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Chapter V, Dental Equipment and Supply1

AMEDD Corps History > U.S. Army Dental Corps > United States Army Dental Service in World War II

EARLY SHORTAGES OF DENTAL SUPPLIES

The critical shortage of dental equipment and supplies was probably the most serious difficulty faced by the Dental Service during the first 2 years of mobilization. There is ample evidence of the extent of this shortage. The Committee to Study the Medical Department of the Army reported, about November 1942, that "there are serious deficiencies in certain critical items of equipment and supplies. Dental officers ... have been handicapped by an appalling lack of certain materials and equipment." A survey of 199 Air Force stations in December 1942 revealed that only 26 were without serious shortages which ranged from instruments to chairs, units, x-ray machines, and field chests,2 and the following reports were typical of many received in the Dental Division during the early part of the war:

    The July (1941) Report of Dental Service from Camp Davis, N. C., reveals the fact that for some time construction of both DC-1 and DC-2 dental clinics has been completed, and that only four handpieces, all of which were borrowed from other stations, were available. This means that at this station, where twenty dental officers are on duty with the station complement, the services of only four can he utilized in a professional capacity at one time. This situation has existed at Camp Davis for many months. . .3

    The dental clinic No. 1 at Camp Livingston, La., has not been activated due to the lack of cabinets, sterilizers, handpieces, and lights. Requisition was made for these items in December 1940. (This report was made in October 1941.)

Overseas, where the shortages were further aggravated by delays and losses in shipping and by difficulties of storage and distribution, the situation was for a while even worse.4 The dental surgeon of the European Theater of Operations (ETO) reported in November 1942 that 30 percent of the dental officers in England had no equipment.5 In December 1942, 39 dental officers in the Middle East theater had a total of 6 field sets, 2 units and chairs, 1 incomplete laboratory, and a few miscellaneous items purchased locally.6 In

    1A general discussion of the organization and operation of the medical supply service has been written under the title, "The Procurement and Distribution of Medical Supplies in the Zone of the Interior during World War II," by Capt Richard E. Yates. This chapter deals only with aspects of the supply problem which were of particular concern to the Dental Service. HD.
    2Memo, Col George R. Kennebeck for Brig Gen David N. W. Grant, 11 Jan 43. SG : 444.4-1.
    3Memo, Brig Gen Leigh C. Falrbank for Finance and Supply Div, SGO, 29 Aug 41. SG : 444.4-1 (Camp Davis)C. (At the time of this report there were about 15,000 men at Camp Davis.)
    4Medical supplies for Europe waited in the channel for as long as four months while high priority munitions were being unloaded. See History of the Dental Division, Headquarters, ETOUSA, 1 Sep-31 Dec 44. HD: 319.1-2 (ETO).
    5Personal ltr, Col William D. White to Brig Gen Robert H. Mills, 2 Nov 42. HD: 730.
    6Personal knowledge of the author who was dental surgeon of the Middle East theater in December 1942.


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December 1942 the North African theater was short 37 percent of its authorized MD Chests No. 60.7 8 In January 1943 the Director of the Dental Division, SGO, stated: "We have no chests 60 at all, it seems, to issue to troops in this country."9

Serious deficiencies of supplies and equipment involved shortages of the following important items:

Burs. The War Production Board (WPB) reported in 1943 that stocks of dental burs in the hands of civilian dealers averaged only 33 percent of prewar levels, and that 88 percent of all dentists complained of difficulty in obtaining this essential item.10 Total output in 1943 was estimated at 48 million while total requirements were placed at over 93 million, of which 52 million were requested by the Armed Forces.11 In spite of the fact that the Army was given only 15 million in 1943 instead of the, 35 million requested, final allocations to the Armed Forces still totaled more than half of all production for the year.12 As late as November 1944 WPB considered construction of a new bur factory at Government expense, though the project was dropped when it became apparent that low output was due more to the lack of materials and labor than to inadequate capacity.13

Heavy clinical equipment. Production of units, chairs, x-ray machines, and other large clinical items had naturally been small in peacetime since they could be classed as capital goods which required replacement only after many years of use. In 1940, civilian dentists purchased only about 2,000 units and 2,500 chairs.14 In 1943, however, the Army alone required about 5,500 units and 5,000 chairs.15 The production of individual companies manufacturing these items was increased from 50 to 300 percent16 but capacity was severely strained. In April 1943, delivery of 1,697 units, of 8,359 contracted, caused certain manufacturers to be classed as "delinquent."17

Dental field chests. During the early part of the war many units were sent overseas without field dental equipment, or with chests which were incom-

    7Ltr, Col Egbert W. V. Cowan to Chief Surg, NATOUSA, 13 Mar 43, sub: Dental needs in the Theater of Operations. On file as incl to pers ltr, Col William D. White to Brig Gen R. H. Mills, 7 Apr 43. HD: 730.
    8Personal ltr, Brig Gen R. H. Mills to Col. William D. White, 18 Jan 43. HD:730.
    9See this chapter, p. 180 for contents of M. D. Chest No. 60.
    10Special problems discussed at War Service Committee meeting. J. Am. Dent. A. 31 : 445-450, 15 Mar 44.
    11Memo, Col Clifford V. Morgan, Chief of Materials Br, Production Div, SOS, for SG, 6 Jan 43, sub: Dental burs-production and requirements. SG: 444.4-1.
    12Memo, Col F. R. Fenton, Resources and Production Div, SOS, for SG, 24 Feb 43, sub: Dental burs-proposed allotment. SG: 444.4-1.
    13Ltr, Senator Harold Burton to Mr. Highland G. Batcheller, Vice Chairman of Operations, WPB, 10 Nov 44. SG: 444.4-1.
    14Info, Medical and Health Supplies Section, Consumer Programs Branch, WPB, for Col C. F. Shook, 18 Sep 42. The original of this letter cannot be located. The source of the figures given was said to be the American Dental Trade Association.
    15Ltr, Maj J. E. Rice to Chief, Reqmts Br, Resources and Production Div, Hq, ASF, 5 Apr 43, sub: Allocation of dental operating units and chairs. SG: 444.4-1.
    16Annual Report of the Army Medical Procurement Office, fiscal 1944. HD: 319.1-2.
    17Incl to memo, Lt Col C. G. Gruber for Chief, Health Supplies Section, Production Div, ASF, 10 Jun 43, sub: Report on dental supplies. SG: 444.4-1.


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plete in essential items.18 This particular deficiency was one of the most critical encountered Since it was extremely difficult to make any informal arrangement for obtaining dental care in the areas first occupied by American troops.

Handpieces. The production of handpieces, especially of the Contra-angle type, was such a specialized operation that expansion of facilities was slow and for many months output lagged behind wartime needs. In many otherwise fully equipped clinics the dental officers could perform only the operations possible with the simpler straight handpiece. At times, in early 1943, dental officers scattered over thousands of miles of desert in the Middle East theater had only a single contra-angle handpiece per dentist, and there was not one replacement in the theater. These shortages resulted from a number of factors among which the following were most important:

1. The Armed Forces took nearly one-third of the Nation's active dentists. In addition to providing these men with complete outfits, adequate reserve stocks had to be assembled for future operations as the loss of dental supplies was inevitably high under combat conditions. (The dental surgeon of the ETO reported that 40 complete field outfits were lost while in shipment to his area.)19

2. The Supply Division, SGO, suffered from a lack of officers trained in dental supply. The director of that division stated in September 1942 that "The dental supply program has been materially retarded due to shortage of personnel capable of negotiating contracts for the Medical Department."20 The Director of the Dental Division, SGO, noted that difficulties encountered had been "in part due to the inexperience of supply personnel in evaluating dental needs and requirements."21

3. Requirements for lend-lease aggravated shortages in some of the most critical items. Late in 1942 when units were being shipped without their dental field chests, the British Army was supplied with 200 of these scarce items under previous commitments.22

4. In peace, the United States had depended to a considerable extent on imports of dental items from European countries. For instance, American industry had produced only from 6023 to 70 percent of the 33 million burs used each year prior to World War II. With the outbreak of hostilities these imports were immediately cut off not only to the United States, but to its allies and to South and Central America.

    18Personal ltr, Col William D. White to Maj Gen Robert H. Mills, 22 Oct 43. HD: 730.
    19See footnote 4, p. 165.
    203d ind, Assistant Chief of the Supply Div, SGO, 19 Sep 42, on Ltr, Lt Col James P. Holliers. SG: 444.4-1.
    21Final Report for ASF, Logistics in World War II. HD: 319.1-2 (Dental Division).
    22Personal Ltr, Brig Gen R. H. Mills to Col William D. White, 28 Nov 42. HD: 730 (ETO).
    23President J. Ben Robinson discusses personnel and supply problems arising out of the war. J. Am. Dent. A. 30: 163-166, 13 Jan 43.


