which made the cables from the ADDS, based on a presumption of this knowledge, unintelligible. The destination of the Third Echelon was unknown, which made the assessment of reinforcement requirements difficult. In addition to this there was a conflict of opinion between the ADDS and the DDS, already mentioned, as to the number of dental officers and mechanics necessary to maintain fitness in the troops then in Egypt.
The opportunity was now approaching to try out the organisation in the field. At the end of August the Division, as yet only of brigade strength, moved to the Western Desert. This meant that only 700 to 900 men would remain at the Base. The ADDS suggested that one dental section should remain at the Base to service these men and that two dental sections, one with a mechanic, should be attached to a field ambulance with the Division. He also proposed to attach himself with staff and dental equipment to Divisional Headquarters, but this was not approved by the AA & QMG, who thought it better for the ADDS to remain at Maadi and make occasional visits to the troops in the field.
Field dental outfits were measured and weighed to give information for loading tables. Mechanics practised packing and unpacking panniers. The dental sections to be attached to the field ambulance practised loading and unloading the 15-cwt lorry, which was to carry one complete section with surgical and prosthetic panniers, tent RD (Ridge, Double), personal kits, etc.
It was not possible to organise anything but a temporary service in the field at this stage but valuable information could be got as to the future role of dental sections, both with the field ambulances page 153 and as part of a mobile section. It immediately became obvious that preconceived ideas as to the character of mechanised desert warfare would have to be changed. The degree of mobility and the amount of dispersion had been underestimated. As an example, at this time Divisional Headquarters was at El Daba, some 190 miles from the Base. The Main Dressing Station was about 60 miles from El Daba and the Advanced Dressing Station another 150 miles away. It was no use therefore having a centrally situated mechanical laboratory to which denture cases were to be sent from the various sections. It was also essential that the sections attached to the field ambulance should have the mechanic restored to their establishments. One dental section would not be able to cover even a field ambulance whose Main and Advanced Dressing Stations were so far apart. There were no troops on foot. Everyone was motorised and this meant that every unit, sub-unit or section had to have its own transport with it at all times. Sudden moves might occur at any time, so a sub-section could not be attached and left with a unit while its transport returned to headquarters to pick up another section. More vehicles would be required for the Mobile Section than were included in the proposed establishment, and experience in the field pointed to the 15-cwt truck as being the best for the purpose. Already it was becoming apparent that standardisation of transport as well as equipment was of fundamental importance. Specially designed vehicles, such as the mobile laboratory included in the Mobile Dental Section due to arrive shortly in Egypt, were peacetime luxuries of possible service in the Base but white elephants in the field. Apart from enemy activity, the rough terrain of the desert and big mileage exacted a heavy toll on all vehicles, making those which were difficult to replace a liability rather than an asset.
The orthodox British dental establishment was found to be insufficient under field conditions, lacking flexibility and mobility. The break away from the traditional organisation was already paying dividends and attracting attention.
On 30 September 1940 Major Fuller wrote in his war diary:
Reports from the Dental Sections attached to the 4th Field Ambulance in the Western Desert indicate that the two dental officers are being of invaluable service to all troops in their area. The sections were carrying out routine treatment within the first twenty-four hours of arrival at the camp site and have since been very busy. Reports from outside sources relate that Senior British Officers tend to be impressed by the fact that the Field Dental Section is carrying out routine denture work in the Field with little or no difficulty. It seems essential that facilities be available for doing denture work in the Field and I cannot understand why on such a long line of communication, the British Dental Sections do not carry prosthetic equipment. The Dental Officer attached to Headquarters Company, 4th Field Ambulance (Lieut. W. McD. Ford) reports ‘British Army equipment page 154 (is) quite satisfactory for a Standing Camp but in my opinion has to be augmented by too great an extent from QM Stores and then becomes too bulky for rapid movement. This is an unsatisfactory factor…. The New Zealand outfit would be ideal with its two panniers containing a minimum of essential equipment; especially the chair case with the collapsible table, canvas buckets and canvas wash basins…. This would eliminate having to rely on the Field Ambulance quartermaster for equipment…. The prosthetic outfit we have here is working very satisfactorily; the lathe head works very well with the treadle of the foot engine.’
In regard to the lathe head working well with the treadle of the foot engine, this was later found to be incorrect as there were frequent fractures of the treadle through overstrain. This was overcome by buying locally some hand-operated mechanical grinding machines. The emery wheel was removed and replaced by lathe chucks. These were included in the mobile field panniers. The gearing was such as to produce enough speed for polishing.
One of the difficulties of pioneering is to gain recognition of the new order by others. No dental scheme, however soundly conceived, could be put into practice unless it was recognised as part of the general organisation of the force. Hitherto, dental sections were attached to medical units and moved only with those units. Movement orders therefore only affected Mary and not the lamb. When it was realised that the dental task could not be accomplished under the limitations of this rigid attachment, it was not immediately appreciated that another unit had to be considered when movements were taking place. The Administrative Instructions No. 1, ‘Action in event of move of Division from Maadi’, issued on 13 August 1940, were sent to Major Fuller but they contained no mention whatsoever of dental matters. Admittedly the dental sections were moving with 4 Field Ambulance, but the dental problem belonged to the ADDS and he had fully outlined his plan of campaign to the ADMS. The facilities for dental treatment in the field were a part of the general organisation that should have been familiar to all unit commanders. The field ambulance had for some time been without its dental section while all work was being done at the Maadi Camp dental hospital. There was therefore no official intimation that dental sections had again been attached to the field ambulance or even if there were to be any facilities at all for dental treatment in the field.
