The New Zealand Dental Services
The proposed establishment of the unit was:
The proposed establishment of the unit was:
|Officers||One Major and seven Captains or Subalterns.|
|Staff QMS||One Warrant Officer (Second Class).|
|Dental Clerk||One Staff-Sergeant or Sergeant.|
|Dental Orderlies||Three Staff-Sergeants or Sergeants and five rank and file of whom two might be corporals.|
|Dental Mechanics||Three Staff-Sergeants or Sergeants and two rank and file.|
|Mechanics' Orderlies||Two rank and file.|
|Motor Cyclist||One rank and file.|
|Batman Drivers I.C.1||Two rank and file.|
|Cooks||One rank and file.|
Attached personnel from the NZASC were ten drivers for first-line transport, of whom one could be a corporal.
|Motor Car, Heavy||One.|
|Lorries 30-cwt 4-wheeled||Two.|
|Lorry 4-ton for use as Mobile Laboratory, fitted||One.|
|Trailer, Water tank||One.|
|Field Surgical Panniers||Eight.|
|Field Chair Cases||Eight.|
|Field Prosthetic Panniers||Eight.|
|Field Store Panniers||Eight.|
|Mobile Prosthetic Laboratory outfits||One.|
|Tents, Ridge Double (RD)||Eight.|
Tents R.D. were to be used as operating tents for the dental officers with the sub-section.
1 In charge.
Outlined my ideas on the Mobile Dental Section to its Commanding Officer, viz., the section will need to consist of a Headquarters and six completely self-contained detachments, each detachment carrying surgical and prosthetic equipment and a mechanic being included in the personnel. They will in effect become dental detachments attached to units in the Field and will have little or nothing to do with the Mobile Section Headquarters. It will not be satisfactory sending denture work back to the Mobile Laboratory except in tactical situations where the Force is static and where either the units or the Mobile Section can readily be found. The Mobile Laboratory will not necessarily be able to be used in the Field. This will depend on the degree of mobility and the condition and number of roads. It will be most satisfactory on the Lines of Communication. It will probably be the tendency to carry portable prosthetic equipment with the Headquarters, this equipment to be such that a mobile prosthetic laboratory can be improvised away from the vehicles and on the ground. The detachments will return to the self-contained Head-quarters when not wanted in their respective units, e.g., before a prospective advancement or retirement.
It must not be thought that the ADDS was not in favour of a Mobile Dental Section for he realised that it was the only satisfactory dental service to the force in the field. His view, however, was that it should be part and parcel of the general organisation, under his direction and with its personnel interchangeable with those in other units if desired. Major Fuller tried to iron out the difficulties by pointing out to Major Mackenzie that there were two situations in which the Mobile Section was expected to work, i.e., in the field and at the base, and that while at the latter it was necessary that the unit be deployed by the ADDS in the same way as other Dental Corps units. No agreement was reached between them and it was obvious that convictions on both sides were deeply rooted. Not only was a clash inevitable but the whole question of command had to be settled if the dental services in the 2 NZEF were to function smoothly. The climax occurred when Major Mackenzie wrote to the ADMS asking for a ruling about the channels of communication to be used by the unit. The answer by the ADMS, if agreed to by the ADDS, would have retarded the progress already made towards autonomy of control of the Corps. The challenge had to be accepted. The ADMS's ruling was as follows:page 162
To O.C. Mobile Dental Section.
Reference your memo of even date on the subject (Channels of Communication) after discussion with Officer in charge Administration and AA and QMG it appears that the Mobile Dental Section may at times be employed with the Division in the Field and at other times at the Base.
When with the Division the channels of communication are O.C. Mobile Dental Section – ADMS (and if necessary – DDMS, who might ask advice of ADDS).
When at the Base the channel of communication is O.C. Mobile Dental Section – ADDS – DDMS.
HQ NZ Div. 10 October 40.
This ruling would have placed the dental services in the field completely under medical control. It was indefinite in proclaiming the status of the OC Mobile Dental Section but assertive in lowering the status of the ADDS, weakening his control over NZDC units and personnel. Fortunately the subject was still open for amicable discussion, as instanced by an entry in Major Fuller's war diary of 10 October:
Interviewed DDMS and ADMS and discussed the question of channels of communication, powers of O.C. Mobile Dental Section, his relation to the ADDS; in general the relationship between the Medical and Dental Services and in particular the relationship of the ADDS to the DDMS.