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5. High wartime wages swelled the demand of the civilian population for dental care which it had not received in the years of depression preceding World War II.

6. The threat of future shortages probably resulted in some hoarding of dental supplies. At a conference of dental manufacturers in September 1942 the representative of one firm noted that his company alone was under contract to provide 261,000 instruments for the Army, and he expressed doubt that such a number was actually required.24 The Director of the Dental Division immediately pointed out the elimination of many dental items from the supply lists of the Army, and claimed, in turn, that the Navy had ordered as many burs as the Army though it had only one-fourth as many dentists.25

In December 1942 a representative of the Supply Division, SGO, claimed that large quantities of surplus burs were in the hands of the schools, supply houses, and the profession, and asked the Association of Dental Manufacturers of America to attempt to collect these for military use. The Association issued a bulletin to its dealers asking that customers be impressed with the need for turning in excess stocks as an alternative to a complete "freeze" on sales to civilians, but this action produced more criticism than burs. The president of the ADA protested vigorously, both at the supposed threat of a "freeze" on civilian sales, and at the implication that civilian dentists were guilty of what was delicately called "anticipatory buying."26 The Supply Division, SGO, replied that it had never intended to hint that hoarding had occurred, and that its action had really been expected to impress the manufacturers with the need for intensive efforts to increase production.27 In any event, the attempt to collect burs from civilian sources produced only about 2,100 packages, and the effort was soon dropped.28

It is difficult to deny, however, that hoarding of scarce supplies was practiced both by civilian and military users. The chairman of the Medical Supplies Commission, Army and Navy Munitions Board, reported that civilian purchases of burs in 1941 had been 70 percent higher than in any previous year, in spite of the number of dentists and patients in the Armed Forces.29 In 1943 total requirements for burs were placed at nearly 94 million, compared with an average prewar demand for about 33 million burs. The Army, alone, asked for over 35 million burs in that year, or more than the normal total peacetime requirement, and combined requests of the Armed Forces totaled 52 million burs.30 The clashes reported above, between the Army, Navy, civilian practi-

    24Memo, Col C. F. Shook for Col F. C. Tyng, 3 Sep 42. HD: 444.4-1 (Dental).
    252d ind, Dir. Dental Div, to Memo cited in footnote 24, 16 Sep 42. HD: 444.4-1 (Dental).
    26(1) Ltr, Dr. J. Ben Robinson to Col F. C. Tyng, 29 Dec 42. SG: 444.4-1. (2) See footnote 23, p. 167.
    27Ltr, Col F. C. Tyng to Dr. J. Ben Robinson, 10 Jan 43. SG: 444.4-1.
    28Ltr, Dental Manufacturers of America to Col F. C. Tyng, 29 Jan 43. SG: 444.4-1.
    29Ltr, Lt Col C. F. Shook to Hon Leslie C. Arends, 23 Jan 42. 9G: 444.4-1.
    30Info memo, Safety and Technical Equipment Division, Health Supplies Committee, WPB, 5 Jan 43. SG: 444.4-1.


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tioners, and the manufacturers, are significant mainly because they show that users tend to overestimate their needs when supplies are uncertain, and because they indicate the need for disinterested control of distribution when production is inadequate to meet all demands.

In the final analysis, wartime shortage of dental supplies was due primarily to increased demand rather than to defects in production. In spite of the difficulties noted in obtaining labor and materials, the output of dental items soon exceeded peacetime rates. The manufacture of burs, for instance, tripled between 1937 and 1944.31 A representative, of The Surgeon General stated that wartime production of dental supplies reached 3 1/2 times normal peacetime levels.32 It is apparent that in time of war the production of dental supplies for civilian needs can be reduced very little if at all, and that any reduction in the output for civilians will be more than balanced by the increased demands of the Armed Forces.

ACTION TAKEN TO IMPROVE THE DENTAL SUPPLY SITUATION

Improvement in the dental supply situation depended mainly on an increase in civilian production, and this phase of the problem was largely out of the hands of the Dental Division. The latter did cooperate, however, in a number of steps to assure the most effective use of the available stocks and raw materials, of which the following were the most important:

Simplification of Dental Items

Early in the war the Armed Forces, governmental agencies, manufacturers, and the civilian profession cooperated to reduce the number of types, and to simplify the design, of many items produced for dental use. As early as February 1942 the Dental Division had voluntarily suggested that for the duration of the war 81 items, including 33 sizes of burs, be dropped from Army supply tables. A total of 134 items were eventually recommended to be dropped, and most were actually removed from the tables. The requisition of nonstandard items was also discouraged.33

In June 1942 WPB issued a "general limitation order" restricting the production of dental burs to 42 of the most used sizes.34 In November 1942 delegates from the Armed Forces, the ADA, the American Dental Trade Association, and WPB, agreed on methods for simplifying other dental items, particularly chairs and units.35 Wood and plastics were to be substituted for metals

    31See footnote 10, p. 166.
    32Testimony, Maj Gen George F. Lull before the Senate Subcommittee on Wartime Health and Education. In Hearings before a Subcommittee of the Committee on Education and Labor, United States Senate, Seventy-eighth Congress. Washington, Government Printing Office, 1944, pt 5, p. 1672.
    33SG Ltr 2, 8 Jan 42.
    34WPB General Limitation Order 139, Schedule 1, pt 1254. In Federal Register, 26 Jun 42.
    35Memo, Col C. F. Shook for Col F. C. Tyng, 26 Nov 42, sub: Dental Equipment Advisory Committee for the WPB. SG: 334.8-1.


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wherever possible, and the production of units was to be limited to the smaller, simpler types similar to the Ritter "Tri-dent." These units provided only the basic essentials: a dental engine, cuspidor, bracket table, warm water syringe, hot and cold compressed air, and operating light. The amount of brass and copper used was to be drastically reduced.

With the aid of a committee appointed by the ADA, and with the advice of all interested parties, the Bureau of Standards also drew up "simplified practice recommendations" aimed at eliminating minor and nonessential variations of standard articles. Steps recommended by this agency, such as the reduction in the number of sizes and types of hypodermic needles produced, were generally accepted voluntarily by manufacturers, though had they not it would have been possible to enforce them through WPB's control over the allocation of materials.

Improved Distribution of Dental Supplies

In the early part of the war supply officers with experience in handling dental items were scarce, resulting in occasional poor distribution of even the minimum stocks then available. An especially frequent defect was failure to balance the equipment sent to each station; one post might receive all its units and no chairs, while another received all its chairs and no units. Angle handpieces were furnished which did not fit the particular straight handpieces issued. To improve this situation the Director of the Dental Division recommended in March 1941 that a dental officer be assigned to the Supply Division, SGO.36 Such an assignment was actually made in November 1942, but it was terminated in March 1943. Subsequent improvements in the allocation of dental supplies resulted mainly from the increasing experience of medical supply officers.

In July 1941 The Surgeon General directed that stations with excess stocks of dental items would report them for redistribution where more urgently needed.37 Stations were also directed to turn in any handpieces in excess of one per operator, plus a 25 percent station reserve.38

In January 1943 WPB issued a general limitation order controlling the production and sale of dental units, chairs, x-ray machines, and sterilizers,39 and governmental agencies were thereafter given first priority in the purchase of such items. Stocks of new equipment already in the hands of jobbers and dealers had to be reported, and 54 chairs and 109 units were obtained for the Army from this source.40

The storage and issue of porcelain teeth, involving hundreds of molds, sizes, and shades, offered considerable difficulty in most supply depots. In

    36Memo, Brig Gen Leigh C. Fairbank for Supply Div, SGO, 17 Mar 41. SG: 210.31.
    37SG Ltr 75, 25 Jul 41.
    38SG Ltr 83, 25 Aug 41.
    39WPB General Limitation Order L-249, pt 3172, 20 Jan 43. In Federal Register, 21 Jan 43.
    40Ltr, Maj Robert E. Hammersberg to Purchase Div, Army Medical Procurement Office, 26 Feb 43. SG: 444.4-1.


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March 1944 each base medical depot was authorized two dental prosthetic clerks who were qualified to handle artificial teeth.41 42 In England, teeth were first stocked in 18 separate depots for convenience in distribution, but without skilled personnel the supply soon became badly mixed. Also, since each depot could keep only a small stock, the supply of any individual mold might run out quickly, necessitating a canvas of other depots to locate additional quantities. To eliminate these difficulties a single depot was finally designated to handle all porcelain teeth, and an expert was brought from the United States to supervise their distribution.

