The New Zealand Dental Services
Preparations for the Italian Campaign and Scheme WAKATIPU
Preparations for the Italian Campaign and Scheme WAKATIPU
The 10th Reinforcements arrived on 18 August 1943 and treatment was started on them in much the same way as for the 9th. This time the men were due to be posted to their units about the beginning of September, making it impossible to complete all treatment in the training area. No. 1 Mobile Unit concentrated on those posted to the Division and the Camp Dental Hospital on those posted to base units, but this was a more cumbersome and less satisfactory method than that of having all the men grouped together. It was, however, unavoidable as the Division was due to move to Burg el Arab in the Western Desert by the middle of September for brigade and divisional exercises. Welcome reinforcements for the Dental Corps arrived with the 10th Reinforcements, viz., three officers, eight mechanics and twelve orderlies.page 243
At the same time Scheme WAKATIPU, under which the balance of the First, Second and Third Echelons were to return to New Zealand, was launched. These men were not expected to leave until the end of November, when those of the Ruapehu scheme who were coming back to the Middle East would have arrived. A concentrated effort was made to have all these men dentally fit before embarkation. Although there was inevitably some disorganisation from these schemes, the dental services fared better than most because the ADDS had always insisted that every key position should be understudied. In addition to this there was the policy of using the hospital ships as a means of exchanging dental officers each voyage when required.
Two interesting discussions took place during August on the functions of field ambulance dental sections and mobile dental units.
The first was between Lieutenant-Colonel Middlemass and Major-General Austin, DDS of the War Office, London, who was making a tour of duty in the Middle East. The war diary account of this discussion is as follows:
12 August 1943: He [Major-General Austin] considers that having a dental officer permanently attached to the MDS of Field Ambulances results in a considerable waste of the dental officer's time. Instead of carrying out dental duties, very often he is asked by his commanding officer to do other regimental duties. Apart from this, when the Ambulance is not in action and resting, very frequently no patients are available in the same area. This is all perfectly true.
In view of these facts Major-General Austin is of the opinion that the organisation should be such that the dental sections attached to a Field Ambulance can be detached and placed in an area where it will do the greatest good, e.g., at the ADS or even with a line unit which may be resting. The location of dental officers would be controlled by an ADDS at Corps or Army Headquarters. These views coincide with my own to a large extent at the moment. Certainly something will be done to make greater use of ambulance dental officers and bring them more under control of a Senior Dental Officer in the Field. OC 1 Mobile Dental Unit can perform the functions of a DADDS.
24–25 August 1943: In further discussions with Major-General Austin about dental officers in the field he said he thought one solution might be to have Mobile Dental Sections only in the field and no attached dental officers to the Ambulances. ADDS Corps or Army would decide where these sections were to go. When it was considered necessary to have a dental officer attached to an Ambulance, e.g., when it went into action, a Mobile Dental Section would be attached. As far as 2 NZEF is concerned the administration of NZDC in the Field could be improved by two means, each of which would give the same end result—unity of all NZDC personnel under one senior dental officer instead of the present organisation where 8 officers in the 1 NZ Mobile Dental Unit are under command of the Unit CO but who has no authority over the dental officers attached to the Field Ambulances.page 244
The administrative position could be consolidated by increasing the establishment of a Mobile Dental Unit by three sections to include the dental sections attached to the Ambulances, which would thus become part of the Mobile Dental Unit.
The other solution is to make the Mobile Dental Unit a Divisional one with a DADDS at Divisional Headquarters. The first alternative would probably be the one of choice.