The DDMS realises that the ruling of the ADMS will require modification. He has made me believe that my feeling that the service was becoming under the complete control of the NZMC was an inference from the unfortunate choice of words in the ADMS's memo and that they had not intended any such policy. It was pointed out to the DDMS that the ADDS will be held responsible by the DDS for any shortcomings and that he will also be held responsible by the Dental Profession for general policy. Accordingly there can be only one authority – the ADDS. The DDMS has undertaken to have the whole question reconsidered by the Officer in charge Administration.
This sympathetic attitude of the DDMS brought excellent results and went a long way towards establishing a happier relationship between the medical and dental services. Colonel W. G. Stevens, Officer in Charge of Administration, became arbitrator and, after hearing both sides of the dispute, gave a clear and concise ruling:
… The situation has changed in the interval between the sailing of the Mobile Dental Section and its arrival in Egypt. The present situation is as follows:
The DDMS is responsible for the health of the NZEF as a whole. The ADDS while retaining a certain degree of independence technically, is responsible to the DDMS for the dental health of the NZEF.
The ADMS is the deputy of the DDMS within the Division.page 163
The ADDS commands the Dental Corps in the NZEF. The Mobile Dental Section is therefore under his command as far as personnel and technical work is concerned and at all times [will] be at liberty to communicate with the ADDS direct on technical matters.
While with the Division in the field, the Mobile Dental Section comes under the command of the ADMS as far as its location and duties are concerned. It should communicate with the ADMS on these matters. If necessary the ADMS communicates with the ADDS, a copy of such correspondence going to the DDMS.
The Officer Commanding the Mobile Dental Section will presumably be the senior Dental Officer with the Division in the field and is therefore the principal adviser of the ADMS on dental matters.
When not with the Division in the field, i.e., while under training in Maadi Camp, the Mobile Dental Section is under the ADDS for all purposes, the ADDS in turn reporting if necessary to the DDMS as in (1) above.
Headquarters 2 NZEF, 14 October 40
This was in effect practically identical with the instructions given by the ADDS to the Officer Commanding the Mobile Dental Section on arrival in Egypt. A memorandum from Colonel Stevens to the ADDS on 18 October further established his position:
Establishment – Headquarters Dental Services 2 NZEF.
Ref your DD 4/1/349 dated 27 Sept. 40, the establishment drawn up therein is approved.
In order to clear up any misunderstandings, it has been arranged that a notification of the appointment of Major Fuller as ADDS 2 NZEF will appear in a future issue of NZEF orders.
To the ADDS and the Corps in Egypt the importance of this controversy lay in the success of the solution. To the historian, however, falls the duty to probe more deeply in order that the reasons for the controversy shall be exposed as a lesson for the commander of the future.
There is no doubt that the commander of the Mobile Dental Section honestly believed that his unit was to be apart from the general organisation under the ADDS and that the DDS had fathered this belief. The DDS's ‘Notes on the N.Z. Divisional Mobile Dental Section’ stated that the OC in the field would be responsible through the ADMS to the ADDS for the dental health of the Division. Two days later, on 29 April 1940, in a letter to Major Fuller he contradicted this:
The Mobile Unit will not be broken up as they will all be selected and trained and MacKenzie will command not you as I stated in the original notes to ADDS and GOC. You have got your own job and cannot handle a unit like this.
This was tantamount to a vote of no confidence by the DDS in the ability of the ADDS to carry out the command delegated to him. It meant that the ADDS was expected to accept full responsibility but was to be deprived of full authority. The attempt to influence the organisation of the dental service to the 2 NZEF from Army Headquarters, Wellington, placed both the ADDS and the OC Mobile Dental Section in an invidious position and should be accepted as the real cause of the friction. If this is accepted as a reasonable deduction, the corollary is that, once there is decentralisation of command, there should be no interference from the higher authority except in the case of inefficiency or a similar reason. The principle, applied to the dental services with the 2 NZEF, would place the ADDS in command of all NZDC personnel, enabling him to delegate his command to units such as the Mobile Dental Section when circumstances warranted it. The main point is that the delegation of command must come from no other source than the ADDS, who should have not only this power but the power to change the personnel of any unit should he deem it necessary. Only under these circumstances could he be expected to accept responsibility. The responsibility of the ADDS to the DDMS for the dental health of the force has never been questioned either in New Zealand or in Egypt.
