The New Zealand Dental Services
CHAPTER 3 — Transition from Peace to War, 1939
Transition from Peace to War, 1939
THE outbreak of war in September 1939 found the New Zealand Dental Corps poor in strength but rich in theory. A peacetime establishment had been recognised, and although a full wartime establishment was not generally welcomed, there was at least an admission that without dentistry the health service to the armed forces was incomplete. The admission had advanced little beyond the conception of a cadre staff of trained organisers and an unspecified number of civilian executives. How far this conception fell short of the actual requirements and the story of the fight for recognition will be told later. In the meantime, the suggested plan for the examination and treatment of troops in the event of mobilisation had to be carried into effect with the dental forces available at the time. The position was definitely better than that existing at the beginning of the first war.
It has already been mentioned in the previous chapter that Lieutenant-Colonel Finn had submitted certain proposals to Headquarters for action in the case of general mobilisation. This transition period is concerned chiefly with two aspects of these proposals:
The standard of dental fitness expected of the troops.
The methods by which dental fitness was established.
1. Dental Standards
Certain standards were laid down for medical and dental fitness in Appendix XXIV of Army Standing Orders for Mobilisation, 1939, the dental ones being the result of submissions from Lieutenant-Colonel Finn.
The standards are given in detail in Appendix II, omitting the medical ones which are not relevant to this history. They were grouped under four headings:
Armed Forces for Home Defence.
Large Expeditionary Force.
Small Expeditionary Force for Garrison Duty Abroad.
Temporary Employment in New Zealand.
On examination the men were classified as:
‘F’ or dentally fit or capable of being made so in three working hours.
‘T’ or requiring treatment longer than three hours to be made fit.
‘U’ or dentally unfit, such as those requiring multiple extractions or suffering from a contagious oral disease.
For home defence nobody in categories ‘F’ or ‘T’ who was willing to receive treatment was to be rejected, but for small or large expeditionary forces only category ‘F’ men were to be accepted to begin with.
Standing Orders also gave instructions to dental examiners as a guide to assessment of standard, as well as defining their authority to make decisions and receive payment for their services. It is unnecessary to quote these details in full, but one curious anomaly is mentioned as an example of how confusion can be caused when regulations have to be built piecemeal to meet unknown contingencies. When these regulations were framed, the DDS did not know whether the dental treatment for the armed forces would be by civilians or a Dental Corps, and they reflect the uncertainty of the time, being built as a patchwork according to fluctuating circumstances. The anomaly concerned the standard expected of an artificial denture and probably arose from an attempt to ease the severity of the dental standards because of the urgent need for manpower, but the new patch was put in without taking out the old one. The two paragraphs, separated from their context, are:
Definition of a well fitting denture
A denture will not be considered as ‘well fitting’ unless six months have elapsed1 from the completion of the extraction of the replaced teeth; no further extractions must be required which will affect the stability of the denture or necessitate alterations. The denture must fit firmly, be without movement on mastication and complete all spaces where natural teeth are missing. The artificial teeth must correctly meet the corresponding teeth in the opposite jaw and afford a good masticating surface. The denture must be free from cracks and breaks.
[The dental examiner is wholly responsible for] … assessing approximately the time that may be involved in the treatment decided upon, taking into consideration from the information that will be made available to him whether arrangements have been made for a camp system of dental attention or by individual practitioners and, also, that where extensive extractions and the provision of artificial dentures is indicated, only the extractions should be completed and the provision of dentures deferred pending absorption.page 18
Impressions for dentures, especially full dentures, will not be taken within a period of four months from the date of the completed extractions and, in no case, will they be taken, even though four months may have elapsed, until the dental examiner is satisfied that absorption is sufficiently completed for permanent dentures to be inserted.
In regulations framed on the basis of a known policy such a discrepancy would be unlikely to occur. As it was, it did not inspire confidence in the efficiency of the Army Dental Service in the eyes of civilian dentists.
2. The Methods by which Dental Fitness was Established
During the pre-war months of 1939, when general mobilisation was expected, the DDS made detailed arrangements for dental examination and charting of recruits. This was to be done by civilian dentists appointed as members of medical examining boards in the various districts. Careful consideration was given to the method of charting to be used and a Form NZ 360 (Record of Dental Examination), together with instructions to examining dentists, was prepared. The Assistant Directors of Dental Services, who had been appointed to the three Military Districts, prepared lists of dentists to serve on these boards and tested the organisation by the examination of recruits to fill the increased establishment of the Territorial Force. The result was that at the outbreak of war, many dentists were familiar with the routine and the scheme was ready for immediate adoption. As will be seen later, there were imperfections in the scheme but it was a good start and, in the absence of other than a skeleton Territorial Dental Corps, the only practical solution.
A plan had also been prepared and authorised whereby civilian dentists would do the limited amount of treatment at a stated scale of fees.
On 6 September 1939, three days after the declaration of war, Cabinet authorised the mobilisation of a Special Force of 6600 men to serve within or beyond New Zealand. Volunteers for this force, ultimately to become the First Echelon of the 2nd New Zealand Expeditionary Force (2 NZEF), were immediately dentally examined according to plan. Within two weeks, the results showed that the number falling into dental category ‘F’ was so low that too many otherwise medically fit men were being rejected for dental reasons. The standard for acceptance was then lowered by including in category ‘F’ those whose treatment to make them dentally fit would take six instead of three hours. Even then, many men who were medically fit were rejected because of dental defects. The added burden thrown on the shoulders of the civilian dentists by this change of standard and the rejection of valuable manpower gave page break page 19 impetus to the Army's programme for the construction of dental hospitals in the mobilisation camps and the formation of a Corps capable of undertaking full treatment of all troops.
The aim of the New Zealand Dental Corps was to send every overseas contingent away from New Zealand as nearly dentally fit as possible. This was stated in the 1914–18 War but was achieved only in the later stages of that war. In this war the plan of dental selection of recruits and their immediate treatment made it effective from the beginning. It was never more than a makeshift plan calculated to implement the NZDC policy and give the necessary breathing space for the mobilisation of the NZDC on a war basis. It was, however, a distinct advance on the position existing in 1914.
1 Author's italics.