The New Zealand Dental Services
CHAPTER 19 — Alamein to Tunisia
THIS was the period during which the Eighth Army successfully attacked at Alamein and eventually completed the destruction of the Axis forces in North Africa. The advance to Tunisia was rapid and the distance travelled was almost halfway from Cairo to London. It meant a complete decentralisation of command in the dental forces. Major Middlemass, OC 1 Mobile Dental Unit, was the senior dental officer in the field with the Division and as such was adviser to the ADMS on all dental matters, being dependent on his own initiative for carrying out the dental policy. Most of the story can therefore be gleaned from his reports which, although primarily concerned with his own unit, of necessity include some of the problems and activities of other dental units.
Between 20 and 23 October 1942 the New Zealand Division moved forward from the training area to take up battle positions, but the Mobile Dental Unit remained at El Hammam, concentrating on the treatment of ASC companies in that area. After the breakthrough at Alamein early in November, it still remained at El Hammam while the Division swung round into the desert to exploit the position in the rear of the enemy. A short distance behind the Alamein line, in the Imayid area, a New Zealand Divisional Rest Station had been established and on 12 November the Mobile Unit moved up to join it. The Division eventually came to rest near Bardia, and immediately following one of the periodical visits forward by the ADDS, the Mobile Unit left El Imayid to join it, spending the night in bivouacs on the Mersa Matruh-Sidi Barrani road. The hospital was immediately set up for work.
Only one month had passed since the Division left El Hammam but there was a large number of patients who voluntarily paraded for treatment as soon as the unit arrived. Very few of these men complained of pain and most of the work was for broken dentures, displaced or broken fillings, and cavities which they either knew or suspected had developed. They were all made dentally fit immediately or given appointments, with the result that the book page 225 for the next three days was full without any possibility of settling down to routine treatment. Besides working as a hospital, every opportunity was taken of the infrequent halts of the Division to detach sections from the unit for attachment within the Division.
Fourteen days were spent in this area until the Division moved across the desert in a flanking movement by way of El Haseiat and Marada threatening Rommel's Agheila position. It appeared that this would be an action in which there would be few, if any, static periods and that the terrain would be rough. There was little use for the Mobile Unit to accompany the Division. There would be no facilities for other than emergency treatment, which could be adequately handled by the field ambulances, and it was poor policy to take transport over rough terrain if it could arrive at its destination just as well over good roads.
The unit was therefore instructed to join No. 1 NZ Casualty Clearing Station, remaining and moving with that unit so that the Division would know exactly where it was if required. On 5 December it moved to Tobruk, where it detached a section under Captain R. Kelly1 to remain with 21 Mechanical Equipment Company. On 7 December it moved with the advance party of the CCS via Tmimi, Derna, Benghazi and El Magrun to Agedabia, which it reached on 11 December. Another section was detached at Benghazi under Captain M. Wylie2 to look after 19 Army Troops Company. On arrival in Agedabia a section under Captain Allan3 was attached to the New Zealand Administration Post for the double purpose of treating some small New Zealand units and of maintaining a close liaison with the Division, which was in wireless communication with the post. In this connection it is interesting to note that communication with the Division was not necessarily made through the CCS, as was stated to be one of the reasons for the original attachment, but that the OC Mobile Unit always reported to the ADMS as soon as there seemed to be a possibility of his unit joining the Division.
The situation, 13 kilometres north of Agedabia, was in a pleasant area in undulating greenish country, although on arrival it was raining heavily and the temperature was very cold. The unit stayed there till 22 December, having been rejoined by the sections from Tobruk and Benghazi. The Division was by this time in the Nofilia area and the Mobile Unit made the 170-mile trip to join it in one day, establishing itself on the coast near Sirte.page 226
It was understood that the Division would remain here for a short period only, probably over the New Year, so Headquarters and its sections were immediately distributed throughout the Division so that all men wanting treatment would have ready access to it. The dental officers from 5 and 6 Field Ambulances joined the Headquarters group.
It is convenient to pause at Nofilia at the end of 1942 to consider Major Middlemass's remarks on general policy in his report to the ADDS of 31 December 1942:
The General policy of the Unit is to keep rendering units dentally fit at every opportunity but, at the same time, to give priority to casualties. It had been thought that the Ambulances would have been able to deal with the bulk of the latter and that this unit could have confined its work largely to routine work. This, for various reasons, is not possible under active service conditions.
