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Chapter VI

Contents

CHAPTER VI

THE DENTAL SECTION


 The dental subdivision of the chief surgeon's office, though part of the personnel division,1 was in a large degree separate therefrom.2 Because of its relationship with the personnel division, its activities are considered here, though these were of a much wider character than control of dental personnel alone. It exercised both general and technical control over all matters affecting the dental service throughout the American Expeditionary Forces; e. g., dental laboratories, procurement and distribution of dental supplies, dental organization, professional dental service, and liaison with the maxillofacial services.2

In view of the fact that the dental service was not classed among the professional services and, therefore, can not logically be discussed with them in another part of this volume or in others, it appears expedient to consider here not only the activities of the dental section of the chief surgeon's office, but of the administrative activities of that service as a whole.

On June 12, 1917, General Pershing cabled through the American ambassador, London, to the Secretary of War, requesting that the senior dental officer of the Army be sent to France with the second convoy of troops, there to establish a depot and organize work, and that dental officers be sent with all troops in proper proportion.3 Confidential orders were issued by the War Department, June 25, 1917, in compliance with the above request.4 During a conference with the Surgeon General of the Army, prior to embarking, the dental officer in question made request for authority to organize and take with him a dental corps unit, to be composed, with himself, of six specially qualified dental surgeons.2 This request was granted, the necessary telegraphic orders were issued, and the members of this unit assembled in New York City, July 10-15.2 Regulation field equipment and supplies, with which the five officers, other than the chief of this group were supplied, were augmented through purchase of complete laboratory equipment and supplies, and special oral surgical instruments and appliances.2 Transportation was secured with the second convoy, due to sail on or about July 28.2

During the latter part of June the Surgeon General had also requested orders directing 20 members of the newly organized Dental Service Corps to proceed to New York for transportation with the second convoy of troops.2 Several members of this corps, attached to Base Hospitals Nos. 8 and 9 and to the First Regiment of Engineers, were at this time also assembled at the port of embarkation, and a total of approximately 30 dental officers were provided transportation with the second convoy.2 Unfortunately, all the equipment and supplies of the First Army Dental Corps Unit was submerged in the sinking of the vessel on which its members were embarked, and though a large portion of the equipment and supplies was rescued several weeks later, it proved worthless and a total loss.2 The unit was reequipped by the local medical supply depot and finally sailed early in August, 1917.2


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Upon arrival in France, all the dental officers destined for organizations of the 1st Division proceeded to the division training area to join their commands; those attached to base hospitals accompanied these organizations to their station, and all personnel of the First Dental Corps Unit proceeded in accordance with their orders to headquarters, A. E. F., then in Paris, where, on August 22, 1917, the head of this group reported to headquarters.2 He was then directed to report to the chief surgeon for duty as assistant in matters pertaining to the dental branch.5

Plans for the organization of the Medical Department, A. E. F., already under way, contemplated the utilization of dental personnel in several newly created administrative positions. At a conference in the chief surgeon's office, it was decided that the First Dental Corps Unit should be broken up and its personnel assigned to stations where technical administration and supervision would be required.2 Its members were then individually assigned to the office of the chief surgeon; headquarters, Field Artillery brigade, Le Valdahon; headquarters, 1st Division, Gondrecourt; Medical Supply Depot, Cosne; headquarters, field hospital company, 1st Division, Gondrecourt training area; and to the dental clinic at headquarters, A. E. F.2

Throughout the war, the dental section continued to function as a part of the personnel division in the chief surgeon's office, moving with it to Chaumont on September 1, 1917, and later to Tours in March, 1918.2

When headquarters, A. E. F., were moved to Chaumont, a headquarters dental clinic was established there.2 Here two complete field outfits and a laboratory were installed under direction of the senior dental surgeon, and began operating within 48 hours after the establishment of headquarters. This establishment continued its activities until the last day those headquarters remained at Chaumont.2

During September and October, 1917, plans were formulated and their application inaugurated for an organization which would direct and control the dental service of the great number of troops expected.2 Consideration was given to providing administrative positions whose occupants would supervise the professional and official service of dental officers on duty with major commands; to the assignment of specially selected dental officers to supply depots and service schools, and to provision of professional consultants of chief clinicians at important hospitals and of oro-dental specialists qualified for service at maxillofacial hospitals.2 The organization of the office of the senior dental surgeon was completed and plans were made for the instruction of all dental officers holding administrative positions.2 Instruction was given to a large degree by means of correspondence between the chief of the dental section and his subordinates. This was supplemented by his frequent inspections at the several divisions and hospitals within the training areas. Instruction of division dental surgeons began with the establishment of a school for them in the 1st Division on September 15.2

On October 12, 1917, a cablegram was received from the Surgeon General's office, announcing that the Army Dental Corps reorganization bill had been signed by the President on October 6, 1917.2 Office orders were then issued assigning the senior dental surgeon to duty as chief dental surgeon, under general


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direction of the chief surgeon, A. E. F., and on October 27 his duties became wholly those of an administrator and director of the dental service, A. E. F.2 Though technically belonging to the personnel division of the chief surgeon's office, he was provided a separate office and clerks. During October and November, further consideration was given to the preparation of adequate plans for the organization of the Dental Corps on the comprehensive lines necessary to meet the need of an army of 1,000,000 men.2

Shortly after the arrival of the chief surgeon's office at Tours, in March, 1918, the office personnel of the dental section was increased by 2 sergeants, Medical Department, for the record room and 1 additional enlisted stenographic clerk.2 Thereafter from time to time the division expanded to meet the requirements of increased service until, in addition to the commissioned personnel, it had a maximum of 4 stenographers and 9 record clerks.2

Until June, 1918, the only officer serving in the dental section was the chief dental surgeon; another officer charged with procurement and distribution of dental supplies was then assigned, and in September, 1918, this personnel was reenforced by a third officer.2

ORGANIZATION OF THE DENTAL SERVICE

Though the organization which the Dental Corps finally developed was begun early in the history of the American Expeditionary Forces, its completion in a satisfactory manner was not practicable until after the bill reorganizing the corps became a law on October 6, 1917.2 By this organization, each division was allowed 30 dental officers, under direction of a senior, the division dental surgeon.2 The latter was under the general direction of the division surgeon and was charged with the responsibility of coordinating, supervising, directing, and inspecting the dental service of the division.2 The senior dental officer with regiments which required more than one dental surgeon was designated regimental dental surgeon and charged with the responsibility of conducting the service of his specialty. When army corps were organized it became necessary to appoint corps dental surgeons, who were under general directions of the corps surgeon. These administrative officers were charged with the coordination and direction of all the dental service of their respective army corps, which included the inspection, supervision, and instruction of the several division dental surgeons, and supervision and control of all dental officers assigned to duty with corps troops.2 After the organization of field armies, experienced dental officers were assigned to duty as army dental surgeons, under general direction of the army surgeons and were charged with the responsibility of supervising and coordinating the dental service in the respective commands in which they served, including the dental service of divisions, corps, army troops, evacuation, and mobile hospitals. Their administrative activities pertained chiefly to the service of dental surgeons of corps and divisions. Those officers rendered reports to them through medical department channels and their own reports and returns were made in turn, through medical department channels to the chief surgeon, A. E. F.2 In the Services of Supply a supervising dental surgeon in charge of the service of his specialty in each section (including the district of Paris) was vested with the responsibility of coordinating and con-


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ducting the service under general direction of the surgeon. He also submitted reports and returns, through medical channels, to the chief surgeon. Hospitals centers, depot divisions, replacement depots and later, embarkation areas were provided with local dental supervisors, usually selected from among the senior dental officers of those commands.2 Their duties, in addition to those of a professional character, were the centralization and coordination of the professional service and supply of the dental department in their respective jurisdictions under general direction of the senior medical officer through whom their reports and returns were rendered to the chief surgeon.2 In all of these organizations large dental infirmaries were established in favorable locations where a number of dental surgeons were assigned under centralized control.2 Each hospital in the American Expeditionary Forces was staffed and equipped for dental service.6 Base and evacuating hospitals usually had two dental officers equipped with complete base outfits and laboratories; all other hospitals had at least one dental officer equipped with operating outfit only.6

In the early fall of 1917, the French turned over the artillery training area at Mailly to the American forces for the development of Coast Artillery organizations.2 As the dental officers who accompanied the first American organizations moving into this area were all recently appointed from civil life, it was necessary to send an experienced officer to organize and coordinate their services. This he accomplished partly through the establishment of a small school of instruction.2

The general plans for the organization of the dental service, A. E. F., were made and tentatively approved early in its history. The approval, however, had the provision that none of them would be put into effect until called for in the general scheme for the organization of higher commands.2 Such organization, however, was immediately initiated for the units of the expedition then present and the 1st Division being well advanced in its combat training, was the first to receive the benefits accruing from this development.2 Among other provisions, orders were issued announcing a division dental surgeon and providing for dental inspection, technical supervision, a headquarters dental clinic, and schools.2 When in the early fall of 1917, the 2d Division moved into its training area with headquarters at Bourmont, dental officers were assigned to its several units.2 No division dental surgeon had been sent over with it, but one was designated from the American Expeditionary Forces in the latter part of November. Under his direction the dental service of this division was organized, a division school established and the other activities were thoroughly coordinated. Like action was taken for the 26th and 42d Divisions.2

An important development within each combat division area was the establishment of a headquarters dental clinic.2 Each of these clinics was served by competent operators and was fully equipped, including complete laboratories; each was technically in charge of the division dental surgeon who was responsible for its efficient management. Later, when divisions entered upon the last phase of combat training, instructions were issued for organization within each division of a portable dental laboratory.2 This unit was placed in charge of a selected dental officer conversant with dental labora-


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tory practice, who was assisted by a specially qualified dental mechanic. This laboratory, which assumed the necessary prosthetic service for the division and obviated need of transferring patients to points outside its command, usually was located at the division field hospital, which was farthest from the line. After our divisions assumed combat activities, this unit assisted in first aid at the front.2

When the line of communications was organized in August, 1917, with headquarters in Paris, all dental surgeons except those attached to divisions, detached combat organizations, or to base hospitals, came under control of the line of communications and were assigned by its headquarters to duty with detached commands in its several sections.2 A headquarters dental clinic was organized in the headquarters of the line of communications, its first equipment consisting of the old type portable dental outfit, with which all dental officers arriving from America were supplied. This equipment was augmented by complete base dental outfits for two operators and one complete laboratory.2

After removal of headquarters, line of communications, to Tours, in June, 1918, this clinic, remaining in Paris, became known as the attending dental surgeon's office, district of Paris.2 It was increased in size by the assignment of additional dental officers with full base equipment to meet the growing requirements of its service, and continued to function until withdrawal of the American Forces in France from the district of Paris toward the end of 1919.2

When the advance section was organized in the latter part of February, 1918, a supervising dental surgeon was assigned to it, and the office of the chief dental surgeon thereby relieved to an appreciable extent.2 This supervising dental surgeon was charged with the supervision and coordination of all elements of the dental service throughout his jurisdiction. The majority of troops then in the area were widely scattered; e. g., engineer organizations making preparation at a number of camps for the early arrival of large numbers of American troops, and signal corps battalions installing telegraph and telephone lines.2 Many other detached organizations were later located throughout this section.2 The dental officers attached to these several commands were all under the technical direction and instruction of the supervising dental surgeon, advance section.2

Approximately 35 dental officers were serving within the advance section at the time of its organization. This number was more than doubled thereafter until November, 1918. But their number remained short of that required and it became necessary to assign several of them to an itinerant service in order that they might visit some of the smaller units.2

The intermediate section, Services of Supply, with headquarters at Nevers, was in operation for some time without organized dental service, but increase of the various activities throughout its area and the arrival of dental officers, newly appointed from civil life and unacquainted with military procedure, necessitated the appointment in April, 1918, of a section dental surgeon.7 The duties of this officer were similar in every respect to those outlined above for the supervising dental surgeon, advance section.2


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The wide dispersion of troops in the intermediate section also presented many difficulties in the furnishing dental service; furthermore, some organizations were much expanded after arrival in France; e. g., an engineer regiment which landed with approximately 2,000 men had expanded before the end of activities to a strength of 20,000.2 Since the legal allowance of dental officers for the American Expeditionary Forces was based on the proportion of one dental officer to every 1,000 men, and as units were organized when they sailed, it was not practicable to supply dental officers in a corresponding degree to those units which were expanded overseas.2

The organization of the dental service for base sections began with the appointment of a supervising dental surgeon for base sections Nos. 1, 2, and 5 in April, 1918.2 Owing to the shortage of experienced dental officers of field grade, it was necessary to utilize one officer to organize the dental service for the three sections. While it was appreciated that it would be difficult for one officer to exercise dental supervision of three important base sections, this arrangement was maintained for several months.2 In December, 1918, a supervising dental surgeon was appointed for base section No. 1 (St. Nazaire) and in the same month another for base section No. 2 (Bordeaux).2 This position in base section No. 5 was at first filled by a temporary assignment but later a permanent detail was made. The supervising dental surgeon of a base section discharged duties similar to those mentioned above in connection with the advance section, but he also exercised technical supervision over the receipt and storage of dental supplies arriving at the port and organized and developed dental clinics at section headquarters and at the disembarkation camps where troops were held temporarily.2

No supervising dental surgeon was designated for base section No. 3, for the surgeon of that section considered such an assignment unnecessary.2

Base section No. 4 having comparatively few American organizations or activities, was therefore never provided with a supervising dental surgeon. The dental service of the permanent command and of detached organizations there was supplied by dental officers assigned to organizations temporarily within the section.2 A supervising dental surgeon for base section No. 6 was not appointed until December, 1918.2

The dental service in the large areas occupied by depot divisions had to be expanded in order that adequate clinics might be established in the several billeting towns and camps. In the First and Second Depot Division areas this was effected by the division dental surgeons, each of whom also organized and equipped a central dental clinic and dental laboratory.2 The establishment provided at St. Aignan (First Depot Division) proved a model for this type of clinic, being the first organized for group dentistry. Later, in order to meet local requirements, a course of instruction was carried on in the first depot division area in order to develop dental assistants from selected young men serving in medical detachments of the division concerned.2

At the five replacement depots, located, respectively, near Amiens (with the American Second Corps), to the northwest of Paris, adjacent to St. Dizier, adjacent to Toul, and near the town of Meaux, the dental service was similar in every respect to that of the First Depot Division.2 It comprised the organi-


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zation of large dental clinics where the mouths and teeth of soldiers passing through the depot might be placed in first-class condition without appreciable loss of time. These clinics gave full opportunity for group dentistry and proved of the greatest value as time-saving expedients.2

PERSONNEL

The total number of officers who served in the Dental Corps, A. E. F., was 1,876.8 The highest officer strength of that corps was 1,805, which it attained on January 11, 1919.8 Of these officers 79 belonged to the Dental Corps, United States Army, 12 to the Dental Corps, United States Navy, about 225 to the National Guard, and the others to the Dental Reserve Corps.8

The total personnel, including enlisted men of the Medical Department assigned to its service, approximated 4,000, of whom more than 2,000 (including the officers above mentioned) were graduate dentists.8 The enlisted men, Medical Department, assigned for duty to the Dental Corps served either as dental assistants or as dental mechanics. Many of them were undergraduates in dentistry.8

The full quota of commissioned dental personnel authorized at the rate of 1 to 1,000 men was never attained in the American Expeditionary Forces, and there was a shortage of over 300 dental officers at the time the armistice was signed.8 A dental officer was sent with approximately every thousand men of large organizations embarking from the United States, but this ratio was not extended to small organizations and to casuals, so that a shortage accrued for the American Expeditionary Forces as a whole.8 This shortage was most apparent in organizations that greatly expanded overseas, as noted above. Furthermore, it was found necessary to give three dental officers to each combat division in excess of the pro rata allowance, because of the fact that certain units; e. g., field signal battalions, machine-gun battalions, with less than 1,000 men each, operated as separate organizations.8 But after the armistice began a general plan for equalization was carried out whereby each command was assured of dental service. The full quota eventually was reached by reassignment of about two-thirds of the dental personnel from each division sent home, for only a skeletonized dental force was authorized to return with the division which it had served.8 That contingent remained with the division for the purpose of rendering professional services during the voyage. This practice of retaining part of the divisional personnel was discontinued in April, 1919.8

Though the great majority of dental officers came from the United States, either with troops or as casuals, several American dentists, among other patriotic citizens already in Europe, offered their services shortly after American headquarters were established in France.2 It was announced that the policy of the Medical Department would be to accept the services of all physicians and dentists, subject to a professional examination which would determine that they were professionally qualified.2 Five approved civilian candidates were eventually commissioned in the Dental Corps after examinations and a considerable number of enlisted men were also examined for temporary commissions in the Dental Corps.2 A total of 123 passed their examinations in


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France, but only 40 of these were enabled to serve as officers on account of a War Department decision not to commission after the armistice began candidates who passed the examination.2 Recommendations were made to the adjutant general, A. E. F., that the 83 successful candidates who had not been commissioned at the time of the signing of the armistice be appointed and commissioned in the grade of first lieutenant, Dental Reserve Corps (inactive status), and that their commissions be given them as a reward of merit on the date of their final discharge from the Army.2 This recommendation was approved and was largely carried out. In many instances, however, the commissions were not forthcoming until several months after discharge.2 The regular Dental Corps was increased by nine officers through appointments made in the American Expeditionary Forces from the Dental Reserve Corps.2

