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The New Zealand Dental Services

CHAPTER 1 — The Origin and Development of the New Zealand Dental Corps in the Great War, 1914–18

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The Origin and Development of the New Zealand Dental Corps in the Great War, 1914–18

BEFORE the Great War of 1914–18, the connection between dental health and fighting efficiency was but faintly recognised. There was a grudging acknowledgment that a toothless recruit might cause embarrassment when confronted with standard rations and thus be a military misfit, but little thought had been given to adjusting his disabilities to the military machine. In most cases he was rejected with the lame, the halt and the blind. Even the layman could see the injustice and futility of this policy, as instanced by the indignant reply of the Scottish recruit in Punch when told that his lack of teeth disqualified him from army service, ‘Mon, I'm no wanting to bite the Germans.’

Napoleon emphasised the importance of good food to the soldier, Florence Nightingale showed the advantages of sound nursing, the triumph of Sir Ronald Ross over the mosquitoes of Panama demonstrated to the world in dramatic fashion one vital part that medicine could play in any campaign. Anything approaching an organised army dental service, however, was as yet unknown in military history. It is not surprising, therefore, to find that at the outbreak of war in August 1914 no organisation existed in New Zealand to provide dental service for the military forces. It is encouraging that there were men with sufficient vision to see the necessity for such a service and the courage to provide one. Ten days after the declaration of war, a force left New Zealand for Samoa. It included, as members of the New Zealand Medical Corps, two dental officers attached to the field ambulance. Two and a half months later, when the Main Body of the Expeditionary Force sailed for Egypt, it included ten dental officers, still members of the NZMC.

These arrangements were thought to be unnecessarily lavish at the time but were fully justified by the work of these officers in Egypt, Gallipoli and France. A brief account of their activities as they affected the formation of the NZDC will be given later, but in the meantime important developments were taking place in New Zealand.

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During the first nine months of the war, civilian dental practitioners were treating recruits both prior to mobilisation and after they had entered camp, either free of cost or at reduced fees borne by the recruit himself. In spite of this a large number of otherwise fit men were being rejected because of gross dental defects, and amongst those accepted there was still much treatment needed. Recognising this as a waste of manpower and seeing the difficulties in providing treatment for the Expeditionary Force, the New Zealand Dental Association in June 1915 put proposals to the Government for the formation of a co-ordinated dental service by civilian practitioners. It offered on behalf of its members to treat all enlisting men who would otherwise be rejected solely on account of dental defects. The fees for this work were to be at ordinary hospital rates, i.e., sufficient only to defray the cost of materials. It proposed that two of its members be appointed supervising officers to act as consultants and advisers to the Director of Medical Services in all matters connected with the dental treatment of recruits and troops. It also proposed that the treatment in camps by the few dental officers attached to the NZMC be reorganised, and it offered £100 towards the provision of better facilities for this.

The Association was taking a realistic view of a situation which demanded urgent action. Instead of pressing for the formation of an army dental service which would take time to organise and develop, it immediately made available a practical service from civilian practitioners. The scheme had the added value of getting the treatment done before the recruit entered camp, thus saving interruption of training. This was an important consideration in view of the announcement by the Minister of Defence that the period of training was to be reduced at the request of the Imperial authorities. It was gladly accepted by the Government and for over two years assisted in making most of the men for the reinforcements dentally fit. Mr T. A. Hunter,1 chairman of the Executive Council of the Association, and Dr H. P. Pickerill,2 Dean of the faculty of dentistry of the University of Otago, were appointed as supervising officers.

The scheme, however, was put forward as an emergency measure only, intended to supply the need until an army dental service was formed. About this time, Surgeon-General R. S. F. Henderson, RAMC, arrived in New Zealand to advise on the reorganisation of the medical services to the NZEF. He was so impressed by the need for an efficient army dental service as advocated by the New

1 Col Sir Thomas Hunter, KBE; born Dunedin, 10 Feb 1863; dental surgeon; Director of Dental Services, NZ Dental Corps, 1916–30; died Heretaunga, 29 Dec 1958.

