The New Zealand Dental Services
CHAPTER 23 — The Italian Campaign
The Italian Campaign
TO preserve continuity in the story of the Italian campaign it is necessary to return to the Fifth Army front, where the field dental units were attending the Division at the end of January 1944. A New Zealand Corps was then formed under the command of Lieutenant-General Freyberg.
Cassino and Monastery Hill, a rocky spur some 1700 feet above the plain, crowned by the ancient Benedictine monastery, were the Corps' objectives and it soon became obvious that the Division was about to face a most difficult operation. The sections of the Mobile Dental Unit remained attached to the units they were servicing and moved to the battle area with them. Only one had to be withdrawn to a safer area because of intense counter-battery activity; the others continued to work despite heavy artillery duels. The headquarters of the unit moved forward to a most unpleasant area characterised by incessant rain and deep mud, leaving the Alife area to be serviced by Captain Foote of 6 Field Ambulance.
For six weeks the Division fought a bloody battle on this front. Dental treatment was consequently spasmodic, but by the time that the Division was withdrawn the Mobile Dental Unit had been reinforced by the addition of the extra sections from the disbanded 2 Mobile Dental Unit and was in a stronger position to meet the increased demands.
On the Cassino front the NZDC came for the first time in close contact with the American Dental Service. They were able to exchange ideas and equipment and compare their respective services. The American dental officer worked on the ratio of one officer to 1000 men and, even though the men had not been made dentally fit before leaving home, seemed to manage adequately. No figures are available as to the amount of dental disease existing among American troops, but to service them effectively with this ratio it must have been considerably less than that in the New Zealand force. Relatively few American soldiers wore artificial dentures of any description, so dental officers in the field carried no prosthetic equipment and all such work was sent back to a centre some 20 miles behind the ‘combat area’.page 260
In early April the subject of furlough for the 411 officers of the first three contingents who were still with the force was reopened and a ballot was taken among the dental officers as to who should be included. Majors Middlemass and B. Dallas were successful. Major McCallum therefore resumed command of the Mobile Unit and Major J. W. Johnston1 took charge of 2 NZ Camp Dental Hospital.
The Division left the Cassino sector about this time and took up positions forward of Venafro in the mountains rising above the Volturno River and fronting the Rapido and Monte Cairo. The country was mountainous, the roads tortuous and narrow, treacherous and greasy in wet weather, making access to forward positions difficult. In many cases the only way in was by foot or mule. The Mobile Unit was first established under olive trees just off the Venafro - San Pietro road but soon moved to an area in the vicinity of Roccaravindola, a white stone village perched upon a steep coneshaped pinnacle. The camp site lay on an easy slope above the road at the foot of the mountains which rose immediately before it.
In this type of warfare, with front and back areas of the Division so close to each other, most of the dental work was carried out in the back areas. The sections could be recalled and reattached easily and, even when the lines of communication lengthened, as they did when the Division again came under Eighth Army control, the headquarters of the unit could retain control without moving far.
The first few months of 1944, when conditions were favourable both in the field and at the bases, recorded the highest returns in the 2 NZEF. Twenty thousand men were dentally examined and 12,000 made dentally fit. The ADDS remarked:
One need only say that, wherever a dental section was found, there also would be a patient occupying the chair, boot soles facing tent door outwards, another waiting his turn nearby; dental officer head down operating at the chairside morning and afternoon, day in day out; mechanic in the background at his bench industriously supplying artificial dentures from laboratory to chairside.
June saw the Division advancing, now in the heat of an Italian summer, with the dental sections still attached to units and the headquarters of the Mobile Unit creeping up behind by stages. Where possible, unit headquarters was located near to the open MDS of the field ambulances, this being the most suitable area for the treatment of casualties and for keeping in touch with the dental sections. The dental sections were with the B echelons of units while the troops were in action, and at the various unit headquarters during rest and training periods. Another dental section was with the L of C units. From Cassino, overlooked by Monastery Hill, surrounded by spring growth so great that it was impossible page 262 to believe that a battle had recently been fought there, through Belmonte and Atina to Fontechiari and then through Sora, Isola del Liri and Fontana Liri, Headquarters arrived at Frosinone. Sections were working everywhere under all sorts of conditions, e.g., the 5 Field Ambulance MDS occupied the grounds and buildings of an Italian millionaire, where the cloisters and the private chapel, the gardens and the pergolas made a peaceful background and a welcome change from the rain and mud. On 17 June the Corps lost one of its keenest officers in a jeep accident. Captain M. Wylie of 1 Mobile Dental Unit, attached to 18 Armoured Regiment, was killed early in the morning of 17 June on Highway 6 near Sora. Apart from his loss as an extremely efficient operator and organiser, he was greatly missed, being popular with his brother officers and other ranks in the Corps and with all who knew him in the Division.