Having fitted the Mobile Dental Section into place in the general scheme, it is now possible to return to a consideration of some of the events which influenced the development of the final organisation. Some of these are possibly only of historical interest, but others are worthy of close study if the mistakes of this experimental period are not to be repeated.
The embarrassment of too much staff and too little equipment was temporarily relieved by the Australian division at Helwan Camp. It was so short of dental officers that even all the urgent treatment could not be undertaken. As the division had some equipment, four officers, four orderlies and four mechanics were lent to it from the Mobile Dental Section. This suited everyone. The ADDS was relieved of surplus staff, the OC Mobile Dental Section found employment for his men and, as the loan was entirely unofficial, the Australians received dental treatment at no other cost than rations for twelve. A strange contrast to this co-operative gesture occurred at the same time at El Daba, where the headquarters of 4 NZ Infantry Brigade was situated. The British dental officer at the Casualty Clearing Station there refused to treat New Zealand troops, so as the NZDC officers were with the page 165 field ambulance many miles away, arrangements had to be made to bring someone from Maadi. Had this occurred before the arrival of the Third Echelon it might have proved embarrassing.
The ADDS paid a visit to the field ambulance dental officer, whose experience in the field helped to crystallise his thoughts on methods of packing equipment. It appeared that the British outfits ought to be condensed, each pannier providing equipment for a definite task. By the rearrangement of the contents, one pannier could become surgical, one stores and supply, and the foot engine could be carried in a small, flat, specially designed ‘suitcase’. (It will be remembered that in the New Zealand surgical pannier the foot engine was included but that there was no room in the British pannier for it.) This would mean that the Dental Officer could move with surgical equipment only, or with equipment and engine, leaving excess stores behind at his headquarters.
On his return to Maadi the ADDS received Colonel Stevens's memorandum mentioned above. The satisfactory ending to this unpleasant interlude was, however, only a milestone on a rocky road.
A subject demanding immediate attention was the appointment and promotion of officers, which under the rules promulgated by the DDS for the NZDC was producing some awkward anomalies. The search for a just solution to this problem required a consideration of many intricate details more of legal than of historical interest. The issue would only be clouded by including them so the description will be kept on broad lines, with more emphasis on policy than on ingenuity of solution.
Fundamentally, the anomalies were caused by a scheme of promotion of officers in the Dental Corps initiated by Headquarters in New Zealand, which was adhered to in that country but was unacceptable to the 2 NZEF. The result was that officers of the First Echelon found themselves superseded by later arrivals in Egypt. The desire of the DDS to secure adequate rank for his officers, which found expression in his successful advocacy in New Zealand, unwittingly produced injustices which his inability to force acceptance of his scheme overseas made him powerless to correct. A rigid adherance to this scheme by the DDS must lead to further injustices unless the 2 NZEF could be persuaded to adopt it too, and there were difficulties with this. There were only two courses open to the ADDS. One was to see that suitable antedated substantive rank was given to the officers of the first and second contingents who would be entitled to it under Dental Corps rules. The other was to see that in future only lieutenants or temporary page 166 captains arrived from New Zealand, so that substantive rank could be conferred according to merit and ability and without prejudice to existing seniorities.
The first course received a sympathetic hearing from the Military Secretary but met with strong opposition from the DDMS, who considered it unfair to some medical officers. The obvious suggestion that the discrepancy might be better adjusted by an improvement in Medical Corps facilities rather than a curtailment of those in the Dental Corps produced a deadlock while Army Headquarters in Wellington was asked for elucidation. The ADDS continued energetically to stress the importance of remedying the injustice, pointing out that the personal feelings of medical officers were being allowed to exert an improper influence in a Corps outside their own.
The justice of the cause triumphed and, in spite of having complained by airmail letter to the DGMS about the Dental Corps rules for promotion, the DDMS did not wait for an answer but gave his approval. The necessary adjustment between the New Zealand and 2 NZEF rules was made and it was agreed that in future promotion would not be automatic but would rest entirely on the recommendation of the ADDS.
It will be noted that the DDMS still acted on the assumption that the Dental Corps was under his direction as part of the Medical Corps, and this attitude permeated all the developmental stages of the Dental Corps. There were constant battles over channels of communication and innumerable conferences between the DDMS and the ADDS in which widely different opinions gradually became reconciled under a mantle of mutual respect and confidence.