In the first place, there are too many casualties for the Ambulances to treat in the time available. The length of the period out of action usually seems to be so small that the treatment of the casualties takes up the greater part of the time of all dental officers in the Field with, as a result, fewer routine examinations. Repairs become too much for one mechanic, although these could be decreased by repairing cracked and broken dentures only and leaving the replacement of teeth until later.
Secondly, the MDS of each Ambulance is, as a rule, located in a Divisional Medical area which is often some miles away from the Brigades, the ADS only being located with the latter. The dental sections of my unit, on the other hand, are located within the Brigades with the natural result that all work goes to them rather than to a MDS some distance away. Consideration was given to having the Field Ambulance dental officer with the ADS when a Brigade was out of action but the precedent that a dental officer is always with a MDS is too well established to be lightly departed from.
A third factor … is that it is general policy within the Division to have only one MDS open and, although there is no reason why the dental officer of the closed MDS should not work, in actual practice all dental patients that go to a MDS go to the one that is open. The one that is closed may not even be in the same area. Distribution of work between all dental officers within the Division is attempted wherever possible as is being done at present but this cannot always be carried out.
The speed of action in this chase after Rommel was finding out chinks in the armour of the organisation but, as the ADDS pointed out in a reply to this report, the answer was in Major Middlemass's own hands as adviser to the ADMS on dental matters. If he considered that the work of his unit and the efficiency of the dental treatment of the Division were being affected by not having a dental officer with the ADS, it was for him to advise the ADMS to that effect.
There were other difficulties due largely to the long line of communication and to enemy action. Water in the Nofilia area was scarce because the enemy had destroyed, temporarily at least, the page 227 greater part of the supply. The shortage was so acute that it was necessary for the first few days to use sea water for general washing purposes and for rinsing the mouths of patients. Also, no stores were received, the indent for the month of November to the Advanced Base Medical Stores having gone astray. A double indent was forwarded for December but, as the Medical Store was at Benghazi, supplies could not be expected for some days. Fortunately supplies of rubber, wax and cements were augmented from an Italian dental store.
In the early weeks of January 1943 the Division was again on the move and once again the route lay into the desert on another ‘left hook’. This time the Mobile Unit moved with the Division. The greater part of the route was very rough and transport was tested to the limit. Eleven days' rations with water and petrol for 450 miles of desert made a heavy load. Before the move many of the vehicles were due for replacement or to be fitted with new engines, and these needs were even greater on arrival at Tripoli. The unit's place in the column was in the rear with the Administrative Group, Divisional Workshops and Ordnance Field Park Company. Work was actually carried out on this march. The groups would be halted and informed that they would be there for four days, so sections would immediately set up and begin treatment. Next day there would be a signal warning units to prepare to move in two hours. A number of patients were rendered dentally fit but, generally speaking, no attempt would have been made to set up sections if it had been known how short the halts were to be. It is interesting to note that, even with sections set up, the unit was always able to move on time.
Indications were that the Division would remain in the Tripoli area for some time. In view of this, it was decided that the unit would confine its work largely to those units that were due for a routine examination and treatment. The degree of activity of the dental sections was in inverse ratio to that of the Division. The resting period of the Division was the opportunity for the Dental Corps to catch up with arrears. Most units were available for treatment, although there was some interruption owing to the men being called on to work on the wharves in Tripoli. Casualty work, with two exceptions, all went to the field ambulances, in which the dental officers were now attached to the ADS. The exceptions were the artillery units and the Royal Scots Greys, who were attached to the New Zealand Division at this time. These two units were treated by the headquarters of the Mobile Unit situated near them at Suani Ben Adem.page 228
The Division was now a great distance from its base so it was decided to form an Advanced Base at Tripoli. An Advanced Base Dental Section was established to operate under a similar system to that of the New Zealand Base Depot and 1 Convalescent Depot Dental Hospitals to ensure that all ranks leaving the New Zealand Advanced Base for forward units were dentally fit. As the demands on the Advanced Base increased, there would be a corresponding decrease on those of the New Zealand Base Depot Dental Hospital so personnel could be withdrawn from that hospital accordingly. Major B. Dallas was sent to Tripoli with the Advanced Base personnel on 28 February 1943 to establish the section, originally consisting of one dental officer and three other ranks, including a mechanic.
