The New Zealand Dental Services
CHAPTER 24 — Summary
IN the search for an ideal there is fascination in the intricacies of the chase, satisfaction in the smoothing of the way and pride in the development of efficiency and power. All played their parts, important parts, in the story that has just been told. Yet all are subordinate to the ideal which runs as the only sure path through the maze of complicated detail. Lest the bypaths should lose us in their seductive lanes, it is right that the highway should be floodlit that its surface may be examined for imperfections and the seal set upon its laying. Let us quote the policy on which the reader may judge the degree of achievement. ‘Notes and Instructions relating to the Organisation and Administration of the NZ Dental Corps 2 NZEF’, compiled by Lieutenant-Colonel Fuller for the guidance of his officers, reads:
It is the purpose of the NZ Dental Corps to provide a service within the Expeditionary Force that is readily accessible to every soldier and that, by being on a scale sufficient practically to eliminate oral sepsis from the Force, makes the maximum contribution towards the common effort of developing and then maintaining a high degree of physical fitness among the troops. Moreover, its efforts must reduce to an absolute minimum the occurrence of dental pain throughout the Force and, as far as possible, prevent the loss of effective men from their units on account of dental lesions.
Because of the fact that every soldier is made dentally fit in New Zealand prior to embarkation, it is the consequent responsibility of the NZ Dental Corps in the Expeditionary Force to endeavour to maintain every man in that state…. Furthermore, by maintaining that standard, the well-being and efficiency of the 2 NZEF as a whole will be favourably influenced, a consideration that is important above all others.
In addition, the NZ Government has undertaken to return every man to civilian life dentally fit when the time arises. Hence, it is desirable, for this reason also, that the standard of dental fitness within the Force should not be allowed to deteriorate, even though the above Governmental undertaking may have no direct bearing on the immediate war effort overseas.
In general the scope of the dental service must be wide, extending from the specialist branches of oral surgery and the dental aspects of maxillo-facial injuries down through the Base dental installations, whose conditions closely approximate those of civil practice, to the dental service in the Field which, although operating under active service conditions, must also be adequate and complete.page 275
In general, and in keeping with the constantly changing features of war, the organisation must be flexible and capable of immediate modification and expansion to meet special circumstances. In particular, it must be designed to serve a Force whose component parts are, for the most part, mobile.
Lastly, the size of the service must be in balanced proportion to the other needs of a Force whose purpose is primarily to fight. The service must never be organised and expanded to such an extent that some of its operations, when measured in relation to the purpose of the Force, are unnecessary; nor should they ever hinder essential military activities of units of the Force, but, on the other hand, their effect should be continually to contribute towards and act as a stimulus to general fitness and efficiency.
On these postulates the organisation and equipment were based. The road was not easy but, from the early squelching in the mud through the comparative comfort of macadam to the ease of the autobahn, it was followed with determination and courage. No soldier was ever far from a dental section of some kind, neither was oral sepsis nor dental pain allowed to interfere with his efficiency. The precious asset of dental health was not only his for the asking but was cherished for him by the constant vigilance of the dental service. Not only was his dental health maintained, it was improved and he was encouraged to appreciate its value and co-operate in its establishment. All this was done without interfering with his duties as a soldier or seriously curtailing his hours of leisure. He was treated as an individual, not as a cog in the war machine. There was always a danger that the struggle for material results might submerge the right of the individual to human consideration and sympathy. This was recognised as one of the risks to be run in an impersonal socialisation of a personal service and steps were taken to lessen that risk. The ADDS wrote an article for the New Zealand Dental Journal from which the paragraphs relevant to this subject were deleted in Wellington. He considered them of such importance, however, that he published them in his ‘Notes and Instructions’ to his officers. They are published here as a matter of interest to all who received dental treatment in the 2 NZEF and in recognition that the risk will still be there in similar organisations in the future.
Institutions, organised services and communities, where the craftsman and the scholar are regimented, tend to become soul destroying. In the case of the dental profession, war time service in an Expeditionary Force probably suppresses, or even destroys the individuality of some operators. That is inevitable. War demands that the individual shall contribute his personality to the common cause. In any event, no dental officer is justified in expecting directly to profit by his service experience.
The greatest weakness is the tendency for operators to pay less attention to the approach towards patients and the handling of them. Those who have left civilian practices to join an Army Dental Service find suddenly that their livelihood ceases to depend on these requirements. Consequently, unless page 276 the weakness is known and guarded against, there can be a tendency in Camp Dental Hospitals and similar units for patients to become just a series of numbers in the minds of the operators. When that happens, the dental officer himself is well on the way towards becoming merely an automaton.
A war time Dental Service is not a post-graduate unit for officers fresh from university and we advise them not to view it as a school for gaining experience and furthering their training.
We draw the attention of junior dental officers to these dangers and we prevent the growth of the purely mechanical outlook. Fortunately there is a safeguard. Every dental officer knows that the soldier is entitled to treatment and attention of only the highest order from the profession and, as it happens, the very standards which must be maintained to achieve this purpose are themselves a protection.
Within the limits permitted by military requirements, every effort is made to ensure that an officer retains independence in his technical work; no steps are taken to supervise or inspect it and no detailed instructions are issued to tell him how operations shall be executed. This is necessary for another reason as every officer is eventually required to serve in the Field, and usually is asked to operate an independent sub-unit in circumstances where he must rely on his own resources.
All officers are asked to consider themselves civilians in uniform when at the chairside (but only at the chairside and at no other time), and to handle and approach every patient with that attitude in mind.
The position should not arise when a soldier is lost to his unit during a critical period on account of insufficient treatment at an earlier date or because the treatment was carried out inefficiently. There is no opportunity or excuse for taking those risks which become justifiable in civilian life by virtue of the fact that, should trouble develop, the patient is within easy reach of the surgery or another practitioner nearby. In the Expeditionary Force it must be assumed that, when the treatment is completed, the soldier will be going to a unit in the Field where conditions will be vastly different. Therefore clinical risks cannot be taken.
This chapter may well close with a quotation from a letter from Lieutenant-General Sir Bernard Freyberg to Lieutenant-Colonel Fuller dated 30 December 1944:
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Thank you also once again for all you have done in the Middle East and Italy. The New Zealand Dental Corps in 2 NZEF has won a great and well deserved reputation. I am very grateful to you for the part you have played in making it the efficient organisation it is.
With every good wish,
B. C. Freyberg