The New Zealand Dental Services
CHAPTER 32 — The New Zealand Dental Corps as Prisoners of War
The New Zealand Dental Corps as Prisoners of War
THROUGH the accident of capture of the complete Mobile Dental Section in Greece, the New Zealand Dental Corps played a large part in providing treatment for Allied prisoners of war. Eight dental officers, twenty-one other ranks and eleven attached Army Service Corps drivers were captured in Greece. One officer and two other ranks were picked up in Crete and two officers and four other ranks were taken prisoner in the Second Libyan Campaign. As it is the exception for more than an occasional dental officer to fall into enemy hands, a contribution of eleven with twenty-seven other ranks trained in dental duties imparted a distinct New Zealand flavour to the profession in captivity. There were others, of course, including British, French and Jugoslavs, but through sheer force of numbers the bulk of the dental work in the prison camps in Germany and Italy was carried out by the NZDC. As Major Mackenzie, Officer Commanding the captured New Zealand Mobile Dental Section, wrote after his repatriation to England in 1945:
It is probably no exaggeration to say that the Dental Officers captured in Greece and North Africa were of more value to the health of our troops as prisoners of war than on the other side of the wire. The majority of the men caught at Dunkirk had had no dental treatment at all before being sent to France. Prisoners coming in later were in a better condition but it was never possible to keep pace with the amount of work presenting. Generally speaking the German authorities were not interested in the health of the prisoners of war. There were one or two exceptions to this rule. As far as I know the bulk of the dental work done in Germany was carried out by NZDC officers and men.
The German attitude towards dental treatment for prisoners of war varied in different camps according to the humour of the commandant. Generally speaking, in the early stages of the war it was one of indifference or even obstruction. Reports from dental officers bear out many instances of antagonism from the German authorities. Captain J. G. W. Crawford, NZDC, writes:
On June 18th 1941 we began dental work in this camp (Oflag VB Biberach, 25 miles south of Ulm) which numbered about 800. The equipment was fair with collapsible chair and electric engine but materials were page 385 not over plentiful. A German Army Zahnarzt [dental surgeon] from time to time smuggled us in extra supplies especially local anaesthetic of which we were always short. Unfortunately for us this man committed suicide later but he had always been a good friend to us. Orders from the German authorities prevented us from using local anaesthetic on French and Slav prisoners. British officers were the only men who were granted the privilege of having local anaesthetic for extractions. There were many hectic scenes when we extracted teeth for the unfortunate French prisoners.
It can readily be understood that because of the sadistic instructions of the Germans, the extractions for French or Slav officers were limited to cases of extreme urgency. The enforced prostitution of his profession must also have added considerably to the strain imposed on Captain Crawford. Later he moved to Stalag 383, where he found the artificial denture problem his greatest worry:
Since my arrival in this camp last December there has been no opportunity for making artificial dentures. Towards the end of May 43 a large number of teeth arrived from the British Red Cross Society. In addition several flasks and some wax were sent. I have endeavoured to get dentures processed at an outside laboratory but that has not been possible. I have also tried to get the necessary vulcaniser, polishing lathe etc., from the German authorities but they are unable to supply. I have in my books 200 men in need of either full upper and lower or full upper or lower dentures. This list does not include at least 100 men with broken dentures.
It is inconceivable that the German authorities could not provide a vulcaniser for the camp and this clearly shows their unsympathetic attitude in not allowing the dentures to be processed at a laboratory outside the camp. It was not until August 1943 that arrangements were made to send denture cases to a laboratory in Regensburg for processing. By this time denture materials of all kinds had begun to arrive from the British and International Red Cross. By April 1944 facilities were made available from the same source to do all denture work in the camp.
Captain R. D. Spencer, NZDC, described similar troubles about artificial dentures in his camp:
In Fort 13, very largely owing to Captain Cook's tact in dealing with the Germans and his organising ability, we gradually built up an excellent surgery with two sets of equipment and a very good laboratory. The German doctor was far from co-operative and much of the equipment was obtained by ‘under the counter’ dealing with a German dentist in Thorn. This was paid for with Red Cross funds and not infrequently with our own meagre cigarette supply. All the teeth were supplied by the British Red Cross Society as was rubber but the Germans supplied acrylic resin and also quite good filling materials.