It had become obvious that 1 Mobile Unit had as much as it could manage with the New Zealand Divisional Headquarters Group, 5 Brigade Group and 6 Brigade Group. No. 2 Mobile Unit had been working in Maadi on reinforcements and by 13 February had completed this work. As 4 New Zealand Armoured Brigade was due to move to the field, it was decided to make it a responsibility of 2 Mobile Unit which, in addition, could detach sections to treat non-divisional units in the field.
Even with the most careful conservative treatment there were bound to be some cases where the natural dentition deteriorated beyond the stage where the teeth could be saved. This is serious enough in civilian life, but with a force in the field is infinitely worse. Major Middlemass reported from Tripoli:
A certain number of patients requiring complete extractions are now presenting. With many of these men the retention of their teeth during three years of war has been made possible by persistent and periodic conservative treatment of the gingivae [gums] thus keeping them in a fair state of health. The almost negligible number of cases of Vincent's infection within the Division is evidence of the effectiveness of this treatment. Now, however, excessive recession of the gingivae and loosening of the teeth is becoming apparent and the stage has been reached … where conservative treatment is no longer indicated. Old partial dentures, so often the forerunner of full denture prosthesis, are a contributing factor.
These extractions will be carried out in a Casualty Clearing Station if a hospital is not available. Here the patient will receive the necessary care and attention and any post-operative treatment that may be indicated. Dentures will be inserted as early as possible to avoid sending men out on operations without teeth.
Judging by the returns of the number of extractions carried out in the Tripoli area there cannot have been many of these cases, but it is of interest to note that even under field conditions such operations can be carried out without unduly interfering with the efficiency of the force.page 229
Another interesting fact was noted in the same report from Tripoli:
Another practice that has been found necessary on occasions in the Field is the making of a new denture instead of remodelling an old one when the time for treatment is uncertain. Sudden movement of units has resulted in men having to move without a denture which has been in the process of being remodelled with insufficient time to complete fitting and processing. To avoid this, new dentures are now made even though remodelling would suffice, wherever there is any uncertainty regarding the period that a unit will remain stationary. The old denture is taken from the soldier at the time of insertion of the new one.
The common sense of this is obvious. Except on the grounds of economy or the preservation of stocks in short supply, it appears that, for the comparatively few cases that come into this category, it is better to allow the patient to keep the old denture as a spare than to demolish it for the value of the teeth.
In early March the Division moved out of the Tripoli area on another ‘left hook’ operation. This time the Mobile Unit remained at Suani Ben Adem with left-out-of-battle (LOB) personnel whom it made dentally fit. This was a pleasant time as the unit was camped in a lush green field, broken, in parts, by a blaze of colour from wild flowers. The tents were pitched beneath olive and almond trees in the shelter of a thick green hedge. After many months of the desert this was a pleasant change. Here the ADDS paid a visit and found half the dental officers working one day and half the next. Here also we can leave it and follow the ADDS in his tour of other dental units with the Division and at the Advanced Base.
War Diary ADDS, 13 March 1943: Moved forward in the Mobile Dental Unit utility car. Am carrying five days' rations and sufficient benzine for 700 miles or more. In the evening found 1 NZ CCS on the Ben Gardane-Medenine road. The Division is on the move again and commenced the move from Medenine today to its next assembly position. The 5 Field Ambulance is, however, still at Medenine but moving tomorrow. Found the Ambulance in the late evening and discussed dental matters with the dental officer attached.
The Division was on the move to an assembly position in the far south in preparation for a ‘left hook’ at the Mareth line and a drive directly through the Gabes gap. It was travelling incognito, hat badges, shoulder titles and identity marks on all vehicles being removed. The final stage for all vehicles was to be by night.
14 March 1943: Drove up to Medenine in the early morning. This town which fronts the Mareth hills is within range of enemy guns. Drove back to CCS and discussed dental matters with dental officer attached. Located 6 NZ Field Ambulance while they were on the march. Moved on to Ben Gardane and in the late afternoon found 4 Field Ambulance on the page 230 Ben Gardane-Foum Tatahouine track. At 2000 hours moved out on to the Divisional axis again and drove through the night, the final hours across open desert, locating Advanced Divisional Headquarters in the final hours of darkness.
15 March 1943: Saw ADMS and discussed dental matters with him. Delivered dispatches to the GOC 2 NZEF and collected dispatches from him for Cairo. 6 NZ Field Ambulance arrived here at dawn and after lunch with them I began my journey back to Tripoli. On the General's suggestion I did not return by the Ben Gardane track but made a wide sweep south through the desert to avoid convoys and to travel over better tracks. Bivouacked the night on a high plateau above Dehibat. The country was fascinating with deep gorges and precipitous canyons of many colours. The native Berberine villages are troglodytic.
Major Middlemass was deputy for the ADDS and was responsible for general co-ordination. In particular, he co-ordinated the systematic treatment of units and supplied reinforcements to dental sections in the field. Major B. Dallas was responsible for ensuring that all personnel moving to the field from the Advanced Base were dentally fit. Major Gleeson, dental officer attached to 3 General Hospital, was responsible for the control and direction of the dental aspect of maxillo-facial injuries.
It might be thought from reading the account of the ADDS's tour of the forward areas that dental sections there would do little more than cope with emergencies. It is of interest, therefore, to note part of the report of the dental officer with the CCS, Captain E. P. Pickerill, for the month of March 1943:
Although certain sections of the CCS remained on their trucks at Ben Gardane, the dental section was set up to relieve the congestion of patients at 15 CCS nearby. These consisted in the main of non-NZ troops and kept my mechanic and myself consistently busy.
Practically all cases of non-NZ troops requiring new dentures were referred to British CCS's but it will be noticed that Corporal Madigan1 (the mechanic) has been kept very busy with repairs, establishing a record for the month—66.
Two cases of impacted wisdom teeth were referred by British Field Ambulances and have been successfully treated. I lay claim to be the first person to have removed an impacted wisdom tooth in Medinine.
The unit moved three times in the month. Work done is as follows:
Examinations 207 Fillings 122 Extractions 107 New and Remodelled dentures 9 Repairs to dentures 66 General anaesthetics administered 53 Maxillo-Facial cases 10
This would have been a good month's work under any conditions but under field conditions was remarkable. It is all the more remarkable when it is realised that during all actions from the battle of Alamein onwards, Captain Pickerill was one of the unit's regular anaesthetists, his eight-hourly period in the theatre being arranged late in the day or during the night so that his work at the dental chair during the hours of daylight would not be interfered with. His maxillo-facial work involved long hours of tedious work (an intermaxillary wiring would take at least two hours and there was continual supervision needed in each case). He improvised a quantity of surgical apparatus and such was his success that many of his cases needed little further treatment on arrival at hospital.
At the beginning of April, the Division had reached Gabes in Tunisia and was proposing to advance still farther. The Mobile Unit was still at Suani Ben Adem, but although it was not expected that there would be an opportunity for carrying out much treatment at Gabes, it was considered that it was too far behind and there would be too much delay in joining the Division when that opportunity arose. Major Middlemass had already moved up to Gabes to 4 Field Ambulance and had arranged with the ADMS for Captain C. Moller1 to bring the unit up and attach it to 1 NZ CCS which, in most cases, would be within 100 miles of the Division. The unit moved on 6 April, spent the night between Zelton and Pesida and reached Gabes on 7 April. On 10 April it moved to Cekhira and again on 13 April to a point 15 kilometres north of El Djem. This was an attractive spot with an unending vista of red poppies and multi-coloured wild flowers but was also close to fighter and bomber airfields. It was some 45 miles south of the hills around Takrouna and Enfidaville, to the shelter of which the enemy had retreated.
No. 1 Mobile Dental Unit remained at El Djem with 1 CCS as there was no opportunity of carrying out treatment on the Division, then preparing for the attack on Takrouna which followed in a few days. After the battle, however, all six sections were attached to divisional units as soon as they were relieved and brought back to their ‘B Echelon’ areas. The Headquarters remained at El Djem but the dental position was easily handled by the sections and, except for the inconvenience of having a headquarters 45 miles away, the working capacity of the whole unit was not greatly decreased.