It has already been noted that in the early part of the war units we're shipped overseas without their authorized dental field chests. This situation was due primarily to the serious shortage, of this item, but it was aggravated by the policy of shipping personnel and equipment on different transports, in the mistaken belief that if the equipment failed to arrive promptly the dentists could readily draw new chests from theater supplies. This difficulty had been encountered in the First World War, and a dental officer was finally assigned to the New York Port of Embarkation with specific instructions to make sure that no dentist left the United States without his dental equipment.43 Similar action was taken in November 194244 but improvement in this situation was slow until overseas depots were finally stocked with dental field outfits which could be issued promptly on arrival. The difficulties encountered in both World Wars indicate that every effort should be made to have dental equip-ment accompany dental officers as part of their personal baggage.

Purchase of Used Equipment

During the period when supply shortages were most acute The Surgeon General was deluged with proposals that he purchase used dental equipment for Army clinics. In particular, large numbers of dental officers who were paying for items lying idle in storage, and who noted the scarcity of these same items at the stations where they reported for duty, urged that the, Army solve both problems by purchasing or leasing such equipment. Widows of dentists, and finance companies, were also eager to unload dental outfits for which the market was poor at a time when dentists were entering the military service in large numbers. Late in 1942 WPB made a preliminary investigation which indicated that some 11,000 each, chairs and units, could be obtained from dentists entering the Army or Navy; and on the basis of this information it even recommended, for a while, a complete suspension of the manufacture of the

    41For training given enlisted men to qualify them as prosthetic supply clerks, see ch IV, p. 158.
    42T/O & E 8-187, C 1, 24 Mar 44.
    43The Medical Department of the United States Army in the World War. Washington, Government Printing Office, 1928, vol III, p. 624 (cited hereafter as The Medical Department . . . in the World War.)
    44See footnote 22, p. 167.


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larger dental items during the war.45 In January 1943 ASF also urged all its agencies to make maximum use of secondhand equipment.46

Superficially, the proposal to purchase the equipment of dentists entering the service appeared to have considerable merit. The attitude of The Surgeon General, however, was one of caution, typically expressed by Brig. Gen. C. C. Hillman, assistant to The Surgeon General, in September 1942:

    It appears to this office that medical and surgical supplies now in the possession of civilian physicians might better be used to continue the care of the civilian population than to be acquired for the Army. For military use a certain degree of standardization is essential. You can well imagine the difficulties that the Medical Supply Division would encounter if they attempted to gather up generally supplies and instruments from civilian physicians and with them supply our military hospitals.47

A later statement by Col. C. F. Shook was even more specific:

    It is possible that dental units may be acquired in this manner, but the number is questionable. The plan is an Utopian plan, but it would require more personnel than The Surgeon General's Office has at its disposal, and in many instances [it] would rob professional schools and recent graduates of the equipment they need in their profession.48

Under pressure of the great need for dental equipment, however, The Surgeon General did make an effort, beginning in the fall of 1942, to acquire secondhand items. In October 1942 he reported that where suitable used equipment was found it was being purchased,49 though such procurement was certainly on a small scale, apparently by local supply officers.50 On 30 October 1942 questionnaires were sent to 3,000 new dental officers, asking if they owned suitable equipment, and if they would sell it to the Army at a suggested price of original cost, less 5 percent for each year of use. (Instruments were not to cost over 80 percent of original price.)51 Of the 3,000 officers questioned, only 496 were willing to sell any equipment. Of this latter number, only 184 had items which the Army considered suitable. The remaining equipment was old, was manufactured by firms which had gone out of business, or was otherwise undesirable. It appeared that men with modern outfits were not anxious to sell. The equipment offered was also scattered over 41 states, so that a con-

    45Ltr, WPB to Col C. F. Shook, 18 Sep 42. SG: 444.4-1.
    46Memo, Maj Gen Lucius D. Clay for Chiefs of Supply Services, SOS, 25 Jan 43, sub: Used equipment and supplies in the hands of jobbers, dealers, and users. SG: 400.139-1 (St. Louis Medical Procurement District) M.
    47Ltr, Brig Gen C. C. Hillman to editor, Journal of the American Medical Association, 7 Sep 42. SG: 400.139-1.
    482d ind, Col C. F. Shook, on ltr 16 Sep 42, to SG from the surgeon, Camp Adair, Oregon, 1 Oct 42. SG: 440.1 (Camp Adair) C.
    49Ltr, Col C. F. Shook to Mrs. Edna Francis, 29 Oct 42. SG: 400.139-1.
    50Formal authority to purchase used dental equipment without the usual advertising for bids was not granted until January 1943. See Ltr, Col M. E. Griffin to CO, New York Medical Department Procurement District, 21 Jan 43, sub: Purchase of second-hand dental equipment from dentists in the Army. SG: 400.139-1 (St. Louis Medical Department Procurement District) M. This requirement appears to have been ignored by local purchasing agents, however.
    51Ltr, SG to all newly commissioned officers, 30 Oct 42, sub: Acquirement of dental equipment. SG: 444.4-1.


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siderable administrative organization would have been required to inspect it and advise on acceptance or rejection.

In spite of these unfavorable developments The Surgeon General directed medical depots, on 12 February 1943, to purchase used items when such action seemed justified by sound business judgment.52 Results were poor, however, and in April 1943 The Surgeon General reported that the amount of equipment being obtained did not justify further expenditure of time by military personnel. He stated further that the replies to his questionnaire were being turned over to WPB for use in its program of procurement for civilian needs. WPB9 in turn, followed up 100 offers as a test, and quickly decided to abandon the whole project, leaving the purchase and resale of used equipment to established dealers.53 The Army-Navy Medical Procurement Office reported that only 45 used chairs and 25 units were purchased by medical depots in 1943, and all of these were obtained from dealers.54 It is probable that a few second-hand outfits were purchased locally, by medical supply officers of camps or hospitals, but the number was certainly small, and played a very minor part in meeting total requirements. By September 1943 all prospective sellers were being referred to civilian agencies.

WPB sponsored a voluntary collection of instruments, as a test, in the vicinity of St. Louis in October 1942, but the drive netted more scrap than useable supplies.55

Some of the causes for failure of the used equipment program were the following:

1. Dental officers were reluctant to sell equipment without ironclad guarantees that they would be able to purchase the same or corresponding items at the end of the war. However, World War I experience had shown that excess dental items had not been available for sale until 2 years after demobilization and the Army was therefore in no position to give prospective sellers the assurance they required.

2. Much of the newer equipment offered was encumbered with liens which so complicated purchase that the Legal Division, SGO, advised against any attempt to procure such items.56

3. The attempt to use miscellaneous types of secondhand equipment involved serious problems of maintenance. Isolated posts could not conveniently obtain the parts needed for the repair of older items which might break down in use.

    52Ltr, SG to COs of all medical depots, 12 Feb 43, sub: Procurement by depots-purchase used equipment. HD: 314 (Code R-3).
    53See footnote 30, p. 168.
    541st ind, Col. M. E. Griffin, 3 Jun 46, on ltr, Brig Gen Thomas L. Smith to Army-Navy Medical Procurement Office, 24 May 46, sub: Purchase of dental units and chairs. SG: 444.4-1.
    55Ltr, CO, St. Louis Medical Procurement District, to SG, 23 Oct 42. SG: 400.139-1 (St. Louis Medical Procurement District) M.
    56Memo, Legal Div, SGO, for Col C. F. Shook, 1 Feb 43, sub: Purchase from Army officer of secondhand dental chairs and equipment subject to liens. SG: 400.139-1.


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4. Inspection of items offered for sale involved long trips by dental officers, and only a small proportion of the outfits offered proved suitable for purchase.

5. Used equipment was actually more expensive to the Government than now. One officer inspecting an outfit in New York reported that the price was reasonable by retail standards, but that the old chair would cost more than the Army regularly paid for a new one, and that the small unit would cost more than the quantity price for a new senior unit.57 Equipment was often offered to the Army only because it was hoped that an even better price would be obtained than in what soon became an inflated civilian market. Also, the depots could not issue used items until they had been reconditioned, and such reconditioning, with transportation charges, often cost almost as much as new equipment.58

6. With the productive capacity of manufacturers strained to the limit to meet military needs it was felt that the purchase of used equipment by the Army would result in a critical shortage of items urgently needed by civilian dentists. It was believed, further, that the sale, maintenance, and repair of miscellaneous used equipment could better be handled by established dealers than by the Armed Forces, and that such nonstandard items were better suited to civilian needs, especially after the WPB stopped production of new equipment for civilian use in January 1943.