2 Lt-Col H. P. Pickerill, CBE; born Hereford, England, 1879; plastic surgeon; Major, NZMC, 1916–20; died Silverstream, Aug 1956.

page 5 Zealand Dental Association that, within two months of the Government's acceptance of the civilian practitioners' scheme, the formation of the New Zealand Dental Corps was authorised.

In November 1915 the New Zealand Dental Corps came into being. It was to be a separate organisation from the New Zealand Medical Corps, controlled by a Director of Dental Services in the rank of lieutenant-colonel, with two Assistant Directors in the rank of major. Mr Hunter became the first DDS and Dr Pickerill and Mr J. N. Rishworth1 were appointed as ADDSs. Principal Dental Officers were appointed to the main mobilisation camps, those dental officers attached to the NZMC were transferred to the new Corps and additional officers were appointed. The Gazette notice of the formation of the New Zealand Dental Corps appeared on 24 February 1916. (See Appendix I.)

At this time the 9th and 10th Reinforcements were in camp. The Principal Dental Officers at Featherston and Trentham soon found that the amount of work was enormous and asked for help. The Corps grew rapidly. More officers were appointed, buildings were erected, equipment found, mechanics and orderlies provided and a general organisation evolved. However, it was not until the 17th Reinforcements were in camp that the NZDC and the civilian practitioner scheme were completely coping with the work. This reinforcement numbered 1998 men, and the treatment given to them by the Corps and the civilians amounted to 6335 fillings, 5237 extractions and 854 dentures, leaving 371 fillings, 48 extractions and 32 dentures still to be done.

The Army's policy was to send away each month a reinforcement numbering approximately two thousand. During 1917 most of the treatment, and during 1918 practically all the treatment, was done before embarkation.

Overseas, the autonomy of control of the Dental Corps was not so quickly achieved as in New Zealand, but this is readily understandable in view of the obstacles to be overcome in fitting a new service into an established organisation such as a fighting division. During the voyage of the Main Body of the Expeditionary Force from New Zealand to Egypt, the dental officers began, under the poorest conditions, the task of examining every soldier and carrying out as much urgent treatment as possible. Their examinations revealed a serious condition, fully justifying the foresight of the authorities in providing dental officers for the Expeditionary Force. What had appeared to the critics to be an unnecessary luxury was soon to be applauded as an important contribution to the mainten-

1 Col J. N. Rishworth, MBE; born Blenheim, 1876; dental surgeon; DDDS, 1 NZEF 1917–19; DDS, NZDC, 1930–34; died Auckland, Feb 1946.

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of fighting strength.1 It was expected that the Main Body would very soon be in action after only a short period of training. The ADMS2 therefore instructed the dental officers to concentrate on making every soldier, as far as possible, free from pain or disability in the near future. On arrival in Egypt they were distributed among the various regiments and units, where they extracted septic roots and badly decayed teeth, placed temporary fillings in large cavities, removed salivary calculus and made the mouths as healthy as possible. To attempt the achievement of complete dental fitness was quite impossible. As it was, the working conditions were far from ideal. Soldiers requiring treatment were undergoing a course of intensive training and could not be readily spared for dental parades. Fortunately, commanding officers were quick to realise the importance of the work and did much to assist. This appreciation of the value of the dental service was increased when it was learned that the Australian forces had arrived in Egypt without dental officers and had asked for assistance from those of the NZEF. Four New Zealand officers were temporarily transferred for duty with the Australians in spite of their inability to cope with all the urgent work amongst their own troops. Soon also, many patients from the British forces came seeking treatment.

When the Anzac forces went to Gallipoli, four New Zealand dental officers went with them, two with the New Zealanders and two with the Australians. The equipment for each officer was greatly curtailed, provision being made only for emergency operations for the relief of pain. During this campaign the troops lived mostly on bully beef and hard biscuits which played havoc with teeth, both natural and artificial, with the result that it was not long before there were urgent requests for more equipment.