At Stalag 357 on my arrival on 14 July 44 there were approximately 100 men requiring dentures, many of them having been without teeth since the date of their capture as far back as 1940.
All prisoners of war were entitled to be fed on the same scale as German Base troops. This clause of the Convention was flagrantly broken by the Germans and they did not attempt to conceal the fact that we were not page 386 being fed according to the Geneva Convention, in fact they admitted that we were being fed on the microscopic German civil non-workers' ration which was to begin with:
1 lb potatoes per day.
Dried peas or swedes (usually the latter).
300 grams of brown bread made from half rye flour and half potato flour.
6 ozs per month of fresh meat, usually horse.
About a level tablespoon of sugar and margarine per day.
The German doctor seemed powerless to increase the ration but he did try, when pressed, to provide facilities for me to make teeth for the many who had none.
Even this meagre ration was cut down early in 1945 as a reprisal for the alleged ill-treatment of German prisoners of war in Egypt, so that, although the facilities for making dentures were there by November 1944, the diet of weak soup of swede and water, with one kilogram loaf per day to eight men and possibly two potatoes each, hardly required teeth to assimilate.
Captain C. C. Cook, NZDC, who was captured in Crete and who worked with Captain Spencer at Fort 13, has something more to say about that stalag, but before that it is interesting to record his impressions of dentistry as a prisoner of war in Salonika:
June to November 41. I was attached to the staff of the Barrack set out for the sick. In no way could this be called a hospital and conditions were primitive. The German in charge, Major Shott, was unco-operative and rude. For dental work the only instruments available were:
1 pair upper root forceps
1 pair lower wisdom forceps
2 useless elevators
1 glass syringe
1 box Harvard cement
1 box Synthetic porcelain cement.
There were no facilities for heat sterilization and lysolat tablets were used.
This equipment was added to in September and by 20 November, when the whole camp was moved to Germany, Captain Cook had completed 234 extractions and 134 cement fillings. Considering that nearly 27,000 British troops alone passed through this transit camp and that Vincent's infection was rife, the provision for even urgent dental treatment was totally inadequate.
On arrival at Fort 13, Stalag XXA, Thorn, Poland, containing 6000 English and about 1500 French prisoners of war, Captain Cook found that dental treatment had been confined to urgent work only. Captain Blanthorne, a British Army Dental Corps officer, was much overworked providing even this amount of treatment. Permission was officially given to Captain Cook to work with Captain Blanthorne, but in itself this was little more than a gesture. Dr Weideman, the stalag doctor, was the controlling authority who page 387 gave permission to work but placed as many obstacles as possible in the way of fulfilment. To quote Captain Cook:
Weideman was most unco-operative and rude and made working conditions as awkward as possible for all officers. He shifted at least twelve medical officers from the Stalag at various periods and the only reason he left the dental officers was that he couldn't replace them. Theoretically he was in charge of all medical personnel but, in practice, he allowed dental treatment to be in charge of Dr. Lebrun, the German Army Dental Officer in Thorn. This worked admirably as Lebrun was more co-operative but unfortunately he was shifted about May and Weideman then ordered all dental requests to be referred to him. He was most scrupulous in inquiring into the use of everything ordered and quite often refused things. He was outwitted however by a very good contact being made with the only large dental depot in the district and the best of everything was available for filling work.
The denture position all throughout 1942 was most unsatisfactory. Up to the end of February all denture work was paid for individually or by raffles. From then on the supply of dentures was controlled by the German Army through Weideman and up to the end of August, 32 Full Upper or Full Lower dentures were supplied out of a conservative estimate of 260 required. The German order was ‘Only men suffering from stomach trouble caused by the absence of dentures are to receive them and workers are to have preference.’ Non-working NCOs were therefore to be left without anything. The mechanical work was done by five British dental mechanics working for German civilian dentists.
The position of the edentulous prisoner of war was bad enough when his only qualifications for relief were to be a worker and become ill, but that was not all. Having reached the stage when his dentures were authorised, there was no guarantee that he would receive them expeditiously. Captain Cook reported that the processing of dentures from the camp by the British dental mechanics working for the German dentists was allotted the lowest priority. The German authorities would not supply wax, teeth or rubber, and Weideman would not allow a vulcaniser in camp until he was later persuaded to do so by a representative of the International Red Cross.