The easing of the supply situation in 1943 permitted the Medical Department to withdraw from a program which had originally been undertaken, as an emergency measure, with strong misgivings.

Local Procurement of Dental Supplies

World War I attempts to obtain dental supplies by local purchase had not been encouraging. The American Expeditionary Forces contracted for some French equipment in 1918, but the French Government was soon forced to limit sales to items totaling not over 1,000 francs per month to prevent a threatened exhaustion of the civilian market. A considerable amount of laboratory supplies was then purchased in London, but the British War Office quickly prohibited further procurement from that source.59 It was apparent that local markets, geared to peacetime needs, could not furnish any significant proportion of the supplies needed by a major force.

In World War II medical supply officers in the Zone of Interior were authorized to make emergency purchases of small items not obtainable from medical supply depots, and this privilege was sometimes extended to include dental units or chairs. The amount of material obtained by such means was not an important factor in the overall supply situation in the United States.

    57Ltr, Lt Col H. T. Marshall to SG, 14 Jan 43, sub: Purchase of secondhand dental equipment. SG: 400.139-1.
    58Ltr, Brig Gen R. H. Mills to Dr. McCarthy, 29 Sep 42. SG: 444.4-1.
    59The Medical Department...in the World War (1927), vol II, p. 115.


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In overseas areas local purchase was restricted only by the need and by the availability of stocks, and local procurement played a more important part in supplying equipment required to establish initial dental installations. Cabinets, lathes, cuspidors, and angle handpieces were obtained in Australia; burs, porcelain teeth, and acrylic resin in Palestine, and general dental supplies through reverse lend-lease in England. The Chief Surgeon of the European theater claimed that all the dental burs needed by the United States forces in England in 1944 could be obtained through local purchase.60 The British Army also loaned field chests to the United States Army units arriving in the Middle East without dental equipment in 1942 and 1943. Supplies procured abroad were important at a time when equipment was not plentiful, but in general they did not go far to meet the total needs of the United States forces overseas. Production in the less industrialized nations was often negligible, and stocks on hand were quickly reduced to a point where civilian dental care was threatened. In Cairo, for instance, a single representative of a United States aircraft plant practically cleaned the shelves of the few dental supply houses, and acrylic resin disappeared into the black market for the remainder of the war, where it sold for approximately $20 a unit.61 Except in those rare instances where a highly industrialized nation could assume full responsibility for supplying one or more items, local procurement was little more than an expensive and ineffective measure to meet emergency needs pending arrival of standard Army supplies.

Measures to Insure the Maximum Use of Available Items

In April 1942 Brigadier General Huebner, AGF inspector for training, reported that large numbers of men in the field were unable to chew the Army ration because of dental defects.62 Since deficiencies in dental treatment at that time were due mainly to lack of supplies, the Director of the Dental Division, SGO, was forced to take radical action to insure full use of the limited equipment then available. He recommended that outfits in critical locations, especially in replacement training centers, be used for from 15 to 24 hours a day, by the employment of 2 or 3 shifts of dental officers.63 It is not known exactly how many dental officers were used on night shifts during this. period, but 916 additional dentists were requested at the time the system was initiated, and it is believed that most of this number were so used, at least temporarily. The use of double shifts could only be regarded as an emergency measure, however. The output of dental officers at night was less than during daylight hours, the proportion of broken appointments was nearly doubled,64 and patients were

    60Cable, Brig Gen Hawley to SG, 26 Oct 43. SG: 444.4-1.
    61See footnote 6, p. 165.
    62Memo, Dir, Mil Pers, SOS, for SG, 27 Apr 42, sub: Dental supplies in the field. SPGAP/10282-14 (G-1).
    63Memo, Brig Gen R. H. Mills for Exec Off, SGO, 27 Apr 42. SG: 703.1.
    64Annual Report of the Medical Service, Camp Claiborne, La., 1944. HD: 319.1.


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tired and hard to handle after a full day's work. It was also difficult to arrange meals and transportation for both dentists and patients at irregular hours. The operation of multiple shifts did accomplish its primary purpose, which was to increase the total amount of work completed in the face of a crippling shortage of supplies.

In the field the contents of a single M. D. Chest No. 60 were often divided so that two officers could utilize one set of equipment. One officer might devote his time to operative procedures while the other handled extractions, gingival diseases, and emergencies. The multiple shift system was also used to a limited degree in some theaters until adequate supplies arrived.65

Conservation of Scarce Supplies

Every effort was made to conserve critical items during the war. After December 1942, dull burs were saved and returned to depots for resharpening under contracts with civilian firms.66 Wax was collected, sterilized, and reused in the larger laboratories, and scrap amalgam returned to depots for recovery of the mercury and silver content. Items of rubber, brass, lead, tin, or other scarce materials were saved for salvage.

In 1942 about 180 enlisted men were sent to dental manufacturing plants for intensive 2-week courses in the maintenance and minor repair of dental equipment.67

In September 1944 The Surgeon General published a technical manual covering the care, lubrication, and repair of dental handpieces.68

The repair of unserviceable handpieces was undertaken on a large scale. At first it was anticipated that manufacturers would assume responsibility for the reconstruction of their products, but they proved reluctant to use their overburdened facilities for this purpose and the medical supply service had to take over the program. Two shops equipped to rebuild handpieces, were established in the United States in 1944 but shortages of equipment and personnel hampered early operations so that only 3,500 handpieces were returned to service that year. By early 1945, however, most of the previous difficulties had been overcome and in February these shops together reconstructed a total of 2,500 handpieces. Since only about 700 handpieces were received for repair each month this capacity permitted a rapid reduction of the large backlog of defective handpieces which had accumulated over the past months.69

    65In the Middle East theater and in England, RAF dentists sometimes used their outfits in the mornings and early afternoons, lending them during the late afternoons and evenings to U. S. Army Air Force dentists stationed nearby.
    66SG Ltr 176, 8 Dec 42.
    67Report of the Dental Division, SGO, for fiscal 1942. HD: 319.1-2.
    68TM 8-638, 23 Sep 44.
    69The problem of the repair of dental handpieces. Bulletin of the U. S. Army Medical Department, 89: 25 June 1945.


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Substitution of Critical Items

The Army, like the civilian profession, made wide use of substitutes for critical items of dental supply. Acrylic resin was substituted for vulcanite, though this inevitable change was only hastened by the shortage of rubber. The alginates were used in impression materials in place of scarce agar compounds. Various substitutes for tinfoil were evolved. An attempt to use silver in place of nickel for plating instruments was unsuccessful, however, as the coating tended to pit and was subject to attack by mercury particles. Very early in the war diamond points were made available, to conserve dental burs. Items of copper were almost eliminated from dental supply tables. In general, no item made of critical materials was purchased for the Dental Service unless diligent research failed to reveal any acceptable substitute.

PACKING AND SHIPPING DENTAL SUPPLIES

General principles for the packing and shipping of dental supplies were no different from those for other items, and the handling of dental material offered few unique problems. Early in the war considerable breakage of heavy equipment, especially of dental x-ray machines, was reported, but this situation was remedied as the depots gained experience in preparing medical items for shipment under wartime conditions.70 The handling of gold offered some difficulties. It was found that unless such materiel was placed in the custody of a responsible ship's officer, to be delivered only to an authorized agent on arrival, it was often "misplaced" either en route or at the docks were it was unloaded.71

EFFECTS OF CLIMATE ON DENTAL SUPPLIES

Considering the wide variations of climate encountered by the United States troops it is surprising that complaints of damage from extremes of temperature were relatively few. Cements, especially the silicate cements, set so rapidly in the hotter areas that their manipulation offered some difficulty; when the humidity was high it was impossible to cool glass, slabs to the desired 70 degrees without precipitation of moisture. In the tropics the softer brands of waxes and impression compounds proved unsatisfactory, but materials specifically designed for use in such areas gave no trouble. Anesthetic solutions and x-ray film deteriorated rapidly when they could not be stored in cool locations, necessitating care to use oldest stocks first and to avoid accumu-lating quantities which could not be utilized in a reasonable time.72 Small

    70For additional data on packing problems see annual reports of the Supply Division, SGO, for fiscal years 1943 and 1944. HD: 319.1-2.
    71Personal Ltr, Dental Surgeon of the China-Burma-India theater, to Maj Gen R. H. Mills, 1 Jul 44. This letter has been seen by the author but it was not made a permanent record.
    72See Essential Technical Medical Data Reports for China-Burma-India theater, 1943 and 1944. HD: 350.05.


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carpules (ampules) of anesthetic solution were reported to be undamaged by freezing in the Arctic, though later investigations indicated that the rubber plugs sealing such carpules might be pushed out by exposure to extreme cold.73 In general, standard items on the supply tables proved satisfactory under any conditions where dental treatment was practicable.

ZONE OF INTERIOR AND COMMUNICATIONS ZONE EQUIPMENT

Prior to World War I it was planned that in a mobilization only portable equipment would be issued to dental officers, in the Zone of Interior as well as overseas. By the fall of 1917, however, it was apparent that this policy was not economical because dental officers could not operate as effectively with equipment which had been designed primarily for portability as with the more convenient chairs and units used routinely in civilian offices. Standard chairs, wall-bracket engines, cabinets, instruments, and laboratory equipment were therefore issued to all Zone of Interior training camps and to base and general hospitals (fig. 4).74 Teams of 10 dentists, with base equipment, were also organized for use in favorable locations overseas.

Prior to World War II it was recognized that field units would require outfits which were easily portable and could be used well forward in the combat zone; on the other hand, it was clear that dentists outside the combat area should not be required to use equipment designed to be set up in a tent or dugout. It was therefore planned to provide standard base items in the Zone of Interior and in fixed and semifixed installations in the communications zone. (For establishments in that zone, it was expected that minor modifications, such as substitution of a mobile engine and cuspidor for the dental unit, could be effective.) This policy was actually carried out in the Zone of Interior, where dentists generally worked with equipment similar to that in their own offices. Zone of Interior camps and hospitals had units, chairs, cabinets, operating lights, x-ray machines, air compressors, and instruments which met normal civilian standards for convenience and reliability.75 In the summer of 1942, however, lack of shipping space became so acute that drastic restrictions were placed on equipment for overseas use.76 The large hospitals and dispensaries of the communications zone were thereafter allowed only the dental field chests, augmented with essential laboratory and surgical tools and equipment77 though many installations were later able to obtain captured base outfits or to purchase chairs and engines locally.

    73Ltr, Dr. J. Edward Gilda to Maj Ernest Fedor, 21 Jul 47. This letter was seen by the author but not entered in permanent files.
    74See footnote 43, p. 171.
    75U. S. Army Medical Department Supply Catalog, 1942.
    76Personal Ltr, Brig Gen R. H. Mills to Lt Col Richard F. Thompson, 18 Jul 42. HD: 730.
    77Memo, Brig Gen R. H. Mills for chm, Medical Department Supply and Equipment Board, SGO, 25 Sep 43. SG: 444.4-1.


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Zone of Interior dental Equipment.  

 

 Figure 4.  Zone of Interior dental Equipment.

 

 

The primitive character of the communications zone equipment was soon the target of much unfavorable comment. The Chief Surgeon of the European Theater asked that hospitals and general dispensaries in his area be given at least a minimum of base equipment.78 Another senior medical officer, returning from an overseas inspection trip in November 1943, reported that "Field observations and the opinions of qualified dental officers in the Southwest Pacific Area indicate the need for revision of equipment lists for fixed installations to provide electric engines (portable), wall-bracket operating lamps, and portable cuspidors, small type. It is recommended that the Dental Division be consulted with reference to this matter."79 The Dental Division had already requested reconsideration of the restricting order in September 1943, but the recommendation had been disapproved. A new request for authority to ship mobile dental engines, operating lights, and cuspidors overseas was now made, and this time approval was granted.80 Until then the

    78Ltr, Capt F. J. Reynolds, Overseas supply Div, NYPOE, to SG, 2 Nov 42, sub: Dental equipment. SG: 444.4-1.
    79Report of Col William Wilson on inspection trip to the Southwest Pacific theater. Quoted in: Memorandum to the chairman, Medical Department Supply and Equipment Board from Maj Gen R. H. Mills, 2 Nov 43. SG: 444.4-1.
    80Ltr, Capt M. H. Kannal to Overseas Supply Officer, NYPOE, 13 Nov 43, sub: Dental equipment. SG: 444.4-1.


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small amount of base equipment which had arrived overseas before enforcement of the embargo, or which had been obtained locally, had been spread very thin, over a few important installations. Fixed and semifixed units now began to receive items which materially increased their efficiency and output.

DENTAL FIELD EQUIPMENT

Dental Operating Chests

The basic dental field equipment issued in the First World War was bulky and difficult to transport. It was packed in six chests, containing an engine, a chair, a desk, instruments (two chests), and miscellaneous supplies.81 A seventh chest containing a cuspidor was added in September 1917.82 For overseas use another five chests were added, containing an oil stove, a portable table, a box of medicines, alcohol, and additional supplies. As delivered in France the complete outfit occupied 39.28 cubic feet of space and weighed 775 pounds.83 Transportation of this "portable," equipment was always a problem, and not infrequently the entire outfit had to be abandoned in a hurried move.84

In the period between World Wars I and II the dental field equipment was considerably simplified. The Medical Supply Catalog of 1928 listed three chests, occupying 8.7 cubic feet, and weighing 209 pounds.85 The chests contained a foot-engine, chair, and instruments and supplies. Development of a dental field outfit which could be packed in a single, standard, Medical Department chest had been going on at the same time, however, and this same 1928 catalog listed, for the first time, the new M. D. Chest No. 60, which was essentially the item used during World War II. (Figs. 5 and 6.)

The M. D. Chest No. 60 occupied 5 cubic feet, and weighed from 157 to 187 pounds, depending upon variations in the constituent items.86 Total cost was approximately $305. This chest contained a wood, aluminum, or steel folding chair, a foot-engine, an alcohol sterilizer, and routine operative and surgical instruments and supplies to a total of about 160 different items. It contained no prosthetic equipment as such supplies were packed in other chests not available to the smaller units. Issued to the dental officers of each tactical command allocated dental facilities, it provided the minimum equipment

    81Manual for the Medical Department, 1916, Washington, Government Printing Office, 1916 (cited hereafter as Manual ... Medical Department).
    82Manual ... Medical Department, C dated 29 Sep 17.
    83See footnote 43, p. 171.
    84The Annual Report of The Surgeon General for 1919 states that "The transportation of dental equipment and supplies has ever been a source of irritation to division commanders, transportation officers, and division surgeons. . . . Much loss of equipment and consequent loss of dental service in several divisions has resulted thereby. The First Division, moving into combat area, in. May 1918, was forced to abandon their entire dental equipment through lack of transportation facilities. . . . At that time it required the entire resources of our Medical Supply Depot No. 3 to resupply emergency equipment for this division after its arrival in the new area." In Annual Report of The Surgeon General, U. S. Army, 1919, vol II, Washington, Government Printing Office, 1920.
    85AR 40-1710, 23 Apr 28.
    86See footnote 75, p. 178.


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Dental field operating equipment.

 

 

 

Figure 5.  Dental field operating equipment, M. D. Chest No. 60, 1941.

 

 

needed for operation of a dental service where mobility was essential. When restrictions were placed on the shipment of more elaborate outfits overseas, Chest 60, augmented, was also supplied to general and station hospitals and general dispensaries of the communications zone. It lacked many of the refinements which made for convenience in operation, but contained the basic elements needed to meet routine needs in the combat zone. Patients requiring major oral surgery or prosthetic replacements had to be sent to more fully equipped installations, such as hospitals or mobile prosthetic teams.

Thousands of dentists who had always enjoyed every convenience in their civilian offices soon found themselves operating with dental field chests on tropical islands or at. the edge of arctic glaciers. It is not surprising that their


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Field dental clinic

 

 

Figure 6.  Field dental clinic using M. D. Chest No. 60.

 

 

equipment was the subject of much thought and criticism. Many recommendations from the field were highly impractical, failing as they did to consider the realities of procurement, maintenance, and transportation in time of war; others were based on sound observation and suggested changes which were ultimately incorporated into the outfit as the war progressed. Addition of an Electric Dental Engine. Older dentists who had operated foot-engines had no difficulty with the engine in M. D. Chest No. 60. Younger men mobilized in World War II had not had such experience, however, and generally refused to use the foot-engine.87 The Dental Division resisted this trend at first, and as late as September 1943 stated that "The addition of a small electric engine is not recommended. It is no great hardship to operate a foot-engine and it can be used under most any condition. If at fixed or semifixed installations an electric engine is considered necessary, a requisition can be Submitted for item 52530, Engine, electric, portable."88 It was found, however, that dental officers either used their assistants to pump the foot-engine, making them unavailable for their normal duties, or they obtained some type of improvised motor for attachment to their engines. Shops wasted valuable time and materials devising weird contraptions to mechanize this equipment. It was also

    87Personal knowledge of the author confirmed by numerous photographs in the files of the Signal Corps Photographic Library. In no photograph is a dental officer shown pedaling his own foot-engine. Dentists either improvised engines or had the assistant operate the foot-engine.