Then for the first time since fighting began in Italy the Division was able to rest, and it assembled near Arce in the lower Liri valley in the middle of June. Here was the opportunity for dental work. The advantage of continual treatment through the days of battle was becoming evident when dental units, who would normally be snowed under with work, could take part in the leave privileges granted to the rest of the men.
The next phase in the campaign, the taking of Arezzo and the advance on Florence, began in mid-July. Units became widely scattered and it was impossible to estimate how long any area would be occupied. In many cases sections would set up their tents and equipment only to find that they had to move on immediately. The Mobile Dental Unit headquarters became adept at quick moves. Major McCallum reported that tents could be struck, equipment loaded, hot evening meal served and vehicles cleared within an hour.
On 15 July 1944 a circular was sent to all dental officers from the ADDS which, by a curious coincidence, was very well timed:
An experienced NZ Dental Officer in his monthly report makes the following statement:
‘On enquiry it has been found that all patients examined here have been made dentally fit within the last six months. Nevertheless, as can be seen from the weekly returns, about half those reporting required gross scaling, and on enquiry it was established that in the majority of cases no such scaling had been done for the last twelve months. Obviously it is of no great value to concentrate on saving teeth by fillings if they are going to be lost by pyorrhoea.’
In comment on the above statement, I think it quite probable that a tendency has crept in to pass by unnoticed a proportion of cases that rightly should have been scaled. Will you please take care not to overlook this aspect of dental treatment.
Shortly after receipt of this, seven extremely virulent and five mild cases of Vincent's stomatitis were reported from the Division. What might have been a serious outbreak was averted by immediate isolation of the serious cases in hospital and suitable treatment of the others. An inquiry was instituted to find the reason for the outbreak. The result is interesting and instructive.
If scaling had been neglected, and it is understandable that the more obvious filling work might overshadow the importance of prophylaxis, there would be many mouths in a receptive condition for the disease. Unless by accident, a dental officer would not suspect its presence among the troops until a patient reported through pain or illness, and it was unlikely that he would so report until the disease had reached that stage. As the disease is contagious, efforts were made to trace the source of infection. The significant fact emerged that there was a large increase at the same time of venereal disease, traced to contact over a wide area with the Italian populace in the Divisional Rest Area at Arce. The lesson was clear. Establish mouth conditions resistant to the disease and the risk of infection is reduced to a minimum.
It was then the Italian summer and working conditions were pleasant among wooded hills and vineyards famous for Chianti wine. The country, however, was known to be highly malarious and strict anti-malaria precautions had to be taken. The prospect of casualties from malaria was alarming to the Corps as the margin for wastage was extremely small. Several other factors were causing anxiety in this respect. Firstly, two dental officers had returned to New Zealand on furlough. Secondly, three were boarded for medical reasons and returned to New Zealand. Thirdly, Captain Pickerill, who had been in England undergoing a maxillo-facial course which had already extended longer than was at first expected, was recommended for a medical board on arrival back with the 2 NZEF. Fourthly, there was the controversial question of treatment of repatriated prisoners of war from Germany, who were expected to arrive in the United Kingdom after the cessation of hostilities.
The controversy in this last factor was between Headquarters in New Zealand and those in 2 NZEF. From the dental point of view, it was felt in the 2 NZEF and in London that treatment of these men who had been part of 2 NZEF should be undertaken by the dental service to that force. To this end 2 NZEF was agreeable and anxious to send to England a complete Camp Dental Hospital, and more when required, on the understanding that this could not be done until the end of the war, or at least until the New Zealand Division had finished operating. In July, however, a letter was received from Headquarters 2 NZEF:page 264
An appeal has been received from NZ Headquarters in the United Kingdom for these personnel to be supplied forthwith, as circumstances have arisen to increase the urgency. It may be taken that the appeal is a really genuine one. It is incumbent upon us to exert every effort to meet it…. The difficulties of the situation are fully appreciated by this Headquarters and have been communicated to London.