Mechanical equipment for a laboratory began to arrive at the end of January 43 and also a consignment of wax, teeth and rubber from England. On 23 February 43 the first denture was made in the Stalag and by March the laboratory was in full swing. It is convenient to mention here that the first lot of dentures made were a number sanctioned by Weideman under the German Army scheme for stomach cases as far back as the beginning of October 42 and held back by him for five months until the laboratory was opened. For some time the forms of these men were kept as evidence of his failure to look after the general health of prisoners of war but they had to be left behind on movement from Thorn. At the time it was not thought prudent to have an open breach with him by demanding that the Germans should make the dentures as the laboratory was more than we really expected.
The British War Office gave instructions to dental officers to forward reports through the protecting power and on reading these page 388 it appears that, had it not been for the persistent nagging of the German authorities by the dental officer prisoners of war, there would have been few facilities made available for dental treatment of any kind. As it was, the artificial denture position was never satisfactory. Captain W. Skegg, NZDC, who was first in an Italian camp, stated that the position there was even worse, the Italians providing virtually no equipment. In many cases treatment which should have been provided by the Germans had to be paid for by the prisoners of war themselves. Captain J. M. Green of the British Army Dental Corps writes:
The first dental treatment for prisoners of war in this area (Kreis Cosel) was provided by a civilian practitioner who did fillings, extractions and dentures the cost being met out of camp funds (canteen profits). There is no record of the work but the total bill was 1773 Reichmarks. The first prisoners of war here being Arbeits Kommando E/3, Captains Warren1 and Noakes, NZDC, were posted here in February and May 42, both bringing with them a few instruments. They obtained permission to buy materials and instruments from a private firm and gradually equipped the dental centre which consisted of a small hut, 9 feet by 12 feet, serving as a surgery, laboratory and, in bad weather, waiting room. Up to the time of leaving the camp, these officers made 90 dentures with the assistance of Staff-Sergeant Turner A.A.M.C.
In December 42 I came from Marlag and Ilag, Stalag XB and later Milag Nord where I had been in charge of the dental centres and relieved Captains Warren and Noakes. More material was bought including a Field Dental Chair and large stocks of Palapont, Paladon [acrylic resin denture materials] wax and filling materials. Owing to the shortage of teeth a method was evolved of making stocks of teeth from Palapont and between 50 and 60 dentures were made before the Red Cross supplies arrived.
Men were charged 30 Rms2 for dentures to cover all costs for materials etc., and the scheme worked excellently, the accounts being kept by the canteen at E/3. In May 43 the German authorities withdrew permission to purchase materials and paid the latest incurred so the nominal charge of 30 Rms has been stopped.
At Oflag VIIB where Captain D. Greenslade, NZDC, Captain R. B. Neal, ADC, and a Canadian dental student, Lieutenant J. Brick, were working, there was a similar reluctance by the Germans to honour their obligations. The Senior Medical Officer reported:
Prosthetic treatment cannot be carried out in this camp. Shortly after prisoners of war came here in September 42, permission for prosthetic treatment of any sort was refused by the German authorities on the grounds that there was a great shortage of dental rubber, artificial teeth and wax. An assurance was given, however, that if these materials were supplied by the British, prosthetic treatment could be carried out by a German civilian dentist in the locality, an arrangement which existed at Oflag VI/B. When the necessary materials were obtained from the British Red Cross Society, application to have dentures made locally outside the camp was refused onpage 389 the grounds of the great demands being made on the German dental technicians. It was agreed that urgent repairs to dentures could be carried out, the British supplying the necessary materials, but of some twelve dentures sent for repair, only three were repaired after some four months and the rest were returned unrepaired. The extreme urgency of prosthetic treatment was discussed on several occasions by the Senior British Medical Officer, the Senior Dental Officer and the German Camp Doctor and on 5 June 43 it was agreed that the processing of dentures would be permitted in the camp. An indent for equipment was submitted to the German Camp Doctor together with a request for a British dental mechanic to be sent to the camp. The German camp doctor submitted the whole matter to the appropriate German authority. On 18 June a Senior German Medical Officer visited the camp hospital and in the course of his inspection made notes of the prosthetic position and it is hoped that it will not be long before a prosthetic department can be established. At the present time 53 officers require full dentures. This is due mainly to extractions which had to be carried out after capture. A much greater number require dentures remodelled or repaired. The supply of partial dentures for many cases is very necessary, many patients lacking the minimum number of teeth for adequate mastication. Nevertheless the greatest concern is for the edentulous and for those prisoners of war who must remain edentulous until repairs are carried out on their dentures.