At the end of October the Mobile Dental Section, seeking the solution to a small problem, became instrumental in deciding a matter of major policy in the Middle East. The ADDS forwarded a memorandum to the DDMS and ADMS asking:
Should the unit be armed with weapons and trained in their use?
Should they be issued temporarily with weapons, trained in their use and later, in the field, issued with arms should conditions demand it?
Should the unit receive neither arms nor weapon training?
This brought up the whole question of the personal defence of medical and dental personnel, which apparently had not been fully considered before. The copy sent to the ADMS went on to the AA & QMG and from there to HQ 2 NZEF, to the GSO I and the GOC. The DDMS's copy went on to the DDMS BTE and then page 167 to the DMS Middle East (General Tomlinson). The final decision was that the Mobile Dental Section was to be considered in all respects similar to a field ambulance, i.e., officers could be armed with revolvers but no arms were to be carried by other personnel of the New Zealand Dental Corps.
As a change from the navigation of the uncharted seas of administration, the appearance of a purely dental problem presented little difficulty of solution. Two patients from the Australian camp at Helwan were admitted to 2 General Hospital suffering from osteomyelitis.1 It was considered that this infection had arisen from posterior superior dental nerve blocking for dental extractions. It was not reported whether Australian or New Zealand dental officers were the operators. Although recognised as a legitimate technique in local anaesthesia of the maxilla, this type of injection is seldom necessary for other than extensive surgical operations which would be performed under hospital conditions. In the dust-laden atmosphere of Egypt the observance of rigid asepsis, so essential to avoid post-operative complications, was difficult and what might have been perfectly justifiable in Australia or New Zealand became a surgical risk in Egypt. The ADDS therefore gave instructions that neither the infra-orbital nor the posterior superior dental nerve blocks would be used in Egypt by the New Zealand Dental Corps.
In November 1940 the first of the reinforcements, known as the 4th Reinforcements, was ready to leave New Zealand for Egypt. The DDS took advantage of this to implement a scheme for dental reinforcements which, while providing a dental service for the voyage, gave the ADDS the opportunity to maintain his force at its fullest energy. Apart from dental personnel attached to such medical units as general hospitals, etc., he decided to allot in future to each transport one officer, one orderly and one mechanic for duty on the voyage and return to New Zealand. These were seconded to the 2 NZEF and if required by the ADDS could be retained in the Middle East, allowing unsatisfactory or burnt-out personnel to return in their stead. To overcome possible embarrassments an NCO being retained overseas was liable to revert one step in rank.
1 A serious bone infection.
On 13 December the unit moved to Helwan Camp. Its first task was to be the re-examination of the entire First Echelon as soon as it arrived in the camp and the establishment of dental fitness. In addition it was responsible for attending to all urgent cases at the prisoner-of-war camp at Helwan. Later a captured Italian dental surgeon worked at this camp.
The Mobile Dental Section was to be used, as it should be, as part of the general organisation working as a camp dental hospital under the direction of the ADDS, but still under the command of its own OC. At the same time, the dental sections attached to 4 and 6 Field Ambulances were operating a tented dental hospital at Helwan to take care of the Third Echelon and had borrowed two mechanics from the Base for this purpose. No. 1 Camp Dental Hospital was open in Maadi for all routine treatment and the Base Dental Hospital was attending to all patients from the Discharge Depot and Reception Depot.
The NZDC organisation was not only beginning to take shape but was attracting attention from other dental corps in the Middle East. As a fitting conclusion to 1940 an extract from a letter written by Major Fuller on New Year's Eve to Colonel Finn is quoted:
Colonel McCallum [newly appointed DDS of the Army Dental Corps] rang me yesterday from Middle East [Headquarters] and has come to realise that they have been working along the wrong lines as far as dental treatment in the field is concerned. Largely as a result of the publicity given to us by Ford [Captain W. McD. Ford, NZDC] up in the desert and from conversations with him he now intends putting mechanics with British Field Ambulances. War Office are showing signs of similar opinion. As McCallum says their policy has been centralisation; he now realises that it should be decentralisation. That is my opinion too, even within the Division. The small sections are the only solution in modern warfare.