At great sacrifice and at the expense of 1 Mobile Dental Unit, three officers and twelve other ranks were immediately assembled to be ready to leave at a moment's notice for England. Major McCallum, who was at that time next in seniority to the ADDS, was the obvious officer to be in command of the dental services in England. He had the necessary experience of work in the field and full knowledge of the intricacies of supply from British sources. In addition to this the commander designate of the New Zealand prisoner-of-war repatriation organisation, Lieutenant-Colonel L. F. Rudd, DSO,1 before he left the Central Mediterranean Force for England, asked particularly for Major McCallum. It was anticipated, and discussed with Colonel Rudd, that Major McCallum should assess the position in England and ask for necessary reinforcements from 2 NZEF. As far back as April 1944 the DDS in New Zealand had been asked to send, when required, equivalent numbers to 2 NZEF to make good this loss. This, of course, was expected to take place after the cessation of hostilities. In the meantime the DDS at Army Headquarters, Wellington, feeling that the responsibility for treating the prisoners of war was his and knowing that 2 NZEF could not immediately supply enough personnel, cabled to London:
DDS considers insufficient provision has been made for dental requirements. He recommends as follows. (A) Personnel group HQ, 1 officer ADDS, 1 WO I, 1 S/Sgt, 1 Sgt, 5 Rank and File, total 9. Dental Pool, 20 officers (5 majors, 15 captains), 2 S/Sgts, 18 Sgts, 9 Cpls, 41 Ptes, total 90. (B) Full dental equipment and stores for 20 operators.
Above to serve Navy, Army, Air. He expects extensive work and strongly recommends all be made dentally fit before departure from UK which is in accordance with general policy and greatly in interests Prisoners of War.
Personnel to be provided (A) 3 officers 12 other ranks by ‘Fernleaf’.2 (B) 10 officers 26 other ranks from Prisoners of War. (C) 8 officers (including ADDS) and 40 other ranks from New Zealand. These and equipment etc., to be despatched by direct ship estimated time of departure 25 August.
1 Col L. F. Rudd, DSO, OBE, ED, m.i.d.; Auckland; born Christchurch, 13 Jan 1898; barrister and solicitor; 1 NZEF, 1917–19; wounded and p.w. Apr 1918; OC 6 Fd Coy 1939–41; Military Secretary, 2 NZEF, Jul 1941–May 1944; comd 2 NZEF Reception Group (UK) Aug-Oct 1944; British legal mission to Greece, 1945.
Dental personnel to be supplied by 2 NZEF viz., 3 officers, 12 other ranks cannot leave Italy until early September…. Suggest therefore for consideration that replacements being sent from NZ to 2 NZEF for this party should be sent direct to UK and that we do not supply any personnel.
This was agreed to and the 2 NZEF took no part in the organisation of treatment for repatriated prisoners of war in England. Comment on the establishment and on the general service in the United Kingdom belongs to another chapter. In this context it is right to mention that the 2 NZEF had at no time underestimated the amount of work to be done on the prisoners of war and had reported to New Zealand to this effect; that they felt that their experience and organisation would have been the more economical solution to the problem, and that they were disappointed that what they considered their duty to their former companions was being discharged by others.
A further drain on the resources of the Corps in the 2 NZEF was still another furlough draft. In the middle of July advice was received that a proportion of other ranks of the 4th Reinforcements, together with the remaining officers of the first three contingents, were to return to New Zealand, the scheme being known as TAUPO. The number lost to the Corps was thirteen, consisting of one officer, Major Gleeson, and twelve other ranks. The whole draft was about 1700 men, all of whom had to be made dentally fit before embarkation.
On 25 September Colonel Fuller fell a victim to infective hepatitis (jaundice) which was claiming many victims in the force. He was admitted to 1 General Hospital but continued to attend to service affairs while a patient, being assisted by Major Johnston, OC 2 Camp Dental Hospital, acting as DADDS.
In early October the proposed move of Advanced Base to Senigallia was cancelled so 2 Camp Dental Hospital remained at San Basilio. This left the treatment of Headquarters 2 NZEF personnel to the dental section attached to 1 Convalescent Depot, as page 267 soon as that unit could get to Senigallia. These moves and cancellations of moves fully tested the elasticity of the dental organisation and emphasised two important points. Firstly, that the continuous treatment of the force at the Base and in the field had established such a satisfactory state of dental health that short periods away from treatment could be tolerated with impunity. Secondly, the coverage was so complete that no unit was ever far from some dental section.