Major-General Austin's views were naturally based on his knowledge of the British organisation wherein the dental officer attached to the field ambulance was less concerned with continuous dental work under all conditions than his counterpart in the New Zealand Forces. It must be remembered that during action, especially during such a long and vigorous operation as the pursuit of Rommel across North Africa, the dental officer with the New Zealand Field Ambulance worked almost beyond the limits of human endurance. He was dental casualty officer for a brigade, maxillo-facial expert, anaesthetist, first-aid assistant, sometimes liaison officer and often fairy godfather to troops less fortunately situated than his own. The brief respites from this were when the Mobile Dental Unit caught up with the Division. It is reasonable to grant him at least a reduction of tempo at these times. He was still responsible for casualties from his brigade, but the systematic and more extensive treatment belonged to the Mobile Unit. As a member of the field ambulance he was part of his brigade and belonged exclusively to it. He was always there when he was wanted, he absorbed something of the tradition of the brigade in general and of his field ambulance in particular, he shared their triumphs and vicissitudes and was accepted as one of a team. To make him just one of many Mobile Unit dental officers would be to sacrifice a degree of individuality impossible to recapture. His duties were not the same as those of the officers with the Mobile Unit and to that extent he became something of a specialist in his own branch. General Austin's proposals, therefore, while possibly applicable to the British organisation, did not apply to the New Zealand field force. Lieutenant-Colonel Middlemass's concurrence with them was based on his experiences as OC Mobile Dental Unit in the field. Later, as the result of further observation and, after full discussion with Lieutenant-Colonel Fuller on his return, he fully supported the blueprint laid down originally. At the time, however, the recent North African campaign, a victorious advance against decreasing enemy resistance, dominated the position and hid the broader concept designed to cover all types of warfare. This is exemplified in the second discussion which took place between Lieutenant-Colonel Middlemass and the ADMS regarding the use of the Mobile Unit. They were in full agreement on four fundamental points, which page break page 245 are important enough to merit separate analysis as similar situations could easily arise in future warfare.
The Mobile Dental Unit should move with the Division in the Administrative Group. The Unit should either be completely within the Division or completely away from it. In the event of a sea-borne invasion the Unit would be among the last to be moved, probably with the Divisional Workshops.
This conclusion was satisfactory for the type of warfare envisaged but was a dangerous precedent to establish too firmly. The infinite variety of circumstances met in warfare must dictate the policy at the time. When under the command of the Division in the field, all movements and attachments of the Unit were made by the OC in consultation with the ADMS, and as these two were, or should be, in constant communication, it was unnecessary and unwise to prejudge the position.
There are occasions when a section from the Mobile Dental Unit could be attached to the open MDS even when the latter is operating in very forward areas. Very often the dental officer attached to the Ambulance may spend a large amount of time in the theatre and is then unable to carry out work on dental casualties. The section from the Mobile Unit would be able to do this work while the Ambulance dental officer would carry out the necessary wiring, etc., for maxillo-facial wounds. Further, the number of dental casualties that present at an MDS is often more than one dental officer can cope with.
This, of course, was based on experiences in the recent campaign, probably at Takrouna. That type of static warfare was unusual and casualties were pouring into the MDS. In normal static warfare, except during intense ‘set’ battles, there are seldom enough casualties even to keep the medical personnel fully employed, so the dental officer would not be needed in the theatre. Also, when the Division is in action and casualties are numerous, routine dental treatment is a secondary consideration. The position was unlikely to arise and, in fact, did not do so in the static warfare in Italy.
There are times when a section from the Mobile Dental Unit may conveniently be placed with the ADS, e.g., in static warfare where the Division is holding a front, a dental section located at the ADS makes the evacuation of dental casualties back to the MDS unnecessary. The Field Ambulance dental officer must remain with the MDS in order to be available to assist in the treatment of any maxillo-facial wounds.page 246
Where, however, an MDS is closed and two or three ADSs are evacuating to one MDS, then the dental officers at the closed MDSs may move up and carry out dental treatment at their respective ADSs.
This was an academic point and proved to be neither necessary nor practicable. In static warfare, such as occurred in Italy, the Division was concentrated in a small area of little depth. The ADSs were well forward in areas where no Mobile Dental Unit should go and, as the distance from the ADS to the MDS was short, there was no need for the Field Ambulance Dental Officer to go there either.
Dental personnel at Ambulance dental sections come into the administrative control of the OC 1 Mobile Dental Unit as regards policy.