While the majority of dental officers of the American Expeditionary Forces served in France, a large number arriving with organizations in England were detained there temporarily or permanently for duty at our several hospitals, aviation camps, and instruction centers.8 Several dental officers were detailed for duty with organizations serving in Italy and northern Russia, and in March, 1919, 20 dental officers, with enlisted assistants and full portable outfits, were sent to the United States military mission, Berlin, Germany, for special duty in the Russian military prison camps.8

During the fall of 1917 it was announced that the six American base hospitals then loaned to the British would eventually come under control of the American Expeditionary Forces, but this was never actually accomplished.2 Nevertheless, a number of medical and dental officers belonging to these units were detached and assigned to service in the American Expeditionary Forces. Thirteen dental officers were obtained in this manner.2

SCHOOLS

Division schools for the instruction of recently joined and inexperienced dental reserve officers were established in the early fall of 1917.2 It was recognized that these officers, however well qualified professionally, were unacquainted with methods of conducting a military dental practice, with customs of the service, the system of obtaining supplies, military correspondence, and the formulation of reports and returns.2 The instruction, therefore, considered the methods of conducting a military dental practice, duties of an officer, customs of the service, procurement of supplies and equipment, preparation of reports and records. The division dental schools were in charge of the division dental surgeons and under general direction of the division surgeon concerned.2 Sessions were held two afternoons a week. The advantages of this instruction were soon apparent in the dental service of the 1st Division, in which the first school of this character was established, and which became the model for the dental section of the Army sanitary school. Similar schools were conducted in all the other early divisions in France.2

The plan for division instruction was changed in November, 1917, by the organization of the dental section of the Army sanitary school at Langres.2

With a full realization that a large number of specially qualified officers, both medical and dental, would be needed for face and jaw surgery, immediately


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upon entry of the American Army into combat activities, preparations were made to establish a post-graduate course of instructions in oral, plastic and prosthetic surgery.2 This was conducted at the American Red Cross Military Hospital No. 1, Neuilly, which was selected for this purpose because of its central location and the excellence of the facilities which had long been established there.2 A competent faculty of well-qualified and experienced instructors was assembled at this hospital, under the direction of a colonel of the Medical Corps.2 The several subjects of the curriculum were as follows: Special anatomy, bacteriology and infections, face and jaw fractures, plastic surgery, oral surgery, prosthetic surgery (fracture appliances), postoperative care, Roentgenology and photography, anesthesia, and Medical Department administration in war.2

A schedule for lectures and clinical instruction was prepared and it was planned that the school would open in January, 1918, but this was deferred until March.2 Owing to the enemy offensive, which started March 21 and the necessity for using in large degree as evacuation hospitals all hospitals in the Paris district, this important course was indefinitely postponed.2 It was finally abandoned on account of the continuous battle activities immediately north of Paris and because of the arrival in March, 1918, of 40 medical and dental officers, specially trained in maxillofacial surgery. The availability of these officers, obviated any need for the school. They were organized with teams and distributed as described below.2

A school for the instruction of enlisted men as dental assistants was early organized at headquarters, First Depot Division, St. Aignan.2 Through diligent investigations conducted in the several units of the 41st Division, now designated First Depot Division, and of the several casual groups arriving from the United States as replacement troups, several hundred young soldiers were found and brought to this school for instruction as dental assistants. A large percentage were undergraduates in dentistry who in consequence readily took up this special work. They were given an intensive course of instruction and upon its completion were awarded certificates of proficiency. A list of each class was sent to the chief surgeon, A. E. F. who made assignments from it throughout the dental service.2

In order to meet the demands for competent laboratory assistants-dental mechanics-a school was organized at the central dental laboratory headquarters, First Depot Division, in extension of the course for dental assistants.2 The men sent here were given intensive instructions in primary laboratory work for a period of one month. Upon its completion they were classified and those rated as most proficient were sent to a second school for dental mechanics, which was established in the dental laboratory at American Red Cross Military Hospital No. 1, Neuilly.2 Here they were given advance instruction in dental and oral surgical prosthesis, which comprehended the construction of swaged and cast-metal splints and all other fractured jaw appliances required in maxillofacial surgery. Upon completion of a six-week course of instruction, the graduates were given certificates and assigned to duty at the various base hospitals where this special type of surgery was being conducted.2


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After the armistice began a school for instruction of dental assistants in oral hygiene and prophylaxis was organized at headquarters, Base Section No. 2, Bordeaux. It admitted students selected from among 400 enlisted men and gave them instruction on a number of subjects pertaining to the practice of dentistry. On graduation these men were assigned to service at the larger clinics.2

In February, 1919, the American University was established at Beaune.2 Its dental department began work on March 12, 1919, being the first department to open.2

During the autumn of 1918 a special course of clinical instruction was conducted in dental and maxillofacial prosthesis by the senior consultant in prosthetic dentistry. This officer visited each hospital center and important base hospital and then gave instruction to officers and dental mechanics in the highly specialized technique of maxillofacial prosthesis.2

SUPPLIES AND EQUIPMENT

Originally the types of dental equipment for the American Expeditionary Forces were those prescribed by the Surgeon General, viz, portable dental outfits for dental officers attached to field organizations, and the base dental equipment (as far as practicable) for all base hospitals.4

The plans promulgated by the headquarters, A. E. F., in the summer of 1917, for the shipment of all Army supplies provided for a reserve of approximately four months, but requisitions issued by the Medical Department for the shipment of supplies for the 1st Division included approximately a five months reserve.4 Its subsequent instructions in regard to the 2d, 26th, 42d, and 41st Divisions contemplated but a four months reserve and thereafter until the inauguration of the automatic supply table, excess supplies were issued on the basis of three months reserve. The plan contemplated the storage of 15 days supply at the advance depots, 30 days supply at the intermediate depots, and 45 days supply at base sections. While this plan was never completely followed, it proved of value as it assured storage in France of a reserve supply. The plan was materially changed after the adoption of the automatic supply system which became effective in March, 1918.2

The Medical Department automatic supply table was prepared after due consideration and elaborate study based on plans outlined by the general staff in the summer of 1917. Six months experience and observation were utilized in its formulation and preparation. The dental department participated in its preparation in so far as its own supplies were concerned.2

The dental tables of the automatic supply were formulated to meet actual requirements of portable dental outfits for the 30 dental officers authorized for each combat division, for the outfits of the various detached commands in the Services of Supply, and for normal replacement of these assignments.2 The calculations for base dental outfits were made upon the requirements of hospitals which pertained to divisions and of those that were to be stationed in the Services of Supply plus the normal replacement for equipment of this character.2 The arrival of certain kinds of dental equipment and supplies was delayed by the priority shipment of other articles-rations, clothing, ammunition, etc.-by con-


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gestion at the ports of embarkation and debarkation, by lack of adequate facilities at the base ports for systematic storage and by lack of facilities for prompt movement by rail to place of destination.2 Because of this delay it was necessary to make some emergency purchases of dental equipment and supply in France, through the medical member of the general purchasing board in Paris.2 With a view of facilitating these special purchases, a dental officer was assigned temporarily to duty with that board. Until the automatic supply became effective and continuous the purchase of certain articles of dental equipment was conducted on so great a scale as seriously to embarrass the French market.2 The French authorities soon observed this situation and placed an embargo on the further purchase of dental supplies by the American Army, but upon our protest to this inhibition the embargo was raised for a few weeks and further purchases were authorized to the value of 1,000 francs per month.2 The demands for laboratory equipment were so great and the supply so limited in France that it was necessary to investigate the possibilities of purchasing this type of equipment in England.2 The supply officer for the Medical Department who was ordered to London for this purpose succeeded in purchasing laboratory equipment and supplies in amounts considered sufficient to last until material of this type was received from the United States, through operation of the automatic supply table.2 The British War Office, on observing the depletion of this type of special material, also placed an embargo on further purchases of it by the American Army. None of this much-needed laboratory equipment which had been purchased by the medical supply officer in England ever reached France, for the British vessel on which it was shipped was sunk by enemy submarines.2

The original plans for shipment of dental equipment contemplated that each dental officer embarking with his organization for overseas duty take with him a complete portable outfit, whose several chests were filled with six months' supply.2 Theoretically this arrangement was eminently satisfactory, and proved to be so in the early months of the war before the overseas transportation became congested. Later, dental equipment was placed aboard ship with all the other elements of the cargo which were unloaded en masse at the base ports in France. Here the dental equipments were lost in the overcrowded warehouses or at the large supply dumps adjacent thereto.2

In the effort to remedy this situation, a cablegram was sent to the Surgeon General recommending that previous instructions on this matter be so modified as to direct each dental officer to carry his portable outfit as baggage, for which he would be personally responsible both on shipboard and after arrival in France.2 This plan was carried out more or less satisfactorily and was insisted upon as the only possible method that would insure the dental officer having his equipment in his possession on arrival.2 But in maintaining this plan the dental service ran counter to that general instruction to port commanders which directed that equipment be unloaded from ships and placed in a pool, to be subsequently claimed if possible, and if not, replaced through emergency requisition on supply depots.2

In accordance with previously arranged plans of organization, competent dental officers were assigned to duty at the important supply depots, the first officers thus assigned reporting at the depot at Cosnes on September 1, 1917.2


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His duties were later extended to include purchase of dental equipment and supplies through the medical member, general purchasing board. On March 1, 1918, a dental officer was assigned to the advanced medical supply depot, Is-sur-Tille.2 On account of the great amount of dental supplies received at medical supply depot No. 1, base section No. 1, in the earlier months of 1918, a dental officer was placed there on duty as assistant to the medical supply officer, where he remained until June, 1919.2 In 1918 one or two more dental officers were detailed to serve with the other large supply depots. These officers remained for short periods on temporary duty.2 In the late autumn of 1918 a dental officer was sent to the Gievres depot for temporary duty to develop certain articles of field equipment.2 No dental officers were permanently assigned to supply duty at the base ports other than at St. Nazaire (base section No. 1), but the supervising dental surgeons in the base sections were available to render counsel concerning dental equipment.2

Actual field experience in combat divisions early demonstrated the fact that the old pre-war portable dental outfits were not practicable for active field service. The bulk and weight of the several containers seriously handicapped their transportation with mobile units. After careful study the following conclusions were reached concerning the field dental equipment:2 The full portable outfits were to be retained for use at camp hospitals and at such other detached organizations of the Services of Supply as could readily furnish transportation for them. Modified portable outfits packed in three chests were provided for combat divisions.2 These consisted of the essential equipment of medicines and of a small stock of supplies which were considered sufficient for the practice of field dentistry.2

An even more reduced outfit, termed "campaign equipment," was provided for the use of dental officers with divisions in battle areas.2 This consisted of a dental engine chest and its normal contents, plus the contents of the emergency dental kit. This kit was designated personal dental equipment and was to be carried by each officer at all times while in the combat area. It comprised a few essential instruments and medicines in cloth rolls and a very small amount of supplies, all contained in Hospital Corps pouches carried over the shoulder by the dental officers and their assistants.2 Thus officers were enabled to render first-aid dentistry at all times for the relief of pain and for minor oral surgical or dental operations. This modification of dental equipment helped solve many of the transportation problems for the dental service in combat divisions, and while it increased the weight carried by dental officers, it proved advantageous by making it possible for anyone requiring emergency dental service to obtain it at any time from the dental officer of his command.2

In combat divisions, the transportation of dental equipment and supplies was always a problem and when not carried individually, a source of irritation to division commanders, transportation officers, and division surgeons.2 This was largely due to the fact that no provisions had ever been made in the Tables of Organization for dental personnel, commissioned and enlisted, or for dental equipment. Omission in these tables of the Dental Corps and of provision for transport of its supplies resulted in the loss of much equipment and the consequent temporary lack of dental service in several of the divisions.2 The


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1st Division on its movement into a combat area in May, 1918, found it expedient to abandon all its dental equipment on account of the lack of transportation, for this material had not been considered by its transportation officer in making his allowances for the rapid movement of equipment and supplies.2 This loss was immediately investigated and efforts were made for finding and salvaging the abandoned equipment. Though not found at the time it was subsequently redeemed through the salvage service.2 In the interim, through efforts made at intermediate medical supply depot No. 3, the dental service of the division was reequipped with modified portable outfits. As a result of the information obtained by the chief dental surgeon, who was sent to investigate the matter, the dental service, both personnel and equipment, was for the first time provided for in division tables of organization.2 Instructions on the subject were published in General Orders, No. 99, G. H. Q., A. E. F., June 19, 1918, which provided for a divisional dental service comprising 31 officers and 32 enlisted men, with 10 portable dental outfits, 20 modified portable outfits and 1 portable laboratory. The total weight of this equipment was 12,000 pounds and its bulk 574 cubic feet.2

A portable dental laboratory was also adopted to meet the prosthetic requirements of a division.2 All essential equipment for this was packed in one dental supply chest, which weighed approximately 200 pounds.

When the several army corps were organized provision was made for supply parks at or near the headquarters of each, except for the Second Army Corps, which was operating under the British.2 In accordance with the Abbeville agreement replacement supplies were to be furnished by the British Army for the troops composing divisions of that corps. Therefore, the American Expeditionary Forces were not directly concerned in its replacement supplies until the late fall of 1918, when the corps reverted to American control.2 The initial dental equipment and supply for the troops in that corps would have been amply sufficient to carry them through their campaign under British control, had it not been that all their equipment was reduced to a minimum and excess supplies abandoned immediately prior to their entry into the combat zone. Each division was directed to organize supply dumps in its area for replacement purposes.2 The corps parks and division dumps were fed from the advanced medical supply depot, Is-sur-Tille, as were also the army supply depots at the time of the organization of the First Army, August 12, 1918.2

Great difficulty was experienced in procuring the necessary special equipment for maxillofacial surgery and for the prosthetic and reconstruction procedures required in the practice of that specialty.2 Adequate consideration and study had been given this subject prior to the departure from the United States of specialists in this line, and provision had been made whereby special chests containing maxillofacial unit equipment would be shipped immediately on their departure.2 These plans failed and the much needed special equipment for this service was not received until after the signing of the armistice. It was found subsequently in the midst of a quantity of supplies at the port of Marseille.2 Loss of this equipment necessitated the purchase of all articles of this type that could be found in France and the manufacture of such parts of it as were not found in that market.2 The British and French afforded the


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benefit of their experience in the treatment of face and jaw wounds and this greatly appreciated assistance helped materially in procuring much of this special equipment through purchase and manufacture.2 Though this equipment was not available on many occasions when it was needed by the dental officers at evacuation hospitals, mobile hospitals and at some few base hospitals, the deficiency was well met by individual ingenuity and by improvisation.2

Generally speaking, the system of dental supply through operation of the automatic table was satisfactory, this being especially true in regard to field equipment.2 Theoretically, the automatic table met the situation in an admirable manner, and had ocean, rail, and storage facilities permitted its movement according to the priority schedule, no shortage or delayed replacement or replenishment would have occurred.2 As it actually worked out, the lack of laboratory equipment and supplies was embarrassing on several occasions and there was a long period extending over several months when the shipment of greatly needed base outfits, including electrical equipment, was withheld.2 Consequently projects for installation of this type of equipment in all base hospitals and major clinics were delayed. A large consignment of this class of equipment and supplies arrived in November, 1918, and was thus available for the several hospitals and the many large clinics then being established in base sections, embarkation camps and army areas.2 In these places efforts were being made to render complete dental service for the troops who had been temporarily deprived of it, through the exigencies of an active campaign.2

The following special appliances were developed in the American Expeditionary Forces to meet the requirements of its dental service:2

AMEX DENTURE

A denture cast in aluminum of one piece, wherein the base plate and the teeth themselves were reproduced in this light, inexpensive metal. This process of plate construction lent itself admirably to the military service, inasmuch as more than 98 per cent of the dentures required were for partial loss of teeth. For full dentures, well-matched porcelain incisors and cuspids were attached thereto solely for esthetic purposes. These appliances materially reduced the expense of dentures, the supply stock, and necessary equipment.2

AMEX CASQUE

A surgical appliance for face and jaw reconstruction; the further development of a similar article used in the surgical services of the British and French Armies. It consisted of an adjustable steel band, fitting around the circumference of the head, with adjustable cranial bands and an adjustable perpendicular rod and horizontal face bow. Its use in facial and jaw reconstruction permitted of absolute fixation for either soft parts or osseous fragments, and it was of great value in this class of highly specialized surgery.2

EMERGENCY KITS

These consisted of two Hospital Corps pouches to be slung from the shoulder, one for the dental officer and one for his enlisted assistant.2 They contained the essential instruments and medicines, secured in cloth rolls, and sup-


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plies for administering first-aid dentistry and for the simpler operations of field dentistry. They were prescribed articles of personal equipment for dental officers and were ordered carried whenever combat organizations entered the combat area. Through them it became possible for the troops to receive emergency dental treatment for the relief of pain without leaving their commands.2

FOLDING TRENCH CHAIR

This article of equipment was developed for the purpose of supplying a seat, with stabilized head rest, in order that dental services might be rendered conveniently in trenches, dugouts, and advanced dressing stations.2 It was made of aluminum, reinforced by steel rods and was capable of being folded and carried in a musette bag with the two pouches of the emergency kit. It weighed, complete 4½ pounds.2

DENTAL AMBULANCES

The difficulties of supplying dental care to troops at outlying stations emphasized the great need for dental ambulances, which when fully equipped as "mobile dental clinics" would be capable of traveling under their own power from station to station.2 Plans were made to have such mobile dental clinics; further, it was planned that they would remain at each station a sufficient number of days to permit of the emergency dental treatment of the command. Eleven such vehicles voluntarily contributed in America, and only requiring transportation overseas, unfortunately remained at a home port of embarkation for many months through lack of shipping facilities. Several communications urging their transportation were made by cable and letter to the United States, but these were fruitless.2