At Reserve Lazarett Obermasfeld, Stalag IXC, conditions appear to have been more satisfactory. A dental centre was opened on 18 June 1941 under Lieutenant P. Francin of the French Dental Corps, first with a surgery and then, in September, with a laboratory as well. This camp contained prisoners of many nationalities. In February 1942 Captain J. T. Dodgshun arrived and reported as follows:
Accommodation. 1 surgery and 1 laboratory—satisfactory.
Surgery—sufficient. These have been supplemented recently by the British Red Cross.
Laboratory. The supply of materials has been sufficient to cover the output of dentures. Early this year it was becoming more difficult to obtain artificial teeth. In March however a consignment was received from the British Red Cross Society. Oflag A/Z and the British Stalag IXC (Molsdorf) forwarded similar Red Cross consignments to this centre as the prosthetic work for those camps is carried out here. At first dentures were processed in vulcanite but now Paladon is used exclusively and sufficient rubber has been obtained to repair vulcanite dentures. With the arrival of Red Cross consignments the present stock of artificial teeth are adequate for future requirements. Providing that issues of materials by the Germans continue as they have to date, the dental position can be regarded as good.
There are many more reports from different camps, some good, some bad, but enough have been quoted to show that the German policy was indefinite, allowing the different camp authorities to page 390 interpret it as they wished. In most cases their attitude was antagonism or indifference. This is in marked contrast to the moral obligation accepted by the New Zealand Government whereby all enemy aliens, whether civilian internees or prisoners of war, were given dental treatment by the NZDC to the same standard as that provided for the New Zealand Armed Forces at no cost to the individual. The British Government protested but it is doubtful if the Germans took much notice as it was merely a reminder of an obligation of which they must already have been familiar. On 26 February 1944 the following memorandum was sent to Berne from the Foreign Office:
When delegates of the International Red Cross Committee visited Reserve Hospital number 128 (Stalag IIID) in June 43 it came to their notice that the conditions which had to be fulfilled before artificial teeth would be provided by the German authorities were:
At least fifteen teeth must be missing.
There must be proof that most of the missing teeth had been lost by the prisoner of war during his captivity.
There must be from the absence of natural teeth incapacity to work. In the view of His Majesty's Government, insistence that artificial teeth can only be supplied where there is compliance with the above three conditions is entirely incompatible with the provisions of Article 14 of the Prisoners of War Convention which, in its second paragraph lays down that the expenses of the treatment of prisoners of war needing medical and surgical care, including the cost of temporary remedial apparatus (and artificial teeth are clearly apparatus of this kind) shall be borne by the detaining power.
His Majesty's Government therefore request the Swiss Government, on their behalf, to represent strongly to the German Government that the conditions mentioned shall be cancelled both at the Reserve Hospital number 128 and at any other hospital or camp where they are imposed and that henceforth there shall be in regard to artificial teeth and dental treatment, proper compliance with Article 14 of the Convention. They request to be informed in due course of the German response to these representations.
Notwithstanding the lack of co-operation from the Germans, a large amount of work was carried out by NZDC officers and men in captivity. Their enthusiasm and determination to work for their fellow prisoners made them invaluable in the camps and even the Germans recognised their worth, if only as an acquittance of their own obligations. Captain Carter of the Australian Army Medical Corps, the first Commonwealth medical officer to be repatriated from Germany, wrote to the DDS in New Zealand in December 1943:
Major MacKenzie and his Mobile Unit were split up after capture in Greece. The C.O. and one other being sent off to Belgrade and Lieutenants Noakes, Warren, Spencer, Crawford and Dodgshun remained in the main prisoner of war hospital at Piraeus. Here Lieutenant Noakes became responsible for all jaw injuries, doing work of a high order, the others doing routine dental work including dentures. They were still at it when I left the hospital in late August. Owing to their industry, practically all patients were sent into Germany dentally fit. The value of their work is such that page 391 they have already been warned by the German authorities that they will not be repatriated till after the Armistice.