After some months, five more dental officers were sent to Gallipoli from Egypt and a Field Dental Clinic was established at No. 2 Outpost, Anzac. The area was continually under fire and, owing to the scarcity of fresh water, constant visits had to be made to the beach for sea water to use in the vulcanisers. This clinic was the wonder and admiration of the British and Australian forces. It is interesting to quote from the official history of the New Zealand Medical Services, 1914–18, by Lieutenant-Colonel A. D. Carbery, CBE, NZMC:

1 ‘An army today is a self-contained community; it contains everything its members need for war, from bullets to blood banks. I will always remember Churchill's anger when he heard of several dentist's chairs being landed over the beaches in Normandy! But we have learnt since the 1914–18 war that by caring for a man's teeth, we keep him in the battle.’— The Memoirs of Field-Marshal Montgomery, p. 348.

2 Assistant Director of Medical Services.

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New Zealand had certainly led the way in the provision of an adequate dental service for an Expeditionary Force and a dental hospital capable of carrying out any form of repair or mechanical work and the making of dentures, and provided with cylinders of nitrous oxide gas and dental engines, perched on a trenched hillside, cheek by jowl with a very noisy mountain battery, surely reaches the ‘limit’ in front line dentistry.

Following the evacuation from Gallipoli in December, there was a period of rest for the NZEF in Egypt. This was followed by a programme of training and a reorganisation to form a New Zealand Division. At this stage one of the original dental officers, Captain B. S. Finn, DSO, NZMC,1 was appointed Administrative Dental Officer to supervise and co-ordinate the work of the Dental Services. These were, however, still part and parcel of the medical services under the control of the ADMS. The autonomy of control achieved in New Zealand did not apply to the dental services overseas. That was to come later. The rap on the door requesting admission was insistent enough to demand attention. As Carbery states when discussing the reorganisation of the medical services for the Division at this stage:

One other administrative matter we must consider. The New Zealand Dental Service was now to be reorganised. Captain Finn, DSO, NZMC, the dental officer whom we have seen evacuating wounded from the No. 3 Pier at Chailak Dere, for which good work he had a DSO, was now appointed as acting administrative dental officer, attached to NZEF Headquarters. The ideal of a compact dental service attached to a Division was not as yet fully attained. The opinion of the GOC, NZEF at this time was that the OC of a medical unit to which a dental section was attached should be able to undertake the administration of the section so that a separate Dental Corps Headquarters was unnecessary.

Dental sections were formed comprising one dental officer, two mechanics and one orderly. Two were attached to each of the three field ambulances, with nine panniers of equipment weighing 7½ cwt. Later this was reduced as it was considered to be too much for the ambulance transport. In all, eleven sections were allotted to various units, including two to the New Zealand Infantry Base Depot which was to accompany the Division and one to the New Zealand Stationary Hospital. The Dental Stores Depot, with reserve stocks, was mobile and had a staff of one quartermaster-sergeant and a packer under the administrative dental officer.

In April 1916, when the Division took up its position in the Armentières sector in France, the dental services worked to this plan but in August of that year, when the Division moved preparatory to the Battle of the Somme, the dental sections were ordered to the Base as it was found impossible to carry their equipment.

1 Col B. S. Finn, CBE, DSO, ED, m.i.d.; born Invercargill, 17 Oct 1880; dental surgeon; trooper, South African War, 1900–02; NZ Dental Corps, 1914–18 (Major, ADDS); DDS (Navy, Army and Air), 1934–49; died 23 Aug 1952.

page 8 The service had, however, attracted attention because of its novelty and efficiency. Inquiries came from the DMS1 of the Fourth Army, to which the ADMS of the New Zealand Division replied that he considered the sections unsatisfactory as field units because of the weight of their equipment, and that he preferred the old arrangement of having a dental officer with light equipment, weighing only 80 lb, attached to each field ambulance. In the meantime the sections concentrated on the treatment of reinforcements at the infantry base at Etaples.

They were soon missed in the field, and late in October 1916, at the request of the ADMS, three sections were returned to the Division. So much work had accumulated that they were quite unable to cope with it and the ADMS, in consultation with the GOC, decided to transfer several dental surgeons and mechanics, who were serving in a combatant capacity, to the Corps, and in November a dental hospital was established in a small communal school with a few huts attached. For the first time overseas the NZDC worked apart from medical units. As Carbery writes of this dental hospital:

Days of attendance were allotted to brigades and other formations. Sundays were also work days and were devoted to officers. The NZDC worked hard and well; in their first two months they treated 1702 cases and owing to the close proximity of the trenches—the front line was only 3¾ miles away—of a fully equipped dental establishment capable of executing any type of work required, a soldier could come down from the most advanced positions and have efficient treatment without being more than a few hours absent from his duties in the line.