On 31 August 1940 information was received that the First Echelon was not to remain isolated for much longer as the Third Echelon from New Zealand and the Convalescent Depot from England were expected within a month. It was known that the Convalescent Depot had a dental section attached, but the exact number of dental personnel to arrive with the Third Echelon was page 155 still in doubt. The ADDS was continuing his policy of writing at length and often to the DDS, but his recommendations were not always accepted and the answers to his letters were infrequent. He knew that the Mobile Dental Section with 8 officers and 26 other ranks would be arriving, as also would a field ambulance and general hospital, each with a dental section, but it was not until the echelon disembarked that he realised that there were in addition 3 officers and 9 other ranks for attachment to the Base.
However, the exact number did not affect the general arrangements and he was able to outline his proposals at a conference of heads of services with the AA & QMG on 1 September. His diary of that date reads:
Submitted scheme as follows which was approved:
Present Camp Dental Hospital at Base to become Base Dental Hospital, to be responsible for rendering all reinforcements and ex-hospital patients dentally fit before proceeding to the Field and that all personnel returning to New Zealand are also rendered dentally fit.
The Divisional Mobile Dental Section which is a self-contained unit to be located in a central camp area, to establish a tented Camp Dental Hospital and be responsible for the dental fitness of the third contingent in addition to carrying out a training programme.
The ADDS's office and store to be transferred to Administrative Headquarters 2 NZEF located in a new building which will have accommodation for dental officers. This building would be used as a dental hospital when the camp is filled with reinforcements and the Mobile Section is in the Field.
The Base was to be at the extreme end of the camp area while the new office and the tented camp dental hospital were to be centrally situated. The ADDS was unable to advise about equipment as he was still in the dark as to what was being forwarded from New Zealand with the echelon, or if that originally ordered from England was coming soon. He could only assume that these matters had been satisfactorily arranged between Army Headquarters in New Zealand and the representative in England. The broth was being stirred by many cooks.
His plan for Dental Headquarters consisting of ADDS's office, NZEF store and reinforcements camp dental hospital, as well as the site, were approved. For the Mobile Dental Section he was able to get three buildings in the Engineers' area, one for a store, one for an office and hospital, and one for a dining room. The section would share a cookhouse with an Army Troops Company and the officers would mess with the same company.
The Convalescent Depot, detached from the Second Echelon in England, arrived in Egypt on 17 September and its dental section was absorbed into the Base until accommodation became available page 156 with the Depot itself. As there were administrative difficulties associated with the shortage of equipment, the ADMS agreed to release the dental equipment brought to Egypt by the Convalescent Depot for use in Maadi Camp. Later it will be seen that the system of pooling personnel and equipment, with subsequent reallotment, of which this was the harbinger, became universal in the New Zealand Dental Corps with this force. A similar situation already existed in respect of No. 4 General Hospital at Helwan, which was at this time without a dental officer, being visited once a week by one from Maadi. It must be remembered that neither the General Hospital nor the Convalescent Depot was functioning as such, and therefore did not require the undivided attention of a dental section.
On 29 September, in company with the ADMS, the ADDS went to Suez to meet the long-awaited Third Echelon. Everything possible had been done to prepare for its arrival. The body for the Mobile Dental Laboratory was to be transhipped to the Vehicle Reception Station at Abbassia, pending arrangements to mount it on a 4-ton vehicle; the personnel were allotted in theory; the plan was complete to cope with the expected inrush of dental treatment and the hungry coffers were ready to receive equipment.
As already stated, there were more reinforcements than the ADDS expected, but this was not all. The echelon had brought no dental equipment with it, with the exception of the mobile laboratory, and even that had been left in Bombay in the charge of an officer from the Mobile Section. Sixth Field Ambulance had also remained at Bombay. Even with full equipment available, there were more men than could be employed for some time to come and the ADDS felt the embarrassment of being over-staffed at a time when he was trying hard to impress all concerned with the necessity of building a comprehensive dental organisation against future contingencies. The shadow of the axe lay over his schemes, haunting him with possibilities fatal to achievement of the type of service he knew would be required when the Division went into action. In the meantime it was essential to find something for everyone to do. On 30 September he wrote in his diary:
Dental officers with third contingent attached Base marched in. Equipment from the Convalescent Depot is to be drawn and this will be issued to the Base Dental Hospital. Pending the arrival of equipment from England for the Mobile Dental Section the Base Dental Hospital will have to work to capacity to cater for the requirements of the Third Contingent in addition to its normal routine duties. General Hospital, Convalescent Depot and 6th Field Ambulance will have to remain without equipment in the meantime. The Mobile Dental Section will occupy time with Field Training.
The Mobile Dental Section, under the command of Major J. A. S. Mackenzie, disembarked on 1 October and on 3 October the ADDS page 157 arranged a meeting of all dental officers of the Third Echelon and gave them his standing instructions and an outline of what was expected of them overseas.