Reinforcements continued to arrive in Egypt from New Zealand and 1 Camp Dental Hospital in Maadi was hard pressed to render them dentally fit before leaving for Italy. The standard of dental fitness of these later reinforcements was found to be not as good as that of earlier ones. It was therefore necessary to send more officers from Italy to assist in the work. Captains L. R. Sprague,1 R. H. B. Mottram2 and G. D. Sutherland3 were selected, the first named to be promoted to major to take over command from Major Moller, who was to return to New Zealand. Sickness took a heavy toll and at one time during October there were only five dental sections operating with the Division in the field. The main trouble was again infective hepatitis.
November ushered in a change in command of the NZDC with the 2 NZEF. Lieutenant-Colonel Fuller left hospital for the Officers' Rest Home at Loreto on convalescent leave and Major D. W. Earle was appointed ADDS with the rank of lieutenant-colonel. Lieutenant-Colonel Earle had had experience in the office of the DDS in Wellington as administrative ADDS and also as PDO4 of more than one mobilisation camp. He had left for the Middle East in January 1944, relinquishing his majority to do so and, as has been seen, commanded 1 Mobile Dental Unit in the field. He was the exception to the rule that the highest appointments in the 2 NZEF should be given only to those who had grown up with that organisation. Only his administrative ability, which had precluded his earlier despatch from New Zealand, and his seniority qualified him for acceptance as other than an ordinary reinforcement. Major R. D. Stewart5 took over his command of the 1 Mobile Unit.
4 Principal Dental Officer.
Reinforcements for the Corps were not coming to hand as quickly as anticipated owing to an altered date for the arrival of the 14th Reinforcements, but fortunately Brigadier Park1 arrived from the United Kingdom and suggested the use temporarily of some of those accumulated there for the treatment of prisoners of war. The DDS, Wellington, agreed, as also did Lieutenant-Colonel Rout, ADDS of the New Zealand Dental Corps in the United Kingdom. Three officers, Major H. Colson and Captains J. R. Benson2 and F. J. Jacobs,3 arrived by the Hospital Ship Oranje on 15 December. At the same time word came from New Zealand that five others were on their way, four of them by the Hospital Ship Maunganui. Major Colson took over command of 1 Mobile Dental Unit and the other two officers went to 2 Camp Dental Hospital. The acute shortage of staff in December was to some extent balanced by the fact that the Division was in action most of the time in the Forli area and fewer troops were available for treatment.
With the battle moving steadily northward, the greatest concern in regard to treatment was the lengthening of the Lines of Communication, throwing an added strain on those dental sections responsible for the treatment of non-divisional units. It meant that the responsibility had continually to be changed from one section to another, with frequent redistribution of personnel. At the end of January 1945 the distribution of NZDC sections and units was as follows:
1 Brig R. S. Park, CB, CBE; Auckland; born Dunedin, 18 Feb 1895; Regular soldier; NZ Fd Arty 1917–19 (Lt); NZ Military Liaison Officer, London, 1939–46; Commander, Northern Military District, 1947–50; Commander K Force (Korea), 1950–53.
1 NZ Mobile Dental Unit
1 NZ Mobile CCS
4, 5 and 6 NZ Field Ambulances.
Note. A detachment from the Mobile Dental Unit had been sent to Rome to treat the staff of the New Zealand Forces Club there.
1 NZ Convalescent Depot was at full strength and responsible for all NZ troops in this area with the exception of patients and staff of 1 NZ General Hospital.
2 NZ General Hospital.
3 NZ General Hospital. This hospital now had two dental officers and the requisite number of other ranks to handle all treatment in the Bari area.
At San Spirito.
At San Basilio.
2 NZ Camp Dental Hospital.
1 NZ Camp Dental Hospital at Maadi Camp.
The returns for the year 29 January 1944 to 27 January 1945 show that even more work was completed than in the previous year, 1 February 1943 to 29 January 1944. Static warfare, with its greater facilities for attachment of dental sections, would account for this to a large extent, though shortage of staff would counteract some of this advantage. The previous year's figures are in parenthesis:
|2 NZEF||Other than 2 NZEF||Total||NZ Troops only|
|Number requiring treatment||46,645||2,531||49,176||(39,462)|
|Number rendered dentally fit||41,836||1,815||43,651||(37,635)|
|Number of fillings||48,621||1,194||49,815||(41,699)|
|Number of extractions||5,769||1,451||7,220||(6,020)|
|Number of dentures, new and remodelled||6,673||189||6,862||(5,294)|
|Number of repairs||7,431||313||7,744||(6,830)|
|Total denture cases||14,104||502||14,606||(12,124)|
|Number of maxillo-facial cases admitted and treated||52||3||55||(55)|
It is significant that the number of extractions in proportion to the number of fillings had noticeably decreased, showing again that conservative treatment relentlessly carried out was having its effect.