A very important work performed by the dental officers this winter was the prophylaxis and treatment of ‘Trench Mouth’ or ulcero-membranous gingivitis caused by Vincent's organisms, now very prevalent amongst the men and, in the opinion of some observers, the cause of secondary lung complications of a severe type.

Another quotation from the same source refers to the period of rest and reorganisation of the New Zealand Division in July 1917 following the battle of Messines, and indicates a further stage in the evolution of the New Zealand dental services in the field:

The New Zealand dental sections had been remodelled and had now reached their perfected organisation. The dental section which had been formed in the United Kingdom to accompany the Fourth Field Ambulance was a very mobile unit; all cumbersome equipment had been eliminated, with the result that two small panniers (one pack mule load) now contained sufficient instruments and material for all operations, surgical and prosthetic, and the actual space taken up in transport only half of a half limbered G.S. cart.2 The dental hospital had also been made mobile by allotting one threeton lorry to the purpose of its transport as required.

1 Director of Medical Services.

2 General Service cart.

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There was no difficulty in maintaining a constant supply of expendable material as, in accordance with a contract made between the New Zealand Government and the War Office, all necessary dental equipment could be obtained from Advanced Supply Depots of Medical Stores. In this way all difficulties had been overcome by experience in the field and the New Zealand Dental Corps may justly claim to be the pioneers of a movement which resulted in an efficient and practical dental service for the front line troops.

Not only was dentistry establishing itself as a service to the troops; it was identifying itself as an essential component of the fighting machine, selling its wares with the utmost confidence to a cautious but rapidly appreciative market. These first steps in mobility are interesting as a prototype of the mobile dental unit in the next war, when the whole character of the war made fluidity of movement a primary essence for every unit in a military force.

From the beginning of 1917 onwards the NZDC established many sections in England for the treatment of New Zealand troops, as well as continuing its service in France. There was a depot on Salisbury Plain to train reinforcements as they arrived from New Zealand, two General Hospitals, a Convalescent Depot and, later, separate training depots for machine-gunners, engineers and artillery. To provide adequate dental service for these scattered portions of the New Zealand Forces the establishment of the NZDC was greatly increased. The DDS, Lieutenant-Colonel Hunter (later Sir Thomas Hunter) visited England to advise and report. Major Finn was appointed Deputy Director of Dental Services to the New Zealand Forces overseas, until he was recalled to New Zealand under the exchange system then in force, when Major Rishworth replaced him.

In December 1916 Major Pickerill, one of the two original Assistant Directors of Dental Services, arrived in England. The holder of medical as well as dental qualifications, he was soon seconded to the NZMC and established a plastic surgery and jaw injuries hospital. He devoted his efforts to the surgical aspect of the work, being assisted by a special section of the NZDC. His outstanding work further enhanced the prestige of the young Dental Corps, as well as that of the Corps to which he was seconded.

When the war ended in November 1918 the strength of the NZDC overseas was 42 officers and 70 other ranks.

This necessarily brief outline of the origin and development of the NZDC emphasises in particular the development of the Corps from a minor star in the medical firmament to a constellation of its own. Many authoritative references lead to the conclusion that New Zealand was well to the fore in providing dental services for its army, and particularly in establishing a Dental Corps as a separate entity from the Medical Corps. At this stage it is of little value to retrace the steps by which this independence was won. The important page 10 fact is that at the end of the Great War the New Zealand Dental Corps was independent of the Medical Corps as far as administration of its affairs was concerned. This cannot be too strongly stressed in view of the determined efforts made in the Second World War to take away this independence and merge the Dental Corps once more with the Medical Corps. The arguments used to justify the control of the Dental Corps by the Director-General of Medical Services were based chiefly on an examination of the conditions existing in other countries such as England and Australia. It is right, therefore, to emphasise in this chapter the claim that the New Zealand Dental Corps was the pioneer in providing dental service to the armed forces, that the service was a success and that it was independent in the control of its affairs. If these facts are borne in mind the depth of feeling exhibited in the controversy will be better understood.