The New Zealand Dental Services
CHAPTER 27 — Tonga
THE Tongan or Friendly Islands are in the southern Pacific, east-south-east of Fiji by some 390 miles. Mostly of coral formation but some of volcanic origin, they spread over an area of 250 square miles and are a kingdom under a protectorate of the Western Pacific High Commission.
New Zealand's first association with Tonga, which in any way affected the Dental Corps, was at the end of 1941 when thirty-eight officers and men of the Heavy Regiments of the New Zealand Artillery were selected for duty with the Tonga Defence Force. It was first intended that these men must conform to the special dental standard laid down for ‘A’ Company, that is to say, for men serving in isolated areas such as Fanning Island where dental attention was not available.1 Wearers of artificial dentures would not qualify under this standard for inclusion in the force. Almost immediately this ruling was changed, possibly because so many were rejected under this rigid standard that it appeared there would be no key men included, but probably because there was a civilian dentist practising in Nukualofa, the seat of Government on Tongatabu Island.
In February 1942, 200 additional troops were sent to increase the infantry strength of the Tonga Defence Force from 450 to 650. All these men were made dentally fit before leaving for Tonga, but this did not absolve the New Zealand Government of the responsibility of maintaining that state of fitness. There were too few to keep a dental section fully employed so it was arranged with the Tongan Government that Mr Franzen, the dentist in Nukualofa, would carry out all necessary work at the expense of the New Zealand Government. Mr Franzen was already treating the Tongan members of the Defence Force on behalf of his own Government.
The force was expected to be about 1700 New Zealand and 2100 Tongan troops. ‘T’ Force Field Dental Section was therefore mobilised at Trentham Camp on 10 February 1943. It consisted of three dental officers, Captain E. R. Wimsett1 in command, an administrative staff-sergeant, a sergeant, corporal and private as clerk orderlies, and three mechanics in similar ranks. A dental section was also formed to accompany 15 Fighter Squadron of the RNZAF but this did not stay long in Tonga. There was very little time spent in Trentham, so emphasis was laid on accurate examination of the force so that treatment could begin immediately on arrival in Tonga. This was one of the few occasions when troops were allowed to leave New Zealand dentally unfit, but the circumstances were exceptional. The limited time was largely taken up by inoculations against tetanus and typhoid, in which the Dental Corps participated; the troops were not newly mobilised and had had previous treatment; they were not going to an area where they were likely to go straight into action and there would be plenty of time for treatment in Tonga.
They sailed on 17 February 1943 and, after a rough trip of five days, arrived at Tongatabu, where American heavy transport met them and took them to Houma on the south-west coast. Here the Americans had established 7 Evacuation Hospital in the bush. Battalion camps were being established under difficulty due to the nature of the country and the abnormally prolonged rainy season, which meant mud up to the axles most of the time and sticky, humid conditions.
The Field Dental Section could be split up into three fully equipped sub-sections. It was originally intended to attach one to each battalion of the brigade group, viz., 1 Tongan Battalion, 2 Tongan Battalion, and 6 Canterbury Battalion which took over from 34 Battalion on 8 March. After conferring with Brigade Headquarters, however, Captain Wimsett decided to keep his headquarters section at Houma, partly because of the widely scattered units and partly because patients sent in from the other sub-sections for specialist services such as X-rays could be more conveniently handled at this centre.
Headquarters Section therefore looked after the middle and western parts of the island, the main units being 1 Tongan Battalion, Engineers, Ordnance, Army Service Corps, various batteries, Brigade Headquarters, Signals, Pay and Records and the Women's Army Auxiliary Corps, twenty of whom arrived on 22 March. Treatment was also given by this section to the Observer Section stationed on small, lonely islands sometimes miles from the mainland.
On 9 March one sub-section was attached to 2 Tongan Battalion at the aerodrome and consisting of New Zealanders and Tongans undergoing training. Here the accommodation was in American pattern tents of ancient lineage, so frail that one tent had to be covered by another to get reasonable protection from the incessant tropical rain. These were only used for quarters as two good Indian pattern linen and cotton tents were on issue to each sub-section for surgery and laboratory, so that on starting work the sub-section looked much like any early-war section in New Zealand except for the rain, heat, steam, mud and mosquitoes.
The other sub-section was attached to 6 Canterbury Battalion at Mua. The companies of this battalion were spread over the northeastern part of the island. Unlike the Tongan battalions, there were no natives in this battalion so there were no suitable rations for a Tongan orderly who would normally be attached to the dental sub-section. The section therefore had to do without one.
Apparently the Tongans made good orderlies as Captain Wimsett wrote in one of his reports: ‘Both lads did exceptionally good work and displayed a keenness that could well be followed by all ranks.
Regular examination and treatment was carried out and, when it was decided to reduce the garrison in December 1943, the Corps reported that the main body that left Tonga on Christmas Day was dentally fit almost to a man. Two sub-sections returned to New Zealand with the main body, leaving the headquarters section to establish dental fitness for the few who were to stay in Tonga after they themselves left with the rear party, including Brigade Headquarters, in February 1944.