Lieutenant-Colonel Downs, the Australian ADDS is interested in the organisation we have developed. Colonel McCallum who is also keenly interested met him in Palestine and discussed some of our ideas with him. Downs is coming down from Palestine on the quest for details and McCallum has asked me if I would meet the two of them and take part in a three party discussion.
At the close of the year it appeared as if smooth waters had been reached but in the second week of 1941 another stone was flung into the pool. Further differences of opinion arose between the ADDS and the ADMS of the Division regarding the control of the dental personnel in Helwan Camp. On the dental units being posted to Helwan the ADMS had agreed that such communications as returns of work, parade states and indents on the dental store could be sent direct to the ADDS, a copy only being sent to him for information. Movements, on the other hand, were all to go through the ADMS. This, however, did not suit certain medical officers who gave contrary instructions to the dental officers attached to them. They objected to the ADDS writing direct to the dental officers and insisted that all correspondence without exception should go to the ADMS. It appeared that the page 170 question was developing into a major issue which might eventually need discussion between HQ 2 NZEF and HQ NZ Division. The entry in the war diary of the ADDS of 14 January expresses his opinion at the time:
Interviewed ADMS at Helwan in reference to the question of administration and command of dental units in the Division; discussed all angles of the case at some length and we were unable to come to an agreement or decision. The ADMS feels that the Division should be considered as being in the field and that now all dental personnel within the Division for all purposes are part of his command; that their function and duties are no concern of the ADDS; that the ADDS may not communicate with the dental officers direct and that in effect the Dental Corps personnel within the Division are lost to their Corps. On the surface, this dispute would appear of minor importance; the details of the case concern channels of communication, in particular to indents, weekly returns, etc. and arguments over these apparently minor details created the impression that the complaint is petty. But actually the whole question, built up on minor details, becomes a major issue. It is not the details to which one objects as the service will run no less efficiently if all correspondence without exception passes through the ADMS but it is the spirit of the matter, the attitude of the Medical Service as expressed by the ADMS who states that the dental sections in the Division are his concern entirely; who states that their ultimate responsibility is not to the ADDS. Thus it is a question of the principle involved.
The ADMS states that since the ADDS is responsible to the DDMS so are the dental personnel in the Division responsible to the ADMS entirely. This attitude in practice will not create inefficiency where we have as at present an ADMS who actually will not obstruct the work of the NZDC but on the other hand the appointment could quite easily be filled by an officer with no understanding of dental service problems and who, without dental intervention, would obstruct the work of the NZDC.
Difficulties such as this always arise where personnel of one arm of the service are attached for duty to another arm of the service but in our instance the position is made considerably worse by the fact that in an indefinite manner the ADDS is responsible to the DDMS and by the fact that the Medical Services consider that the dental services are part of them. In other words the dental service has independence only when it suits the other party. Normally there is no friction; it is even possible to state that there should be no friction but yet, to the detriment of the dental services, in each instance where the senior administrative Dental Officer proposes a policy which will conflict with medical opinion, the proposal, instead of being considered by an outside and unbiassed opinion, is invariably quashed in the early stages through having to pass through medical channels. The liability for this to happen always exists.
In the case of the NZDC there would appear to be only one solution—an independent service with the head of the service directly responsible to the Adjutant-General's branch. It then follows that within the Division the administrative arrangements may be either:
A DADDS to be on Divisional Headquarters Staff when the Mobile Section is within the Division, to be responsible for the dental arrangements within the Division and to co-operate and work in conjunction with the ADMS.page 171
the ADMS to act within the Division on behalf of the ADDS as regards dental matters.
These comments written at the time reveal a depth of feeling probably engendered by a fear that further encroachment was imminent and that the carefully laid plans for a dental organisation for the whole force would be adversely affected. The important fact was that the troops in Helwan, especially those of the First Echelon who had need of extensive dental treatment, should have as much work done for them while in camp as possible. The problem was a dental one and the ADDS was near at hand to assist in its solution. It is unlikely that the ADMS would have the requisite knowledge to tackle this problem without advice. Admittedly, in professional units such as the Medical and Dental Corps it must be extremely difficult to state what is and what is not a technical subject. Although the OC Mobile Dental Section was senior dental officer with the force in Helwan and, as such, the adviser to the ADMS on dental matters, it must be remembered that the troops were concentrated in camp and the disposition of the dental personnel had been by direction of the ADDS.
As an example of this attitude the following two extracts from reports are quoted: