The New Zealand Dental Services
New Zealand Dental Corps. War Establishment Notes
New Zealand Dental Corps. War Establishment Notes
Establishment of dental officers to accompany New Zealand Special Force overseas.
When troops first leave New Zealand they will be dentally fit and the establishment of dental officers at this stage will be based on a requirement for maintenance purposes of one dental officer for 2,000 men.
When troops have been absent from New Zealand for six months it is estimated that their dental requirements will show a marked increase and the Dental Corps will require to be reinforced to the extent of providing one dental officer for 1,000 men.
When troops have been absent from New Zealand for a further six months, i.e., a total of twelve months, there will be a further increase in their dental requirements and it is considered that the ultimate strength of the Dental Corps should be based on a requirement of one dental officer per 500 men.
The Dental Corps overseas was to be gradually reinforced by sending dental officers at regular intervals to bring the strength up to 32, or one officer to 500 men in a force of 16,000. This gave an opportunity for dentists to be brought in from civilian life in time to be trained as dental officers before being sent overseas. To continue with the notes of the DDS:
Establishment of Dental Officers in mobilization camps in New Zealand. The following factors must be taken into account in deciding upon the number of dental officers required in the mobilization camps:
The completion of initial dental treatment for recruits.
The maintenance of dental fitness for troops in training.
The training of dental officers for the supply of reinforcements to the NZDC overseas.
The completion of initial dental treatment for recruits.
First Echelon. The majority of the recruits will be dentally fit on entry into camp but there will be a fair proportion who require denture work to complete the restoration of their occlusion in accordance with the accepted standard of dental fitness.
Second and Third Echelons and Reinforcement Drafts. A large number of these men, say 80%, will require some form of dental treatment before being passed as dentally fit. If the present system is continued and all surgical work (fillings and extractions) and repairs to dentures, up to a maximum of six hours' work, is undertaken by private practitioners, there will still remain an increasingly high proportion, say 40%, who will require denture work.
The maintenance of dental fitness for troops in training. This should be comparatively light for several months after the initial treatment is completed. Each man however will be examined on entry into camp. This is essential. It is also highly desirable that each man should be re-examined as far as possible at six monthly intervals.
The training of dental officers for the supply of reinforcements to the NZDC overseas. It is essential that dental officers going overseas should have at least three months' preliminary experience in New Zealand Dental Corps methods and organisation in a mobilization camp. During this period also it would be possible to gauge each officer's suitability for the work.
As already shown …, there will be a progressive increase in the number of dental officers required overseas and it is therefore necessary that the amount of initial treatment performed for recruits in camp should be considered in the light of the necessity for drafting dental officers into mobilization camps and providing them with an adequate amount of work.
It thus becomes obvious that an increasing amount of initial dental treatment will require to be performed in camp and a correspondingly decreasing proportion carried out by private practitioners before recruits enter camp.
Meanwhile, the civilian practitioner scheme as applied to the examination and treatment of the men of the First Echelon was in full swing. Despite its value as the temporary expedient for which it was designed, it soon became obvious that it had many imperfections. Some of these were noted in a memorandum to the DDS from Major R. B. Dodds, NZDC, Dean of the faculty of dentistry of the Otago University in Dunedin:
The medical boarding of the first draft from this area is practically completed now. I have attended every board as an assistant in the organisation under Dr Fergus. The boards, as you know, have been held in the dental school and I have had an excellent opportunity of discussing with all dental supervisors matters relating to the dental examinations. Further, some of the ‘F’ and ‘T’ men have been treated at the dental school, the latter at half hospital fees.page 25
I feel now that the position calls for certain comments with regard to the system as it is operating at present. All these points are derived from first hand knowledge. I have concluded:
That the system of examination with mirror and probe cannot be accurate enough to ensure that, even if Form 362 is completed, the soldier would proceed to camp dentally fit on NZDC standards.
That a number of ‘F’ class men, either through lack of opportunity or other reasons, have failed to attend their dentist to have the treatment in Form 362 completed and thus have gone to camp with a large number of fillings and other work outstanding.
That the whole system offers far too great a variation in the standards of examination, classification and treatment, i.e., there is no common standard in these things that would be acceptable, for instance, to a Principal Dental Officer of a mobilization camp.
That the present system is not sound economically. Organised and disciplined treatment by Dental Corps personnel must inevitably serve the troops on the most economical basis possible.
It follows from these conclusions that, if a force is to proceed overseas using a dental standard accepted by the Dental Corps during the last war, the system must inevitably be that developed during that war from 1917 onwards. Ample evidence that history is repeating itself with regard to this matter may be obtained from a study of old files of the New Zealand Dental Journal—evidence moreover which can be corroborated by NZDC officers who had experience of mobilization camps of the last war.
(signed) R. B. Dodds,
11 October 1939
Major Dodds was merely emphasising imperfections of the scheme which had been anticipated by the DDS and of which he had warned Headquarters with such little effect. There was, however, another factor which carried considerable weight. The public purse was being affected. A draft memorandum by the Adjutant-General, undated but probably written in November, sums up the position with suitable emphasis:
It was anticipated that when recruiting for the special force commenced, the response would be of such an extent that it would provide wide scope in the process of selection and, in consequence, the cost of dental treatment would be kept at a moderate level by selecting from those offering their services only those who were of the required dental standard or those who, by the repair of minor dental defects, involving not more than three hours' dental treatment, could be raised to the dental standard specified.
In view of the above, it was decided that the dental treatment then anticipated as requisite should be carried out by civilian dental practitioners prior to the men being concentrated at mobilization camps.
Actually, the number offering their services was not so great as anticipated and it also became evident that the general dental condition of the men offering their services was much below the standard expected. So much so that it was found necessary to increase the period of dental treatment required to six hours. Even with this added facility considerable difficulty was experienced by Districts in filling their quotas of men who were dentally page 26 as well as medically fit. Consequently the initial estimate of costs of requisite dental treatment has been exceeded, and it is therefore considered desirable that the situation in regard to dental treatment should be reviewed with the object of ascertaining if a more economical method could be instituted.
As far as can be gathered at the moment, of the number who have offered their services and have been accepted in the first echelon, not less than 85% have required dental treatment and, from the information at present available, it is estimated that the average cost per man of such initial treatment will be approximately £2 2s. 0d. The estimated cost for the first echelon is £11,780.
Other factors are, that of recruits entering mobilization camps whose dental treatment was carried out by civilian dentists, it has been found that 15% require further treatment. This is due to an inevitable amount of dental defects being missed by the dental member of the medical board and the ever-recurring denture remakes and repairs which are to be expected when approximately 25% are wearing some form of artificial denture. There will also be a percentage of those accepted for the special force who may have to be provided with partial dentures to remedy deficiencies that are considered detrimental to their general health.
It is anticipated that the general dental condition of the men enlisted in the second and third echelons of the special force will be lower than the standard of those enlisted with the first echelon. If the dental treatment of these two echelons is carried out in the same manner as that for the first echelon, it is estimated that the cost of such treatment will amount to approximately £17,417, giving for the three echelons a total estimated cost of £29,197.
It is estimated that the cost of the alternative method of rendering the special force dentally fit by carrying out all dental treatment in mobilization camps after the troops are concentrated will be £17,135.
In addition to this, trouble was arising out of the claims from the civilian dentists for payment for their services. There were cases when the work was not done satisfactorily, and even claims for work that had not been done. Men were being treated who did not appear in camp for one reason or another. Enlistments were sometimes cancelled after treatment had been completed; specialist fees were being claimed, and so on. The whole position became so confused that finally, on 19 December 1939, the DDS suggested to the Adjutant-General that all claims be certified and passed for payment as the cost of checking them would amount to more than could be saved by adjusting the discrepancies.
The scheme collapsed under its own weight and on 15 December authority was given for all dental treatment, with the exception of extractions which would bring the recruit temporarily below a minimum standard of masticatory efficiency, to be carried out in camp by the NZDC. Even this exception was removed on 9 January 1940, leaving the NZDC with full responsibility for all treatment. In March the dental member of the medical board was dispensed with and all examinations were carried out in camp by the NZDC, the only exception being those suffering from infective oral condi- page 27 tions such as ulcero-membranous stomatitis, which could be recognised by the medical member of the board and deferred until the condition had been treated.
It must not be thought that while this fight for recognition was going on there was nothing happening in the Dental Corps outside Headquarters. Most of the recruits for the First Echelon entered mobilisation camps at Ngaruawahia, Trentham and Burnham at the beginning of October. Fourth Field Ambulance went to Burnham and to it was attached Lieutenant W. McD. Ford.1 At the same time three other officers were mobilised and posted to the camps: Lieutenant J. A. S. Mackenzie2 to Ngaruawahia, Lieutenant J. F. Fuller3 to Trentham and Captain E. B. Reilly4 to Burnham. These four officers had all served in the Territorial Force. Dental sections were set up in the camps for the treatment of casualties, mostly denture repairs. Accommodation was limited to tents except in Trentham, where a building was taken over. Very little work was done at this stage as there was only the Territorial equipment available and this did not include prosthetic equipment. The denture repairs were done with the use of equipment borrowed from private practitioners.