This was virtually the end of the campaign as no further major action was fought on this front. The work carried out by the dental sections during this last phase is interesting as it demonstrated that dental work can be carried out in B Echelon areas during static or semi-static warfare, while it certainly should be carried out whenever a unit is brought out of the forward defended localities into an area such as the main divisional area. Major Middlemass's comments on this method of operation were a remarkably accurate forecast of future conditions:
Mobile warfare as it was known in the desert would seem now to be finished and future tactics will probably consist of attacks interspersed with periods of static or semi-static warfare of variable lengths with forward units holding defended positions. The operation of the Mobile Dental Unit from the time of the Battle of Takrouna to the end of the North African Campaign, i.e., keeping the headquarters group some distance in the rear and sending sections forward to treat units when they are in a passive role, is probably a prelude to the method of working the unit in future operations.
Major Middlemass's experiences with the Mobile Dental Unit established that unit as a functional entity with the force and laid a firm foundation for future dental organisation. His summary of lessons learned in that campaign is therefore valuable, although based on only one type of warfare:page 233
The unit should move and remain with the Division provided the tactical position permits. Its place should be with the Administrative Group.
Note. It can move under any conditions but there is no object in taking transport over rough terrain if it can be taken over good roads after the Division has gained its objective.
In static or semi-static positions it is best situated with the Main Dressing Station, depending on the tactical situation. If this is not possible, a section or sections can be sent to the MDS.
Daily contact should be maintained with Divisional Headquarters, circumstances permitting.
Note. A complete section attached to the open MDS served the dual purpose of providing an extra dental officer to carry out routine duties while his colleague was working in the theatre and of making available an officer to carry out liaison duties between ADMS and OC Mobile Dental Unit.
During an advance such as this the placing of the unit under Corps administration for movement is not good practice. Corps will not necessarily move it when the Division wants it.
Note. After the advance from Nofilia to Tripoli, Corps would give no consideration to moving the NZ CCS forward to the Division and it is probable that if the Mobile Dental Unit had not moved by the desert route with the Division it would have remained some time in Nofilia also.
The foregoing account, dealing of necessity with the organisation of dental treatment for the whole force, gives a broad picture of the campaign as it affected the NZDC. It is incomplete, however, without a closer examination of the conditions under which the work was carried out and the difficulties confronting the individuals who made up the dental team. The dental sections closest to the actual conditions of active warfare were those attached to the field ambulances. Captain N. E. Wickham, NZDC,1 who was attached to 4 Field Ambulance in this campaign, has written an account of some of his experiences, excerpts from which will give an idea of life in a dental section in North Africa under war conditions:
The change from the defensive to the offensive at Alamein had its effect on the Dental Officer, for from the commencement of the highly organised advance across North Africa it became obvious that all his energies must be concentrated on dentistry. Especially was this the case for the Fieldpage 234 Ambulance Dental Officers as, with rapid advances across the desert, they were often the only ones with the Division. The precedent created in previous campaigns, and in such publications as the ‘Army Medical Manual’, of using the dental officer in the Field Ambulance for extraneous duties such as Messing Officer or Liaison Officer had to be broken. Except for specialised duties for which his training fitted him, such as administration of anaesthetics or first aid, he must be left free to concentrate on his own work.
There was always dentistry to be done and in the desert the only respite was during the relatively long moves which, though not restful, provided a welcome change from dental routine. Most of the dental work was of an urgent nature, such as relief of pain, treatment of gingival infections, urgent fillings, replacement of lost or unserviceable fillings, the repair of broken dentures and the replacement of unserviceable and lost ones. There were hospital facilities for multiple or impacted extractions and for post-operative treatment and observation. There was a well equipped operating theatre with anaesthetist and staff and a well-stocked dispensary. Apart from the work for NZ troops there is always a big demand from others. Even civilians made demands on the dental officers. These were treated only for the relief of pain but, especially in Italy, clamoured for other treatment. Here the formula ‘Signor Churchill non permisse’ was sufficient deterrent although one more astute individual suggested that Mr Churchill need not know about it.
Early adequate treatment of maxillo-facial injuries was very important and the Dental Officer with the Field Ambulance was usually the first to see these cases as he would probably be at the MDS. In the highly mobile warfare of the desert it was usually many days before these casualties reached the Maxillo-Facial Unit so treatment had to be as thorough as possible.