Two dental ambulances were, however, presented in France to the dental service, A. E. F.2 One, donated conjointly by two American dentists, had come originally from American Red Cross hospital at Neuilly. It was thoroughly overhauled, equipped, and put in charge of a dental officer November 1, 1917, being designated dental ambulance No. 1, A. E. F.2 Assigned to the motor transport division, Mailly, then located back of the line to the southeast of Soissons, this vehicle continued to operate during the entire period of activities, its station assignment being with one or another of the several units of the motor transport corps in the vicinity of Mailly. The second ambulance was presented to the dental service by the American Red Cross, through its medical director in Paris.2 This ambulance was delivered at headquarters, Chaumont, about March 1, 1918, and was immediately placed in charge of a dental officer and designated dental ambulance No. 2.2 Its station assignment was with the Air Service of the advance section, with headquarters near Colombe la Belle, and its first location at the second bombardment airdrome.2 Throughout the entire subsequent period of activities this vehicle rendered service to the several small detached stations adjacent to the headquarters, Air Service.2

INSPECTION

It was early realized that the best service could be obtained only through providing direct supervision and inspection of dental work by qualified dental inspectors.2 Instructions therefore were issued requiring that each dental sur-


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geon in an administrative position make regular and systematic inspections of the dental officers attached to the command.2 These inspections were to consider personnel, both commissioned and enlisted, discipline and efficiency, character of service, etc. Reports of inspections were forwarded through medical channels to the office of the chief surgeon, A. E. F. In addition to these inspections, it was found necessary at first for the chief dental surgeon to make frequent visits to the headquarters of each division in the American training area. There he inspected the office records, and the methods of the division dental surgeon, as well as the headquarters dental clinic.2 At the same time he gave instructions to remedy defects or to effect a development of the service. As these inspections by the chief dental surgeon were later extended to include base hospitals, he visited during the first six months of the American Expeditionary Forces, base hospitals Nos. 15, 18, 21, 23, 31, 32, 36, and American Red Cross Hospital No. 1, Neuilly. His personal inspections in training areas were made regularly until March, 1918, when the chief surgeon's office was moved from general headquarters, Chaumont, to the headquarters of the Services of Supply at Tours.2

SERVICE RENDERED

The character of the dental service in the American Expeditionary Forces differed considerably in different zones and from time to time, depending on resources and campaign activities.2 When the combat divisions were in training areas it was possible to conduct a high-class tooth-conservation service, with a view of rendering all men dentally fit for the period of the campaign.2 Therefore, consistent efforts were made then to survey and record oral and dental conditions for the entire personnel of organizations. These records were carefully studied so as to give priority for cases requiring oral prophylaxis as a health measure; i. e., for extraction of broken-down teeth and roots, evacuation of abscesses, and removal of rough calcareous deposits.2 This was followed later by such filling operations for tooth conservation and masticatory restoration as were deemed practicable.2 Later, when divisions entered combat areas, and when dental outfits were reduced to combat equipment it was impossible to give more than emergency treatment for the relief of pain, and dental service was necessarily of a simpler character.2 On the march, and during actual engagements, as already mentioned, dental officers and enlisted assistants carried emergency kits, for the sole purpose of rendering immediate treatment, which mainly consisted of extraction, minor surgical operations, medicinal applications and sometimes plastic fillings, so that the soldier might return to the front line without loss of time.2

During the armistice, when the troops had returned to rest and billeting areas for the winter, the character of dental service again changed. More careful consideration was now given to tooth conservation, through permanent fillings, tooth restorations, and the construction of crowns, bridges, and dentures.2 Every effort was made to put the teeth of the men in first-class condition, prior to their return to the United States and release from service.2 The number treated for the month of March, 1919, as compared with the number treated in September, 1918, showed an approximate gain of 300 per cent in dental activities and accomplishments.2 The former was a period of


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rest, the latter one of active field operations. The consolidated report for February, 1919, shows that during that month 119,792 persons were treated and 183,031 dental operations performed.2

The service rendered at base hospitals was of high order at practically all times. Their superior equipment materially enhanced the performance of high-grade professional work, but during the stress of battle the dental service rendered at these units and at evacuation hospitals consisted mainly in the emergency treatment of wounded with special consideration of face and jaw cases.

The practice of dentistry was carried on very thoroughly wherever modern dental equipment, consisting of base dental outfits with electrical apparatus, high-low base chairs, white-enamel steel cabinets and complete laboratories, was installed.2 Such facilities were provided at the large dental clinics organized in the base sections, Services of Supply, in embarkation areas, at hospital centers and at several important headquarters.2

The various base section dental clinics and those at replacement depot, St. Aignan, embarkation area, Le Mans, American University, Beaune, and at the central dental infirmary, district of Paris, were organized for the purpose of centralizing, standardizing, and directing dental service, for coordinating the problems of equipment and supply, and for obtaining the greatest efficiency through technical direction and by friendly competition.2 From 10 to 30 operators were occupied in these large clinics; they became show places of great interest to visitors.2

Comparatively few dentures were required by the (approximately) 2,000,000 men in the American Expeditionary Forces, and those constructed were mostly partial dentures for the replacement of a few lost teeth. The full dentures required were less than 2 per cent of all dentures constructed.2

A consolidated report covering dental service rendered in the American Expeditionary Forces from July, 1917, to May, 1919, inclusive, shows that a total number of 1,396,957 persons were treated; 2,626,368 sittings were given; 497,948 treatments (medicinal) were administered; 2,013,580 operations performed (which included 1,605,424 fillings and 384,427 extractions); and the following prosthetic operations performed: 60,387 crown and bridge constructions, including repairs and resets, and 13,140 denture construction and repairs.2