The practice of dentistry in a prisoner-of-war camp was not only affected by the limitation of equipment and facilities but was influenced by the conditions under which the men were living. As it was extremely difficult to provide artificial dentures, it was essential that as many of the natural teeth should be preserved as possible. Extractions were therefore carried out only in cases where general health was threatened or for the relief of pain. Some teeth which would normally be extracted were saved by root filling, even though the absence of satisfactory means of ensuring asepsis made this a doubtful risk. It was necessary to decide in each case whether the man was better off with a risk of focal sepsis from a devitalised tooth under conditions when resistance might well become lowered, or deprived of a valuable masticator. Prophylactic treatments such as scaling and polishing were important. With lowered resistance due to dietary deficiencies, especially of vitamin C, there was always a danger of outbreaks of Vincent's infection and it was imperative that the oral tissues be kept healthy. A constant watch had to be kept to ensure that teeth carefully preserved by filling were not lost from pyorrhoea. Toothbrushes, pastes and powders were unobtainable in the early days and the diet contained few self-cleansing foods. There was a vicious circle. Masticatory inefficiency and poor diet led to lowered resistance, which in turn threatened further to destroy the masticatory machine.
Some prisoners of war had had little dental attention before capture so, with the great demands on the dental officers' time, it was impracticable to attempt to make them dentally fit. All that could be done was to make them as comfortable as possible by judicious extraction and the insertion of temporary fillings. There was always more work for the dental officers than they could do. Their policy was therefore to examine all the men regularly and concentrate on what was most urgent.
In some cases patients were sent from one camp to another for certain classes of dental work. Stalag IXC, where Captain Dodgshun was stationed, received the allocation of prosthetic materials from other camps in return for undertaking denture work for them. It also became a centre for Allied prisoner-of-war maxillo-facial injuries.
Though kept busy with routine treatment, some of the NZDC officers found time for research. As Major Mackenzie wrote in the preamble to an article for the New Zealand Dental Journal:
A Prisoner of War camp provides an excellent field for research work into the possible causes of dental caries. It would be difficult to find a similar institution so isolated from the outside world where the inmates are so ready to co-operate in experiments, where the exact diet is known and where it is so easy to keep them under observation. Furthermore, those interested in this work have the leisure to study and think unhampered by the distractions of normal life.
Major Mackenzie studied the acidity of the saliva in relation to the incidence of caries among his fellow prisoners. He made a careful study of their daily diet and, with a home-made microtome, prepared several hundred sections of extracted teeth. His findings were published in the New Zealand Dental Journal of January 1945. Captain Dodgshun also wrote a technical report, chiefly on his maxillo-facial work, which though too technical to include here in page 393 full, contains some passages of general interest about the conditions at the hospital in which he worked:
The German policy was to use captured medical and dental officers and personnel to treat prisoners of war both in camps and special prisoner of war hospitals. As a general rule in this hospital [Reserve Lazarett Obermasfeld] the treatment was planned and carried out at the discretion of these officers.
The general conditions of the hospital were not good, mainly due to overcrowding. Most of the wards had a full complement of double-deck beds with only about three feet separating each bunk. When it is considered that a big percentage of the cases were orthopaedic with infected wounds requiring prolonged treatment, the difficulties will be appreciated.
Diphtheria is a fairly common disease on the continent. An epidemic, fortunately of no great magnitude, broke out during the last few months. This was the greatest problem and worry as, although isolation within the hospital was possible for suspects, discharged patients had to go to allow for the constant inflow of admissions. This policy was adopted by the Germans on the grounds that admissions could not be diverted elsewhere.
Under normal circumstances many of the more serious jaw injuries would have been treated in a maxillo-facial centre. The repatriation of wounded was subject to much delay and did not exist at all until October 43. Usually the patient did not see a medical commission before four to six months' treatment had been completed. If passed, about six months elapsed before repatriation took place.
Since no elaborate treatment such as plastic operations or bone grafting could be undertaken, the patient's treatment was delayed for a considerable period before specialist services were available at home.