This has already been discussed but was sufficiently out of line with the policy set out by Lieutenant-Colonel Fuller to become the subject of a special directive added later to his book of instructions for dental officers:
Where a Mobile Dental Unit is attached to a NZ Division in the Field, the officer commanding the Unit has no authority or power of command over the dental officers attached to the NZ Field Ambulances, but, nevertheless, it will be his task to co-ordinate on behalf of ADDS 2 NZEF, and in his absence, the local arrangements as regards dental treatment within the Division.
There were even occasions when the Field Ambulance dental officer, holding different opinions from those of the OC Mobile Dental Unit, was empowered and encouraged to forward his views to a higher authority by different channels. An example of this was the procedure to be adopted when an outbreak of Vincent's infection was suspected. Paragraph 19, sub-paragraph (b) of ‘Notes and Instructions’ reads:
When an outbreak of Vincent's infection in an area is suspected by a dental officer he will furnish a report immediately to ADDS 2 NZEF detailing the reasons for his apprehension and the steps being taken to prevent further spreading of infection.
If the outbreak is suspected by an Officer of a NZ Mobile Dental Unit attached to a NZ Division, or by OC the Unit, the report will be furnished to ADDS 2 NZEF by OC the Mobile Dental Unit. The report will also be forwarded to ADMS the Division and will embody recommendations to him for a local administrative medical instruction on the subject.
If the outbreak is suspected by a dental officer attached to a NZ Field Ambulance or NZ Mobile CCS he should immediately raise the matter with OC the NZ Mobile Dental Unit attached to the Division. The latter may then decide to carry out the procedure outlined in sub-para (b) (2) above. If, after raising the matter with OC the Mobile Dental Unit, the dental officer feels he should take page 247 action independently he should furnish the report described in sub-para (b) (2) above, with the following modifications, viz., the copy for ADMS should be made out to OC the NZ Field Ambulance or NZ Mobile CCS for onward transmission by him and a third copy should be forwarded to OC the Mobile Dental Unit for information.
Before leaving the subject of the discussion between the ADDS and ADMS, there are two other matters on which comment should be made. The first was that the Mobile Dental Unit was to display the Red Cross on all vehicles and tentage when next it went into the field. Presumably this decision was taken after due consideration of the legal aspect as no mention can be found in the Geneva Convention of dental units being protected units.1 The Mobile Dental Unit, being entirely separate from any medical unit, was in a different position from such dental sections as those in the Field Ambulance or CCS. The second was the mention of a DADDS within the Division. This had been considered before and was to come up for discussion again on more than one occasion. The result was always the same: that the service was not big enough to justify an appointment which could not fully occupy the time of a senior officer and that the administration could as easily be done by the Officer Commanding the senior Mobile Dental Unit with the Division.
The Division moved to Burg el Arab in mid-September 1943, 1 Mobile Unit moving with the field ambulance units on the 18th. Italy had capitulated and it was freely rumoured that the Division would shortly be moving to that country. In this case it was arranged that the Mobile Unit should move with the Advanced 2 Echelon, which would be either the last unit in the Division or in the following flight. Work continued on the Division at Burg el Arab until 12 October, when the dental personnel, less equipment and vehicular party, assembled in the Ikingi Maryut staging area in preparation for embarkation at Alexandria. Part of the Division, including 6 Field Ambulance and the dental officer of 5 Field Ambulance, had already left for Italy in the advance party. In the main body which left Alexandria on 17 October, the dental officers were divided among the transports for emergency treatment. They carried emergency haversacks and, after a quiet and uneventful voyage, arrived at Taranto on 22 October. On the outskirts of this town they settled into the transit area to await the arrival of their equipment. A section also moved to Italy with 1 NZ CCS.
Apart from the field units, New Zealand Advanced Base was reformed as a unit of the 2 NZEF and, with 1 Convalescent Depot page 248 and 3 General Hospital, moved to Italy. The three dental sections of these units formed the hospital circuit of the dental organisation in Italy.