    88Memo, Dir, Dental Div, SGO, for Oprs Sprv, SGO, 3 Sep 43, sub: Proposed plan for dental service in an Armored Division. SG: 703.1.


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found that modern warfare required electric current in a surprising number of locations, even in the field. In March 1944 the Dental Division therefore reversed its policy and recommended development of a motor which could be attached to the foot-engine.89 Issue of a conversion unit for use on existing foot-engines was authorized in November 1944.90

Addition of Operating Lamp. Dentists in the field usually bad to work under cover, often in dark buildings or tents. Natural light under such circumstances was completely inadequate for dental operations. In February 1944 the Dental Division requested development of a dental operating light which could be packed in M. D. Chest No. 60,91 and issue of this item was authorized in June 1945.92

Reduction in Weight of M. D. Chest No. 60. Chest 60, weighing something over 167 pounds, was too heavy to be hand-carried long distances in rough terrain or in jungles. In November 1944 a project was started to divide the contents of the field chest between two smaller containers weighing about 100 pounds each.93 Plans were being made at the same time to pack other medical Department outfits in smaller chests, and progress on the dental equipment was held up pending development of a basic container, so that little had been accomplished on this development at the end of the war.94

Reduction in Weight of the Dental Field Chair. An aluminum field chair had originally been authorized for the dental field chest, but when quantity production was started the critical shortage of that metal forced the substitution of steel.95 As a, result the chair supplied during most of the period of hostilities was too heavy for convenient use in a portable outfit. Aluminum did not become available again until near the end of the war, and since the chair could not be placed in production in time to be of much use in the current conflict it was decided to redesign the entire item before resuming manufacture.96 This project was commenced in October 1944, but had not been completed at the end of the war.

Minor Changes in Contents of M. D. Chest No. 60. During the war a number of minor changes were made in the contents of Chest 60. In May 1941 the old glass syringe designed for use with a fresh anesthetic solution made from tablets was replaced with a cartridge-type syringe using prepared car-

    89Memo, Dir, Dental Div, SGO, for Oprs Serv, SGO, 15 Mar 44. SG:700.2.
    90Medical Supply Catalog, ASF, C 2, Med 6, November 1944. Washington, Government Printing Office, 1944 (cited hereafter as Medical Supply Catalog).
    91Memo, Col Rex McK. McDowell for Inspections Br, Oprs Serv, SGO, 29 Feb 44. SG: 350.05-1.
    92Medical Supply Catalog, C 5, Med 6, June 1945.
    93Ltr, Brig Gen R. W. Bliss to Dir, Medical Department Equipment Laboratory, 7 Nov 44, sub: Item 9502500-Chest M. D. No. 60, Complete. SG: 428 (Carlisle Barracks) N.
    94Monthly Status Report on Medical Department Research and Development Projects for Period 1-31 May 1945. HD: 700.2.
    95The Corps Area Dental Surgeons' Conference. The Dental Bulletin. 13: 254, October 1942.
    96Ltr, Brig Gen R. W. Bliss to CG, ASF, 6 Oct 44, sub: Chair, dental, field, folding--development project on. SG : 444.4-1.


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pules of solution,97 making it much easier to maintain sterility of anesthetic solutions in the field. Early in 1945 the alcohol burner for the sterilizer, for which it had been difficult to obtain fuel, was replaced with a gasoline burner.98 A bone-file, rongeur forceps, and m-o-d matrix retainer were added at about the same time.99

Army Air Forces Operating Chest

In May 1944 the Army Air Force approved a special dental field chest for use by its units. Complete, this chest weighed only 2 pounds more than the empty M. D. Chest No. 60. Reduction in weight was accomplished partly by using lighter materials, and partly by omitting certain heavy items, particularly the dental field chair, for which a headrest attachable to an ordinary chair was substituted. The foot-engine was replaced with an electric dental engine. Only 50 of these chests were produced since later modifications in the regular Chest 60 made it better adapted to Air Force needs, and nonessential modifications of standard items were discouraged in the interests of maximum output.100

Prosthetic Field Chests

At the start of the First World War dental replacements were authorized only for teeth lost traumatically in line of duty. Some laboratory equipment was issued to base installations, but no field outfit was provided, and even at Zone of Interior camps the dental surgeon had to draw teeth or gold for each individual case. In March 1918 this policy was liberalized somewhat to authorize the replacement, in time of war, of any teeth needed for mastication, and thereafter a dental field laboratory set, weighing over 200 pounds, packed in a single chest, was issued to each division.101 World War I prosthetic service was supplied on a relatively small scale, however, and nearly three times as many cases were completed overseas in the single month of October 1944 (35,657)102 as were completed in France during the entire period of hostilities in the First World War (13,000).103

The World War II field laboratory set consisted of 2 chests (M. D. Chests Nos. 61 and 62, figs. 7 and 8), which occupied 10 cubic feet of space with a combined weight of 332 pounds. The cost of the complete outfit was about $600. This equipment included a casting machine, a hand-operated lathe, an assortment of teeth, and all the supplies needed for fabricating or repairing

    97SG Ltr 47, 22 May 41.
    98New items of dental equipment. Army Medical Bulletin, No. 88, May 1945.
    99Ltr, Brig Gen R. W. Bliss to CG, ASF, 24 May 45, sub: Stock No. 9502500, Chest M. D. No. 60, Complete; Stock No. 9502600, Chest M. D. No. 61, Complete. SG: 444.4-1.
    100Memo, Col George R. Kennebeck for Plans and Services Div, Office of the Air Surgeon, 3 Jul 46. SG: 428.
    101See footnote 84, p. 180.
    102See footnote 67 for fiscal 1945. HD: 319.1-2.
    103History of the Army Dental Corps, 1941-43, Equipment and Supply Section, p. 15. HD: 314.7-2.


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Contents of dental field laboratory

 

 

Figure 7.  Contents of dental field laboratory, M.D. Chest No. 61.

 

 

the ordinary types of bridges or full or partial dentures.104 It could be set up well forward in the combat zone where it helped dental officers reduce emergency evacuations for prosthetic treatment, but was not adequate for routine quantity production because such conveniences as good lights, electric lathes, handy benches, and well-arranged plaster bins could not be furnished in such an outfit. The limited amount of expendable supplies included was also insufficient to maintain continued high output.

The Chests 61 and 62 were at first supplied to field hospitals, evacuation hospitals, surgical hospitals, the prosthetic teams of auxiliary surgical groups, convalescent hospitals, general and aviation dispensaries, and to the medical battalions of divisions. The later withdrawal of laboratory equipment from most of these units, and its results, are discussed in the chapter on the operation of the Dental Service overseas. The most important change in the Chests 61 and 62 was the substitution, in February 1945, of a motor-driven lathe for the hand-driven type which required two men, working in relays, to operate. Since it had become apparent that electricity would be available in most locations where dental laboratories could function, the wisdom of this move was obvious.

See footnote 75, p. 178.


186

Contents of dental field laboratory

 

 

Figure 8.  Contents of dental field laboratory, M. D. Chest No. 62.

 

 

Dental Pack Chests "A" and "B"

The dental pack chests contained operating equipment to meet the needs of mounted units. The 2 chests, which occupied 6 cubic feet and weighed less than 100 pounds, made a convenient load for 1 animal. They contained a little over 100 items, compared with 160 items in the M. D. Chest No. 60, but with a folding chair, foot-engine, sterilizer, and routine instruments they could be used to perform the most common operations.105 No significant changes were made in them during the war, but in a mechanized Army their use obviously became more and more limited.

Dental Officer's and Assistant's Kits

The dental officer of each tactical unit was supplied 1 large shoulder pouch, and his assistant carried 2 smaller pouches, containing instruments for emergency use in combat when M. D. Chest No. 60 was not available. The 3 pouches were supplementary to each other, and together included items required for the relief of pain, simple extractions, emergency treatment of maxillofacial injuries, and temporary fillings. These kits were also useful during the movement of large units, when regular equipment was crated, and for that reason were frequently issued to general hospitals and other installations having base dental outfits. They were also used by dental officers serving with ski troops or paratroops. The only important change in them was the

    105See footnote 75, p. 178.