The ability of the dental officer to administer anaesthetics was more frequently used in North Africa than previously. The battle casualties arrived at the MDS in large numbers and, since the CCS was further back, more extensive surgery had to be carried out then and there. Most of the operations were short ones and pentothal was usually the anaesthetic of choice. After administration of the required dosage the anaesthetist could assist the surgeon and save time by attending to some of the minor wounds. Often in the desert after working for days in a hot sticky canvas theatre with only a few hours' spell, one was faced with a large amount of accumulated dental work. At other times, the dental tent being pitched near the theatre, it was a question of dentistry by day and anaesthetics by night.
An infrequent but important duty was the dental examination of unidentified bodies. Dental evidence has at times proved invaluable in the establishment of identity of such bodies.
Captain Wickham found faults in the transport and accommodation provided for the dental section with his field ambulance. Unlike the Mobile Dental Unit and the other field ambulance, his dental section had no transport of its own but had to share a 3-ton vehicle. This was unsatisfactory for the truck became loaded with all manner of gear and personnel, making it difficult to locate, unload and sort out the dental equipment when it was needed. Together with the erection of the tent, this was a formidable task for three men, and the mobility and general efficiency of the section were page 235 reduced. This method of transport had become hallowed by custom and nothing could be done to alter it during the North African campaign. The problem was tackled on the return to Maadi, when the front third of the truck was partitioned off for non-dental goods and the rest fitted out as a surgery. Accommodation for the mechanic was provided by a penthouse of heavy canvas and steel pipes built on to the side of the truck so that in transit it folded on to the top of the canopy.
Individual ingenuity, added to an excellent relationship with the workshops in the Division, produced refinements in the standard equipment, increased efficiency and provided extra comfort beyond the bleak though adequate necessities of dental practice in the desert. For example, the lack of a saliva ejector was keenly felt and led to awkward moments during operative and surgical procedures. An efficient substitute was improvised by reversing the plunger and valve of a motor-tyre foot pump and connecting it to a reservoir and ejector tube. The mechanic's hand lathe, requiring two to operate, was converted into a foot-treadle lathe which could be operated alone. Equipment was made in the workshops to enable gold inlays to be made, possibly a luxury for field dentistry but nevertheless an additional service should time and circumstances permit. Even the greatest ingenuity, however, could not completely disguise the discomforts and defects of operating under active war conditions. Captain Wickham's description gives some idea of the general conditions:
The experiences of a non-combatant such as a dental officer are routine and, for the most part, unexciting. Some of these however may prove of interest and provide a rough picture of every day life in the field. The more exciting ones when under attention of the enemy by shell fire or bombing and strafing from the air are infrequent though vivid enough to leave a deep impression.
The desert'. Associations and memories conjured up by these two words are deeply engraved and will far outlast those related to life in Italy. Physically it is just an ever-extending expanse of brown, barren terrain, mostly flat, hard-surfaced and covered with stunted shrub growth but, in places, soft and sandy and in others, rocky and ragged. In places it rises to hills and mountains and in others gives way to precipitous escarpments and deep wadis. Spiritually it holds a fascination and possesses a character that draws and holds one insidiously. Its length and breadth, its utter silence and its complete disregard for man convey a sense of the everlasting. Except when molested by man's war machines, it lies as it has for centuries, pure, unspoiled and quiet, changed only by nature whose winds obliterate scars and conceal the past. Here, away from the civilization of cities, one was thrown into close contact with men for long periods under all sorts of conditions. Tempers were tested but one developed a peculiar sense of humour and achieved a spirit of camaraderie which will long be remembered.
Since for the most part, one was continuously moving across the desert, life revolved about the truck and its crew. It may have been one of the page 236 small 15 cwt. class though, more probably, it was a sturdily-built, all-steel, 4-wheel-drive three-tonner, the type to which Field Marshal Montgomery attributed very largely the success of the Eighth Army. One of many motor vehicles scattered over the surface of the desert as far as the eye could see. When the Division moved in convoy in long lines up to 10 abreast with 100 yards between vehicles, each one left in its wake a small cloud of dust as the whole assembly moved relentlessly forward as one unit.