Towards the end of October six more officers were mobilised and posted to the camps: Lieutenants J. G. W. Crawford5 and C. K. Horne6 to Ngaruawahia, Lieutenants H. A'C. G. Fitzgerald,7 G. McCallum8 and T. V. Anson9 to Trentham, and Lieutenant J. R. H. Hefford10 to Burnham. Two of these, McCallum and Hefford, had served in the Territorial Force. A little extra equipment had been obtained but practically all the instruments and much of the stock was provided by the officers themselves. Accommodation at Ngaruawahia and Burnham had been improved by the provision of marquees. Living accommodation, especially at Trentham, was page 28 exceedingly primitive, consisting for the dental officers of the bare minimum of four walls, a roof and a bed.
Dental examination of all troops in the three camps was then undertaken. This, with completing treatment not finished by the civilian dentists, emergency work for the camp staff and maintenance for the 6600 men of the First Echelon, kept the dental officers fully occupied, working as they were under field conditions.
Towards the end of November a new stage was reached. The dental services expanded and, from an administrative point of view, became consolidated to form camp dental hospital groups rather than multiple field dental sections. Papakura Mobilisation Camp, which was to replace Ngaruawahia as the main camp in the Northern Military District, was opened and Lieutenant Mackenzie was transferred there to take charge. Lieutenant Fuller was placed in charge of Trentham and Captain O. E. L. Rout was mobilised and posted to Burnham. These three officers held the appointments of Principal Dental Officer in accordance with the NZDC war establishments drawn up in pre-war years and now approved. (See Chapter 5, Organisation.)
By the end of December the mobilised strength of the NZDC was 22 officers and about 50 other ranks. Buildings for dental hospitals at Papakura and Burnham were completed and occupied in December, although still far from complete with many internal fittings. Thus in the three main mobilisation camps accommodation was available, for at Trentham a building had been available as a temporary hospital from the start. At Ngaruawahia, however, tents were still in use.
When the troops of the First Echelon were ready to embark on 5 January 1940, they had all received a final check of their dental condition and some 6500 men left New Zealand completely dentally fit. Part of the credit for this must be given to the civilian dentists but the Dental Corps can claim its share. The approximate figures for the treatment carried out for the First Echelon while in camp, i.e., by the NZDC, are: 3000 fillings, 750 extractions, 250 dentures (full, partial and remodelled) and 200 repairs to dentures. The work was done in the face of many handicaps. Temporary accommodation had to be set up and equipment found before anything other than emergency treatment was possible. It took time to make satisfactory arrangements with the camp authorities and officers commanding units to provide a flow of patients, for at this time the general camp organisation itself was only in the developmental stage and the training programmes were subject to sudden changes. Final leave of fourteen days further interrupted the work just at a time when it had started to run more smoothly. Still, by dint of hard work and long hours, the result was achieved and the subsequent page 29 history of the dental services with 2 NZEF overseas indicates that this effort and the treatment by the NZDC of the succeeding echelons and reinforcements was the foundation of the excellent dental health record enjoyed by New Zealand troops throughout the war.
There were other troops in New Zealand than the echelons of 2 NZEF and they provided a problem of their own. Within a week of the declaration of war a force was mobilised to man the coastal batteries and subsidiary defence stations. These men were not selected according to any standard of dental fitness, nor were they included in the civilian practitioner scheme for dental treatment. The only provision made for them was that when a man reported with toothache, the medical officer authorised the necessary treatment from a civilian dentist. This was only for the relief of pain and did not include other work to make him dentally fit.
In December Government approval was given for dental examination and treatment of these troops to be undertaken by the NZDC. The policy was that the NZDC would be temporarily detached from the mobilisation camps whenever intervals in the treatment of overseas drafts made this possible. They were to operate as mobile field dental sections, taking fully equipped outfits from the mobilisation camps. The first of these intervals occurred when the First Echelon went on final leave, and between 21 December 1939 and 11 January 1940 field dental sections operated at Narrow Neck and North Head in the Northern Military District, Fort Dorset in the Central and Battery Point and Godley Head in the Southern Districts. The result was that at least all urgent work was completed for the fortress troops at these establishments.
7 Maj H. A'C. G. Fitzgerald; Hastings; born 1908; dental surgeon.
9 Maj T. V. Anson; Wellington; born Wellington, 1902; dental surgeon; PDO, Northern Military District, 1940–41; Brigade Dental Officer, 8 Bde, Fiji, Jul 1941–Jan 1942; Dental Officer, No. 2 (GR) Sqn, Nelson, Feb–Oct 1942.