187

Dental officer and assistant with field kits

 

 

 

Figure 9.  Dental officer and assistant with field kits.

 

 

 

 


188

replacement, in May 1941, of the glass-barrelled anesthetic syringes with cartridge-type syringes. Contents of kits could be augmented or changed at will to meet the individual ideas of dental officers. It was reported that very little dental work was attempted in combat, and that dental officers often carried kits of medical supplies in addition to, or in place of, the dental sets (figs. 9, 10, and 11).106

Contents of dental officer's kit

 

 

Figure 10.  Contents of dental officer's kit.

 

 

 

Maxillofacial Kit

The maxillofacial kit which provided the highly specialized instruments needed for the care of wounds of the oral structures was designed for use by the dental member of a maxillofacial team.107 It contained forceps, elevators, rongeurs, chisels, hemostats, lances, wire ligatures, and anesthetic syringes. The principal change in this set during the war was the introduction of the cartridge-type anesthetic syringe (fig. 12).

The Mobile Dental Laboratory

(The complete story of the development of this important item is told in a monograph by Lieutenants John B. Johnson and Graves H. Wilson.108 Much

    106History of the Dental Division, Headquarters, ETOU SA, 1 Sep-31 Dec 44. HD : 319.1-2.
    107See footnote 75, p. 178.
    108Johnson, J. B., and Wilson, G. H.: History of wartime research and development of medical field equipment. HD: 314.7-2.


189

Contents of dental assistant's kit

 

 

Figure 11.  Contents of dental assistant's kit.

 

 

 

Contents of dental maxillofacial kit

 

Figure 12.  Contents of dental maxillofacial kit.

 

 

 


190

of the material presented here has been taken from that monograph, and its extensive documentation is not repeated.)

The need for improved dental laboratory facilities was based on a number of considerations, some of which are discussed in greater detail in the chapter on the operation of the Dental Service overseas. In brief, it was generally agreed that prosthetic equipment had to be taken to the soldier whenever possible, to prevent his evacuation to a rear area for the construction of dental replacements. For tactical units this meant that laboratory service had to be provided well forward in the combat zone, where frequent moves were necessary. The laboratory with such a, unit had to be highly portable, it had to be put in operation quickly after a move, and it had to turn out a maximum of work in a short time when the opportunity was presented. M. D. Chests Nos. 61 and 62 were portable, but they failed to meet the other two requirements; it took considerable time to find shelter and set them up in a new location, and with no source of water, fuel, power, or light the only equipment which could be used was wasteful of manpower and did not encourage the most accurate work. Further, the two small chests could not contain enough supplies for prolonged operation in an emergency. The Dental Division therefore recommended, as early as May 1939, that development of a more satisfactory, truck mounted outfit be initiated.109

For reasons which are not clear this project proceeded very slowly. Approval was not granted until December 1941, and a pilot model, constructed with the aid of $18,000 contributed by the manufacturers of precious metal alloys, was not completed until February 1943. This model was tested in the Tennessee maneuvers of May and June of the same year. The first delivery of 11 vehicles was made in March 1944, and distribution in foreign theaters did not begin until near the end of 1944.

As finally adopted, the mobile dental laboratory (figs. 13 and 14) was mounted on a 6-wheel drive, 21/2-ton chassis, capable of maneuvering in all but the roughest terrain. It carried a 1 1/2-KW generator, 50-gallon water tank, electrically heated boiling-out and curing apparatus, acetylene tanks, a folding dental chair, a dental engine, an electric lathe, a full assortment of teeth and all other equipment and supplies for completing or repairing ordinary dentures or bridges. A small trailer was later supplied for carrying the generator and other bulky equipment. It was operated by 1 officer and 3 dental technicians, one of whom was also the driver.

Numerous improvised mobile laboratories had been placed in operation in foreign theaters while the standard truck was being developed. Constructed on vehicles ranging from captured German trailers to 30-passenger buses, these units had already given valuable service, so it was no surprise that the new trucks were highly commended from the start. A typical report was that

    109Memo, Brig Gen Leigh C. Fairbank for SG, 11 Sep 41, sub: Field dental laboratory. SG: 322.15-16.


191

Mobile dental laboratory

 

 

Figure 13.  Mobile dental laboratory.

 

 

 

Interior, mobile dental laboratory

 

 

Figure 14.  Interior, mobile dental laboratory.

 

 

 

 


192

from a division which saw combat in both North Africa and Italy, stating that "The mobile laboratory has proved to be the only answer to the division's prosthetic problem."110 Minor defects were reported, however, as follows:

1. While the mobile laboratory provided shelter for the operators in poor weather it was badly crowded when the chair was set up inside for taking impressions. In practice the chair was usually set up in an adjoining building or tent, and when time and circumstances permitted some of the laboratory equipment was removed as well.

2. In bad weather, some provision had to be made for waiting patients.

3. The laboratory was tied to its vehicle, so that no transportation was available for picking up supplies and mail, or for carrying water for the storage tank.

4. When the truck required repairs it was necessary to close the laboratory.

5. The 11/2-KW generator proved inadequate, and a 21/2-KW model had to be substituted.

6. The single dental lathe was not sufficient, and another had to be authorized.

7. The small tanks of acetylene were quickly exhausted, and larger ones had to be provided.

8. Trouble was experienced in obtaining "white gas" (i. e. without a leaded additive) for the burners.

The most fundamental defects were those noted in "3" and "4." These might have been eliminated by placing the laboratory in a trailer, pulled by a truck which could also be used for other transportation. This possibility was considered, but it was rejected because:

1. Maneuverability of a truck and trailer would be considerably reduced in unfavorable terrain.

2. It was feared that the truck might be commandeered in an emergency, making it necessary to abandon the entire laboratory.111

The mechanical defects noted were quickly corrected, and the mobile laboratory was an important aid in bringing effective laboratory service to the forward areas.

A total of 107 laboratory trucks were ordered, and the last was delivered in October 1945. It cannot be determined at this time just how many of these units were shipped overseas, though the distribution authorized in December 1944 was as follows:

European Theater of Operations

30

Southwest Pacific Area

15

Pacific Ocean Area

5

China-Burma-India theater

4

South Pacific Base Command

4

North African theater

2

    110Dental Service with a Division in the Army. J. Am. Dent. A. 32: 1475-1476, Nov-Dec 45.
    111Statement of Col Rex McK. McDowell to the author, May 1946.


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It has already been noted that many theaters had improvised large numbers of mobile laboratories in addition to those standard trucks authorized by the War Department, and it is probable that the number of these unofficial units considerably exceeded the number shipped from the Zone of Interior.

The Dental Operating Truck

(The history of the development of the dental operating truck has been told in a monograph by Lieutenants John B. Johnson and Graves H. Wilson, to which the reader is referred for greater detail and documentation than will be given here.)112

Dental operating trucks, which were not made available until near the end of World War II, had been used to a limited extent in the First World War. In the summer of 1917 the Cleveland Chapter of the Preparedness League of American Dentists suggested a project for the construction of "dental ambulances" which would be presented to the Army in the name of the Red Cross. Plans drawn up by the League were approved by The Surgeon General, and the first two units presented in October 1917.113 Other chapters of the League cooperated until contracts had been let for a total of 13 trucks, at a unit cost of about $4,000. These dental ambulances were constructed on a standard ambulance chassis, and contained a chair, 6-volt electric engine operated by storage batteries, cuspidor, air compressor and tank, bracket table, sterilizer, and cabinet. Running water was supplied from a storage tank to a small washbasin. The sides of the ambulance opened out and canvas flies were available to cover additional operating space adjoining the vehicle. Four dentists and 1 or 2 assistants could thus operate from each ambulance. Folding chairs and field equipment were provided for the three officers who worked outside the unit.114 The World War I dental operating truck was therefore a compromise which provided efficient equipment and utilities for 1 dentist and transported the regular equipment of 3 others.

Unfortunately, the dental ambulances constructed in the United States in the First World War never saw service in France. A shortage of transportation held them at an American port of embarkation in spite of urgent requests for their delivery by the dental surgeon of the AEF.115 Two, dental ambulances were presented in France, however, and they were assigned to duty with motor transport troops and with the Air Service, where they rendered very satisfactory service. The chief surgeon of the AEF commented upon these units as follows:116

    The need for dental ambulances-mobile dental offices-has been indicated many

    112See footnote 108, p. 188.
    113Weaver, S. M. : Standardized motor dental car and equipment. J. Am. Dent. A. 5: 3-19, Jan 1918.
    114Ibid. See also Dental ambulances and Christmas roll call. J. Am. Dent. A. 5: 1283-1284, Dec 1918.
    115See footnote 59, p. 174.
    116See footnote 84, p. 180.