A typical day on the move would be something like this. An hour before dawn, the blackest and coldest time of the night, a voice using a variety of expressions announced that a new day, just another day, was about to begin. In complete blackness, no lights being allowed, one groped for clothes, rolled up one's bed-roll, threw it onto the truck and set off for the cook's vehicle for a breakfast of biscuit porridge and a soya bean sausage. One was saved the shock of the early morning wash by a scarcity of water. Shortly after first light the collection of trucks and ambulances that comprise the transport of a Field Ambulance were bumping along in dispersed desert formation.
If there is one thing more than another that a soldier considers essential, it is his mug of tea so, in addition to the midday stop for lunch of canned meat and hard biscuits, stops were also made for morning and afternoon ‘brew-ups’. All day one's ears drummed to the screech of second and third gear travel for the going was too rough to permit the use of top gear except on rare occasions. All day one's body was fatigued by continual bumping as well as being generously coated with fine dust. In the late afternoon a halt would be called and the vehicles would be dispersed for the night. Having excavated a shallow slit trench incorporating a hip hole for comfort, one laid out the bed-roll and set off for the cook's truck. Here the hot meal of the day consisted of tinned meat and vegetables followed by rice and dehydrated apples.
By the time the problems of the day had been discussed the next thing was to find one's own truck again in the darkness. Wise and experienced men carefully noted its position in daylight or took a compass bearing on it from the cook's truck as, although there might be only a few hundred yards to cover, moonless nights in the desert are really black, landmarks nil and directions meaningless.
At times during pursuit when an endeavour was being made to cut off elements of the enemy, travelling would extend well into and through the night. These night moves were carried out in the entire absence of lights, each vehicle blindly following the one in front as closely as possible. They were particularly hazardous and the miracle was that so few trucks suffered serious damage from the jolting and bumping over rough terrain.
Whenever, during the advance, the Division paused to fight a battle, a Field Ambulance in the matter of an hour, set up its tents and equipment, dealt with casualties and then remained behind to evacuate these whilst another Field Ambulance went ahead with the Division.
Working conditions … were difficult. Ample light being essential, one was obliged to accept with it exposure to the prevailing weather conditions. In the desert this often meant working in a flapping tent with fine dust, whipped up by an angry wind, swirling into every nook and cranny, covering equipment and even the field of operation. Maintenance of equipment, especially working parts of it, was a real problem under these conditions whilst instruments dropped on the ground in soft sand or mud were difficult to retrieve. Only modified asepsis under such circumstances page 237 was possible and often, as one had begun some surgical operation, a picture of a clean, neat surgery or theatre with instruments neatly laid out and white-clad figures in attendance, flashed vividly before the mind. Yet, … remarkably few cases developed post-operative complications. Sometimes the patient and operator were bathed in perspiration and the instruments almost too hot to handle, whilst, on other occasions the operator's hands were too cold and numb to work and the patient too cold to remain sitting in the chair.
Though disconcerting at the time, in retrospect there is humour, belonging to these times in the desert, such as when diving for one's slit trench during an air raid one found it already fully occupied by one's patients awaiting treatment.
The policy of dental treatment in the field, ‘to ensure that the standard of dental fitness attained in base areas does not deteriorate unduly’, was carried out. In his quarterly report of 1 May 1943 the ADDS stated:
Once again it has been difficult to maintain continuity of treatment in forward areas but this is to be expected. In fact, for planning purposes the conditions of recent months should perhaps be considered the normal. Nevertheless, despite the continual movement and action, dental units in the field have succeeded in maintaining a fairly constant return of work. Needless to say, however, there are some sections of the Division whose treatment at the moment is in arrears, but this occasions no great alarm since the Division only needs to be disengaged for a reasonable period for these arrears to be made good by the dental personnel concentrated in the Field.
There are four salient points arising from this account of the North African campaign that should be stressed:
The handling of the Mobile Dental Units during such a war of uncertain movement as exemplified by the withdrawal of them from the field to avoid unnecessary hazards was correct tactics.
During a victorious advance with the odds in our favour, the place of the Mobile Dental Unit is within the Division.
On the march across North Africa, despite extreme mobility, the Mobile Dental Unit was able to play a useful and worthwhile part.
The forecast of the OC 1 Mobile Dental Unit at the end of the campaign that the mode of operation of dental services in the field in the forthcoming campaigns would be as then established was remarkably accurate.