During February, March and early April 1945 the treatment of the Division and in the Base Camps continued under good conditions regarding availability of patients and staff to deal with them. There was some anxiety over the supply of reinforcements of mechanics from New Zealand and consideration was given to the employment of women in Base Camps and of men of lower medical grading in Lines of Communication. Nothing, however, came of this, though it is something that could be borne in mind for the future. It must, however, always be remembered that under war conditions it is a big advantage to have all personnel interchangeable between the Base and the field, and this would be impossible if women and lower grade mechanics were employed. On the other hand, if there is a definite shortage of key men such as mechanics, it is better to sacrifice this elasticity than allow the work to accumulate beyond the stage when dental fitness would be past achievement. A school for training suitable orderlies as mechanics was started under Captain S. A. Blue1 and this helped the situation.
On 1 May the headquarters of the Mobile Unit began its longest move for some time, crossing the Rivers Po and Adige that day and arriving 20 miles short of Trieste the following day. Business was very much ‘as usual’, even the news on 8 May of the capitulation of the German forces and the end of the war in Europe failing to qualify for so much as a mention in the Mobile Unit war diary. The ADDS's war diary of 9 May reads:
Skeleton staff only. Official holiday.
In contrast the Mobile Dental Unit's diary reads:
9 May 1945:
0800 hours. Weather fine with promise of heat.
0830 hours. Treatment of casualties presenting.
0915 hours. CO called on CO 4 NZ Field Ambulance and remained two hours.
1200 hours. Normal daily routine.
It is possible that the two hours spent with the CO 4 Field Ambulance were in other than official pursuits, even if the time was a little unusual for a social call. It is more probable that the large number of denture casualties anticipated and realised after every action was enough to monopolise the thoughts of every dental officer in the field.
No attempt was made to examine and systematically treat the personnel returning to New Zealand under the replacement schemes, although all who wanted treatment could have it. This had been agreed upon between 2 NZEF and Wellington in the days when Colonel Fuller was ADDS, when he made it quite clear that to examine and chart on NZ361 all troops at the end of the war would not only serve no useful purpose but would seriously interfere with the amount of treatment that could be done for them. It would appear that, with the satisfactory dental health of the force and with only enough staff to maintain it, anything more could not reasonably be expected, especially considering that all the men would be re-examined on arrival in New Zealand by the board of civilian dentists appointed by the Dental Hygiene Division of the Department of Health. A cable received from Wellington on 3 September 1945 altered this agreement:
It has now been decided that personnel certified dentally fit within four months of embarkation for NZ will NOT, repeat not, be dentally examined on arrival in NZ unless on personal request. Every effort will therefore be made to render all personnel dentally fit before embarkation. Dental history sheets of those requiring dental examination or treatment only to be attached to personal files. Dental Officer with draft to prepare nominal roll of those requiring examination and/or treatment for delivery to DDS.
The ship's dental officer would have neither the time nor the facilities to examine a large draft and raise the required nominal rolls, so it meant that examinations would have to be completed before embarkation. More dental officers would have to be kept at the two base hospitals.page 273
Japan's capitulation on 15 August 1945 brought new issues to light as it was learnt that an occupational force for Japanese territory was to be formed from the 2 NZEF. The size of the force would make it necessary to send a Camp Dental Hospital consisting of 5 officers and 19 other ranks. Apart from this, staff was still needed to wind up 2 NZEF affairs. Everyone was anxious to get back to civilian life as soon as possible and it was only fair that those with the longest service should be the first to be released. Colonel Earle decided to call for volunteers. Single men of the 13th, 14th and 15th Reinforcements were not given an option but, from the others, volunteers were called for (a) Jayforce, i.e., the Japanese Occupation Force, (b) winding up 2 NZEF, (c) either of these two. With the exception of those who volunteered for these services, officers and men would be released strictly according to length of service when circumstances permitted. The equity of this decision was not fully appreciated by New Zealand as repeated requests for individual releases were made, irrespective of the order of priority.
On 29 November 1945 confirmation was received that sufficient shipping was in sight to lift by the end of December all the 2 NZEF except 2000, and dental officers were allotted to the four ships concerned.
Regarding stores and equipment, it was proposed to send everything to New Zealand, as was being done with medical stores. This, however, was not agreed to by New Zealand, who stated that they wanted nothing but the maxillo-facial equipment. It was therefore decided to offer it to UNRRA, which agreed to buy it.