In the early months of the American Expeditionary Forces, consideration was given to the selection of certain base hospitals and providing those so selected with special personnel and appliances for handling the maxillofacial cases of the American Army.2 The following hospitals were tentatively chosen for this work: Base Hospital No. 18, Bazoilles; Base Hospital No. 15, Chaumont; Base Hospital No. 21, Dijon; Base Hospital No. 26, Angers; Base Hospital No. 6, Bordeaux, and Base Hospital No. 8, Savenay.2 These units were held in reserve for the accumulation of cases that would require evacuation to the United States.2 These plans were changed in May, 1918, upon the arrival of the above-mentioned group of 40 specialists in general and dental surgery for duty in the maxillofacial surgical service. These officers came over under direction of a medical officer who was a well known specialist in this line of surgery and who was soon designated chief consultant of maxillofacial surgery, A. E. F.2


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The dental personnel of this group soon came under the administrative control of the dental division of the chief surgeon's office.2 The chief surgeon decided to make temporary assignment of a medical and dental officer to each of the several important centers in England, Belgium, and France, where this work was being done, in order that they might observe and study the latest method of procedure.2 They could be spared at this time because American troops had not yet largely entered into active combat, nor had the special equipment which these officers required, been received from the United States.2

Upon the return of these officers from their tours of observation, they were organized by the chief surgeon into maxillofacial teams, each composed of one surgeon and one dental surgeon, and were assigned to the important hospitals or to hospital centers.2 The original plan of designating certain hospitals for maxillofacial surgery was therefore abandoned, the new arrangement providing that each important hospital center and every evacuation hospital would carry on this work.2 Base Hospital No. 115, Vichy, was designated the "head hospital," and an adequate group of surgical and dental specialists was sent there to organize and develop it.2

Between 2,000 and 2,500 cases of face and jaw injuries occurred among the American wounded.2 Of this number, about two-thirds treated in the hospitals in France were cured, and were returned to duty there.2 About 700 cases of severe type, requiring reconstruction operations, were evacuated to the United States.2 The cases selected for such evacuation were of five classes: First, compound, comminuted fractures of the jaw in process of consolidation and having splinted fixation; second, compound, comminuted fractures, with delayed union due to sequestra, presence of infected teeth or foreign bodies and requiring long-continued drainage-splinted with fixation; third, united fractures with loss of bony substance, requiring bone graft or prosthetic replacement-splinted with fixation; fourth, cases with healed scars involving either of the conditions mentioned above and requiring a series of plastic operations; fifth, cases of any of the above types, with extensive loss of soft tissue partially healed and distorted, for corrective plastic operations. The first convoy of these wounded embarked in October, 1918.2

The technique employed in the hospitals of the American Expeditionary Forces for the treatment of the injuries classed in the foregoing categories was based to a large degree upon that developed through the experience gained by the French, British, Belgian, and Italian services, for in these armies, through opportunities covering a period of four years, several men had become masters in maxillofacial surgery.2

The selective methods of making bone grafts, in cases in which appreciable loss of bony substance occurred, were of three types.2 First, free graft from a rib, the tibia, or the crest of the ilium; second, osteoperiosteal grafts from the tibia; third, pedicled graft from the mandible itself, shifted into position.2 Some form of splint was used in all these cases to assure fixation of fragments in normal relation.2 The policy ultimately adopted for this class of cases contemplated that the simpler ones would all be cared for in the hospitals in the American Expeditionary Forces and that the severer cases, after the first stages of the work, would be evacuated to a hospital at a base port, where they would


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receive the properly adjusted "open bite" splints to prepare them for the ocean voyage.2 In this connection, it should be remarked that none of the "closed bite" splints could be used in these cases, for it was feared that because of seasickness they would endanger the life of the patients through subjecting them to strangulation by vomitus.2

Many types of splints were made for these cases and many names were given to the several types.2 With a view of standardizing them, the following terms were finally adopted: Interdental splints were splints made for one jaw, either upper or lower. Intermaxillary splints were those made for both upper and lower jaw and connected by some mechanical method for fixation.2 This latter type was made for both the "open-bite" method and the "closed-bite" method, to meet requirements, and, as many of the cases required at different times both the open- and closed-bite splint, a combination splint was devised which could be used in either circumstance.2 This splint was provided with lock pins through the bicuspid region, which held the upper and lower parts firmly together as a closed bite, but when the pins were withdrawn and the jaws opened, the insertion of metal stilts to retain the open bite was feasible. These stilts were firmly held in position by the reinsertion of the lock pins.2

PERSONNELa

(July 28, 1917, to July 15, 1919)

    Col. Robert T. Oliver, D. C., chief.
        Lieut. Col. William S. Rice, D. C.
        Maj. Richard K. Thompson, D. C.
        First Lieut. John D. Brown, D. C.
 

REFERENCES

(1) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 28, 1917. Subject: Weekly war diary. On file, Historical Division, S. G. O.

(2) Report from Col. Robert T. Oliver, D. C., chief of the dental service, A. E. F., to the Surgeon General, U. S. A., April 13, 1921. Subject: The dental service. On file, Historical Division, S. G. O.

(3) Letter from The Adjutant General to the Surgeon General, June 19, 1917. Subject: Extract from cablegram (cipher cable) received at War Dept., from Page to Secretary of State, London, June 12, 1917. On file, Record Room, S. G. O. (138036).

(4) Confidential Orders, No. 2, par. 2, War Department, Washington, D. C., June 25, 1917. On file, Personnel Record, Personnel Division, S. G. O.

(5) Par. 8, Special Orders, No. 76, general headquarters, A. E. F., August 23, 1917.

(6) Report from Brig. Gen. Jefferson R. Kean, M. C., to the chief surgeon, A. E. F., April 24, 1919. Subject: Data to be used by military board of allied supply. Copy on file, Historical Division, S. G. O.

(7) Par. 77, Special Orders, No. 37, headquarters, intermediate Section, Nevers, A. E. F., April, 1918. On file, A. G. O., World War Division, Intermediate Section (Special Orders).

(8) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. A., May 1, 1919. Subject: Activities of the chief surgeon's office to May 1, 1919. On file, Historical Division, S. G. O.

aIn this list have been included the names of those who at one time or another were assigned to the division during the period July 28, 1917, to July 15, 1919.
There are two primary groups-the heads of the division or the section and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.

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