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    times during the campaign....The use of dental ambulances with outlying commands or detachments within divisional training areas, in the rear of combat sectors, or with the Air Service, would have proven of great value inasmuch as these mobile units could proceed to the various localities with little loss of time, either in actual transport or in the unpacking and repacking of equipment ordinarily required of dental officers on itinerary dental service.

So far as is known, no effort was made to develop a standard dental operating truck in the period between World Wars I and II. When the Dental Division requested such a project in May 1939 it was rejected within the Office of The Surgeon General, and later numerous requests for a mobile dental unit from overseas theaters did not affect this decision. The Air Force particularly desired such equipment, and in December 1943 it finally undertook development of a dental unit on its own initiative. Johnson and Wilson imply that this action precipitated a sudden change of opinion in the Surgeon General's Office. In any event the Dental Division resubmitted its recommendations; they were approved by the SGO, submitted to the Commanding General, ASF, and accepted as a research project by the end of the month. When the Air Force asked for equipment for 50 dental trucks on 30 December 1943 it was told that a standard model was already being developed, and its model was dropped.117 The Medical Department Equipment Laboratory completed a pilot model which was tested and accepted as a standard item by 16 March 1944. Contracts were immediately let for 35 trucks, the first of which was delivered in October 1944.

The mobile dental clinic (figs. 15 and 16) was mounted on a 6-wheel drive, 21/2-ton chassis, similar to the one used for the mobile laboratory. In a space 13 x 7 feet were installed a unit, chair, cabinet, sink, sterilizer, 50-gallon water tank, hot-water heater, and an operating light. Equipment included all items needed for extractions, operative procedures, and for taking impressions for dentures. A 2 1/2-KW generator supplied electric current. No x-ray machine was provided. One hundred and thirty-eight operating trucks were purchased, at a unit cost of about $9,000, including equipment. It is not known how many trucks were actually shipped overseas, but the allotment authorized in December 1944 was:

European Theater of Operations

33

North African theater

18

China-Burma-India theater

18

Southwest Pacific Area

15

Pacific Ocean Area

5

South Pacific Base Command

4

The standard operating truck was not available soon enough to receive extensive testing under combat conditions and estimates of its performance are based

    117Ltr, Col Gustave E. Ledfors, Chief of Supply Div, Air Surgeon's Office, to SG, 30 Dec 43, sub: Requirements of equipment to be installed on mobile dental units. SG 444.4-1. See also 1st and 2d inds to above, 30 Dec 43 and 11 Jan 44.


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Mobile dental clinic

 

 

Figure 15.  Mobile dental clinic.

 

 

mainly on reports on similar improvised units which had been used in almost every theater since early in the war. There was little doubt, however, that this item met an important need. The Director of the Dental Division stated in 1945 that "The success of the mobile operating units in the several theaters, especially in Italy, warrants the conclusion that such units are essential to modern warfare." On the other hand, he did not consider that the final word had been written on the subject. He especially recommended that further thought be given to a. possible combination of a light trailer and truck.118 A German trailer of this type had been towed by a United States unit from the Rhine to Pilsen in Czechoslovakia, behind no more powerful a vehicle than a weapons carrier. If practical, a trailer clinic would not tie up transportation needed to carry supplies and would not have to be closed down when the truck needed repairs or maintenance. It would also be unnecessary for the dental operating team to drive a 2 1/2-ton truck to pick up mail or supplies. The objections to the use of a trailer are the same as those enumerated for the laboratory truck; decreased maneuverability and the danger of losing the prime mover in an emergency if it were detachable from the operating equipment.

    118See footnote 21, p. 167.


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Interior mobile dental clinic

 

 

 

Figure 16.  Interior mobile dental clinic.

 

 

 

 

In spite of the fact that it was not accepted for production, the operating truck developed by the Air Force was believed by officers of that organization to have certain features which should be considered in designing new models. Some of these features were:

1. Provision of a few laboratory items for simple acrylic repairs.

2. Use of a pressure-type water tank located under the body, where it was easily accessible, rather than the gravity-type tank which had to be mounted on the roof.

3. Installation of the unit at floor level instead of about 6 inches above the general floor level, as was necessary in the 21/,-ton truck body.

4. More window space, better natural lighting.

Nonstandard Impression Chests

Units equipped only with the dental field chest had no supplies for taking impressions for prosthetic appliances. Normally, prosthetic patients could be transferred to nearby hospitals for this service, but in some circumstances such a procedure meant the loss of a man to his organization for extended periods. To meet this situation the dental surgeon of the European theater assembled chests


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containing materials and equipment for taking impressions and pouring models which could in turn be sent to a central dental laboratory. A chest would be loaned to an organization for a week or two at a time, and when all prosthetic cases had been cleaned up the chest was returned to a depot for replacement of missing or damaged items and for issue to another unit. Later in the war the mobile laboratory units were often able to bring prosthetic service to these isolated organizations, and the improvised impression chests never became a standard item of issue. At the time they were devised, however, they filled a definite need.

THE DENTAL WARD CART

In hospital practice it was often necessary to provide dental care at the bedside of patients. Personnel who were bedridden for considerable periods of time frequently required definitive treatment which could not be provided with a few instruments carried in a tray, and dentists improvised carts to carry the more essential equipment from patient to patient and from ward to ward. Some of the more elaborate outfits carried a dental engine, operating lamp, sterilizer, aircompressor and spray bottles, and drawers of instruments and supplies for most operative and oral surgical procedures. These improvised carts proved so efficient that a project for their development as a standard item was authorized in May 1945.119 This project was of course not completed before the end of hostilities, but the standard ward cart promised to add to the comfort of patients and the convenience of operators as soon as it should become available.

SUMMARY

Experience in dental supply problems during World War II emphasized the following points:

1. In an emergency calling for the mobilization of many millions of men and thousands of dentists, requirements for dental equipment and supplies will far exceed normal peacetime needs. At the same time production will be hampered by shortages of manpower and materials, and imports are likely to be cut off. Adequate production of such essential items as burs should be insured in advance, and some control of distribution established to prevent such irresponsible buying, by both civilians and the military, as increased the demand for burs from 33 million a year before the war to nearly 100 million in 1943. To insure that minimum needs of the population will be met, plans to stop the production of any item, such as operating units, as nonessential, should be considered carefully and cautiously before being adopted; in many cases it will actually be necessary to increase production to meet new military requirements. It is possible of course, that new types

    119See footnote 94, p. 183.


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of warfare will eliminate mass mobilizations, and hence reduce military needs; it is also possible that the manufacture of dental supplies could become one of the casualties of a war for survival. It must be noted, however, that treatment received by the American public in peacetime is far from adequate, and any further reduction, even in time of war, would have serious results which should be weighed carefully before deciding to cut the production of items used by dentists.

2. Availability of supplies and equipment may well prove to be the factor which will determine the rate of mobilization of dental facilities in an emergency. Nothing will be gained by taking dentists on active duty to stand idle at their camps because they have no handpieces or chairs. The procurement of dental supplies in sufficient quantities will therefore be one of the first responsibilities of officials directing the establishment of an emergency Dental Service.

3. A considerable amount of dental equipment in the hands of civilian dentists will become idle when they are taken into the Armed Forces in a mobilization. It is possible that such equipment will have to be purchased or leased for the military. The individual purchase of thousands of outfits, of widely varying types and degrees of serviceability, is in itself no small problem, however, and the cost of using secondhand equipment will generally exceed the cost of purchasing new items. It should not be assumed that large quantities of dental supplies will be available from civilian sources until test projects have shown that such is actually the case.

4. Close cooperation between the Dental Service and procurement agencies is essential, and such cooperation will probably be best obtained by assigning qualified dental officers to major supply installations.

5. Convenient and complete dental equipment should be supplied as far forward in the theater of operations as is consistent with the operational situation. Mobile operating and laboratory units will make it possible to provide efficient equipment within easy reach of the fighting men.

6. In major moves dentists should not be separated from their equipment if their outfits can possibly be forwarded as personal or unit baggage. Too many dentists spent from 1 to 4 months in idleness after their arrival overseas in World War II because their field chests had been shipped on different vessels or in different convoys.