In the earlier part of his time at the hospital there were few maxillo-facial injury cases as most of them were treated at German hospitals. Later, however, he saw a number from the Anglo-American Air Force and from the Army on the Western Front. When the aerial warfare became more intense the casualties of this type increased, most of them having received only first-aid treatment before admission to the hospital. The average time from date of injury to admission was four weeks though some were as old as two months, while those occurring among the local working parties were received on the first or second day after injury.
Psychologically the officers and men of the Dental Corps had an advantage over the average prisoner of war as they were spared the boredom of idle hours but, physically, the continual work under adverse conditions took its toll, especially in the form of anaemia. One New Zealand dental officer who suffered from severe anaemia throughout most of the period of his captivity describes something of the hardships of the life:
Captured about 20 miles on the Athens side of Corinth while endeavouring to make for the Corinth Beaches, where we had heard that a last evacuation was to be made by the Navy the following night, I was sent with three of my colleagues to help in a temporary hospital in Corinth. page 394 Here four overworked doctors under Captain A. N. Slater NZMC1 were trying to bring some order out of chaos among the badly wounded men from the battle for the Corinth Canal Bridge. We worked here for ten days assisting the medical officers. Over half the patients had no beds and were on stretchers on the floor and even in the corridors. The only food brought into the place was that supplied by the Greek volunteers who came in to help the nurses. Captain Slater and I made several visits to the German Military Commandant of the town asking for food for the hospital and on each occasion were promised that something would be done. It was not however until the end of the sixth day that the remains of the soup left over from the dinner of a nearby German hospital arrived.
After that things began to improve until, a few days later, we were all transported to a very much better place in Athens which was being run, under the Germans, by the staff of the 5th Australian General Hospital which had been captured intact and had been allowed to keep much of its valuable equipment. During the time I was there (June to December) just under 2,000 wounded prisoners of war passed through, many of them having been flown from Crete.
Until reinforcements of doctors arrived from Crete, I was assistant anaesthetist to Captain Slater but later was able to turn my attention to dental surgery. I kept details of my work in my diary but the Germans found it and confiscated it.
The Germans themselves were short of food in the Athens area owing to the destruction of all road and rail bridges into Attica from Salonica and the Pelopponese and the activity of Russian, British and Greek submarines in the Bay of Salonica.
Early in December the whole hospital staff and patients were transferred to Salonica on the deck of an oil tanker and, after a day or two, entrained for Germany. After eleven days in the train we arrived at Thorn in Poland and became attached to Stalag XXA on 1 January 42. I was living in Fort XV with about 600 other ranks, mostly NCOs, and held dental parades every day for the relief of pain, the only equipment available being my emergency kit.
He was appointed to Stalag 357 on 14 July 1944 and moved to Fallingbostel near Hanover on 24 July owing to the Russian advance. This was the camp referred to earlier as providing inadequate diet for the prisoners. On 24 March 1945, 2000 Americans arrived in an exhausted condition, having been on the road for three months from East Prussia. Together with the rest of the prisoners they were made to march east again when the spearheads of the 21st Army Group were about 25 miles from the camp. Of this march he writes:
I was in charge of a column of 1,500 men, half Americans, and we marched from 12 to 16 kilos a day, although the first day we had to go 22 kilos. The occasional tooth was extracted on the march but my duties were mostly medical. Twenty to thirty men left the column every day in a state of collapse. They were collected together later by a medical officerpage 395 into three large barns. Chronic diarrhoea, dysentery and bad feet were a constant embarrassment. Of the four orderlies, two of them collapsed and had to be left behind before we crossed the Elbe. Two days after crossing the Elbe we received liberal supplies of Red Cross parcels and terrifying attacks by rocket-firing Typhoons on the same day. One column lost 42 killed and over 60 wounded in one attack. We learned afterwards that they thought we were Hungarians. We were liberated on 2 May by the 1st Airborne Division.
Such were the conditions and such were the men. They were given the opportunity to perform a valuable service and they grasped it with both hands. To them is due the credit of turning to the general advantage what at first appeared to be a tragic loss to the Corps. The prestige of the New Zealand Dental Corps has been enhanced by their devotion to duty.