Captain Wimsett reported:
It might be appropriate to mention here that the NZDC arrived probably the best equipped unit of the Force. Suffice it to say that we had three hammers and the Engineers only one. The main equipment ship did not arrive until May and until then units had to do their best with what facilities they could make available for themselves. Lack of transport was naturally a great drawback. We were at all times greatly indebted to the Engineers who, despite their own lack of equipment were most helpful in all ways and assisted materially in maintaining the sub-sections in a reasonable state of repair.
When the Dental Corps left Tonga, it was estimated that there would be about 550 mobilised troops remaining, of whom 340 would be New Zealand and Tongan and the remainder United States Navy. Of the New Zealand and Tongan troops, 190 were Army and 150 Air Force. The New Zealand Government, under the agreement with the Tongan Government, was still responsible financially for the defence of the island and this included dental treatment for all mobilised troops. Mr Franzen's services were once more solicited for all New Zealand troops other than the Air Force. All work was to be done by him on an order signed by the Medical Officer, payment being made from the New Zealand Treasury. For the Tongan troops the Tongan Government agreed that, as Government Dental Officer, he should do extractions, fillings and general dental care, but that dentures would be supplied only on an order from the Medical Officer as for New Zealand troops. For the Air Force the DDS instructed the dental officer attached to the RNZAF station at Nausori in Fiji to visit Tonga at regular intervals. The Army ‘Care and Maintenance’ party at the aerodrome was grouped with the Air Force for dental treatment.
If the Tongan native gained anything from his brief association with the New Zealand Dental Corps, the advantage was not entirely one-sided. The opportunity to examine the mouths of natives from different localities in the Tongan group provided further proof of the damage done to the natural dentition by the white man's diet. Much had been written on this subject but it was seldom that such an opportunity arose to observe at first hand. Captain Wimsett's report on the subject therefore merits inclusion in this history:
Of 460 recruits examined, representing four companies of the 2 Tongan Battalion, 195 were found to be dentally fit. Those requiring treatment averaged about one filling per man. Many of them required scaling and cleaning only. These men's teeth are remarkably free from caries though, where this is present, it seems to be of a virulent type. Gum conditions are markedly poor and extensive calculus deposits almost universal, and in most cases teeth require extraction for these reasons. These men have had no dental attention except for occasional extractions usually by Tongan Medical Practitioners and do not appear to employ any type of prophylaxis.
This report applied to recruits, mostly from the outlying islands such as Haapi, where the natives were living away from the influence of white people.
Those personnel who were recruited from the larger villages and especially from Nukualofa, showed extensive caries…. Those natives who lived on a natural diet of yam, taro etc., showed very little caries but still extensive calculus. Those who were able to get bread and canned meats, to which they were very partial, showed extensive and multiple caries plus the usual calculus.page 341
The significance of these observations brings to mind the report made some years ago by Weston Price, a much travelled American research worker, who found similar conditions prevailing in countries whose inhabitants live under somewhat similar conditions to the natives of the Tongan islands. This report is not concerned with any theories but is a statement of cold, hard, and undeniable facts as they were found.
Here was the same story as in Fiji: civilisation and dental caries marching hand in hand to that Gehenna where there shall be wailing but no gnashing of teeth. The dentists of the world are fully employed in smoothing the downward path by deadening the pain of nature's warning or fashioning a crutch for the dental cripple. The answer is there at the beginning of the road, but to reach it the snowball of public opinion must be rolled back up a long steep hill or melted altogether in the fires of Armageddon.
The connection between civilised diet and dental caries is obvious, but the menace of calculus with its handmaiden pyorrhoea is present with the native in his natural existence and is something that warrants further research. Even in his natural existence the native does not use his jaws as much and as vigorously as his distant ancestors did. Gone are the days when the teeth were used to kill the prey and tear the flesh from its bones. Gone also is the mechanical cleansing this exercise would give to the teeth. Loss of function carries penalties and human jaws are growing too small to accommodate all the teeth, as can be seen in the number of third molars with insufficient room to erupt. Captain Wimsett noticed this in the Tongan natives:
One other fairly common occurrence was the number of impacted third molars. The Tongans have, like our Maori people, large wide arches (I never saw one case with a Gothic arch), yet on account of the large teeth there still was not enough room in a number of cases. These impacted and unerupted third molars caused them a considerable amount of trouble and, as is to be expected, it was found necessary to remove them. Access however, as might be expected, is very good and I gained considerable experience in this class of work. Generally speaking the teeth of the Tongans are not difficult to remove.
From the conservative aspect the teeth are somewhat similar to those of our Maori in that the extent of the caries was more real than apparent. Malignant growths of the oral tissues were occasionally seen but mostly only when the case was apparently hopeless as the native seeks help only when sheer necessity drives him to it. On enquiry I found that cancer as the layman understands the term is rare in the Tongan people. Although tuberculosis is very common among the natives I did not see any oral manifestations of the disease and would say that tubercular ulceration of the oral mucosa was rare. The Tongan makes a good patient and is co-operative and grateful for anything one does for him, particularly if the work entails the replacement of anterior teeth which makes him the cynosure of all eyes among his brethren.
The Tongan Group is serviced from Tongatabu to Vavau by the Government dentist. Mr Franzen. Conservative work and extractions for the natives are free but prosthetic work has to be paid for. The Dental Corps remembers with gratitude his valuable advice, his practical help and the hospitality of his home.