Meanwhile, Maadi Camp had filled up again with training depots and base and base units and the dental units resumed their normal functions, with the exception of a detachment from 1 Convalescent Depot which had been sent to El Arish in Sinai on special duty. Opportunity was taken to interchange some of the personnel of the base dental units with those who had been in the field for some time.
These arrangements did not have to last long as, late in November, the decision was made to transfer Headquarters 2 NZEF from Egypt to Italy. The move was expected to take place in January 1944, leaving some seven or eight weeks to plan the new organisation. Actually, apart from reallocating certain responsibilities with various units and the packing of equipment, the organisation was so adaptable that it merely became a matter of redistributing units. Those dental sections attached to medical units remained attached, with the exception of the maxillo-facial specialists who were to transfer from 1 General Hospital, which was staying in Egypt, to another general hospital in Italy. The office of the ADDS and the Store would move with Headquarters 2 NZEF. No. 2 Mobile Dental Unit would move as a unit to the Advanced Base, where it would probably lose its mobility and become a Camp Dental Hospital, from which it was originally formed. The Base Dental Hospital, of which part was already in Italy, would disband and re-form in Italy if required. The Convalescent Depot dental section was already in Italy, except for the detachment in El Arish which would join it on completion of its tour of duty. No. 1 CCS had moved with the Advanced Base. No. 1 Mobile Dental Unit, the field ambulances and 3 General Hospital were in Italy and 2 General Hospital was soon to move there also. This left 1 General Hospital and 1 Camp Dental Hospital as the only medical and dental units unaccounted for.
Training depots and parts of certain services were to remain at Maadi, so part of Headquarters 2 NZEF had to remain too. The only large medical units remaining in Egypt were 1 General Hospital, 1 Camp Hospital and 2 Rest Home. No. 2 NZ Rest Home, situated at Alexandria, was expected to have so little dental work that it would be unnecessary to attach a dental section to it. No. 1 General Hospital was to have two dental officers and 1 Camp Dental Hospital was to remain intact with six dental officers or, at times, more.
It was hoped that all patients in 1 General Hospital would be made dentally fit before leaving the hospital, so as to relieve 1 Camp Dental Hospital of the work normally done by NZ Base page 249 Depot Dental Hospital, which would be in Italy. All dental work in Maadi would therefore be done by 1 Camp Dental Hospital, instead of by two or three units as in the past. The work was grouped under three headings:
All reinforcements from New Zealand were to go to Maadi, where it was expected they would remain for from four to six weeks, during which time they had to be examined and made dentally fit before moving on to Italy.
Besides acting as a reinforcement camp, Maadi was to be a ‘clearing house’ for those returning to New Zealand. All members of the 2 NZEF returning to New Zealand, either for medical or other reasons, had to be made dentally fit and charted on Form NZ361 in Maadi, with the exception of patients in general hospitals who would be treated and charted by the dental officers attached to those units.
Those in Italy posted for return to New Zealand had to pass through the Reception Depot at the Advanced Base before embarking for Egypt and would be treated there, but would not be charted on Form 361. The charting had to be done by 1 Camp Dental Hospital, thus constituting a final check on their condition.
Routine treatment of the staff of Maadi Camp.
These were to be examined and treated once in every six months, the work being carried out between the arrival of reinforcements.
As the New Zealand Store was moving to Italy, the units remaining in Egypt were to make their own indents on British sources for dental supplies and on the New Zealand Ordnance Depot in Maadi for everything else.
A number of protected personnel were repatriated at this time from Germany while, with the Allies' advance into Italy, other small groups of men escaped from prisoner-of-war camps to make their way through the lines to safety. All who arrived at Maadi Camp were made dentally fit before embarkation for New Zealand. Considering the abnormal conditions under which they had been living and the poor diet, their dental condition was comparatively good. A number of acrylic dentures had been made and some conservative work carried out in the stalags. With the protected personnel repatriated from Germany were three dental mechanics, six orderlies and ten ASC drivers of the Mobile Dental Section captured in Greece.