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Chapter VII, Dental Service in Zone of Interior

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

FACILITIES PROVIDED, ZONE OF INTERIOR

General Considerations

From the start of mobilization the Dental Division recommended that wherever possible dental facilities should be centralized into large, efficient, clinics which would permit specialization and skilled supervision. In July 1940 the Director of the Dental Division proposed:1

1. That the plan for the professional service of divisional camps and other new stations include a central dental clinic.

2. That the War Department be asked to include in its building program suitable housing for such a clinic.

3. That central clinics be located in, or suitably near, the station hospitals.

Preliminary plans called for 2 types of dental clinics, of 25 and 15 chairs, respectively. It was later found necessary to provide smaller units for certain exceptional situations, and by the end of the war the following types had been authorized:

DC-1

25 chairs

DC-4

3 chairs

DC-2

15 chairs

DC-5

1 chair

DC-3

8 chairs

DC-6

1 chair

The DC-1 Clinic

The DC -1 clinic of 25 chairs was authorized for divisional camps or other stations with a strength of approximately 15,000 men.2 It was housed in a separate, 2-story, frame building 110 feet long and 30 feet wide. The floor plans of the DC-1 are shown in figure 17. This clinic (figs. 18 and 19) was furnished with the most modern base equipment, including laboratory (fig. 20), x-ray, prosthetic, and oral surgical facilities. Each operator was supplied a standard chair, unit, cabinet, and operating light. DC-2 Clinic

The DC-2 Clinic

The DC-2 clinic consisted of a separate, single-story building with space for 15 chairs. It was a smaller edition of the DC-1, designed to meet the needs of camps of about 10,000 men.3 It was also used as a dental clinic in all station hospitals of 250 beds or more.4 In camps of less than 10,000 men, but large enough to have a 250-bed hospital, the hospital DC-2 supplied all dental care

    1Memo, Brig Gen Leigh C. Fairbank for SG, 17 Jul 40, sub: Definitive dental service in divisional camps and other large installations. AG : 632.
    2Dental expansion program. The Dental Bulletin, supp. to the Bulletin of the U. S. Army Medical Department (cited hereafter as Army Medical Bulletin) 11 : 177, Oct 1940.
    3Ibid.
    43d ind, TAG to SG, 20 Nov 40, on ltr, SG to TAG, 2 Nov 40, sub: Dental service in cantonment hospitals-dental laboratory service, divisional areas. AG: 632.


258

Floor plan, dental clinic type DC-1

 

 

 

Figure 17.  Floor plan, dental clinic type DC-1.

 

 

 

 

Part of general operating room, DC-1

 

Figure 18.  Part of general operating room, DC-1.

 

 

 


259

Oral surgical operating room, DC-1

 

 

Figure 19.  Oral surgical operating room, DC-1.

 

 

 

Dental laboratory, DC-1

 

 

Figure 20.  Dental laboratory, DC-1.

 

 

 


260

for the camp. If the installation had a population of more than 10,000 men, but less than 15,000, additional facilities were provided in the troop area. Equipment of the DC-2 was comparable to that of the DC-1. See figure 21 for the floor plan of the DC-2 clinic.

Floor plans of DC-2 and DC-3 clinics

 

 

 

Figure 21.  Floor plans of DC-2 and DC-3 clinics.

 

 

 

DC-3 Clinic

The DC-3 clinic, occupying a separate building with space for eight chairs, was developed about the middle of 1941 to meet the needs of posts of intermediate size.5 Policy for its use was not definitely stated, however, until early 1942, when The Adjutant General approved these installations for camps of from 3,000 to 6,000 men. The DC-3 clinic was also used in hospitals of from 100 to 200 beds. See figure 21 for the floor plan of the DC-3.

DC-4 Clinic

The DC-4 clinic, with three chairs, was authorized early in 1943, primarily for use in small unit dispensaries. No separate building was provided and the clinic occupied space in the regular dispensary quarters. The DC-4 was sup-plied base-type equipment, with an x-ray machine and some laboratory supplies.6

    5The dental clinic number three. The Dental Bulletin, supp. to Army Medical Bulletin 12: 249, Jul 1941.
    6MD Equipment List No. 95058, 6 Dec 44.


261

DC-5 Clinic

The DC-5 clinic, with 1 chair, was also authorized in 1943 for use in the smaller dispensaries where the 3 chairs of the DC-4 were not needed. It had no x-ray machine and only the most essential laboratory equipment was provided.7 Like the DC-4, it occupied space in a regular dispensary building.

DC-6 Clinic

The DC-6 clinic, which was a simplified version of the DC-5, was intended for use in prisoner of war camps. It was authorized a base-type chair but no cabinet. A mobile dental engine was substituted for the operating unit.8

Cost of the Various Clinics

The cost of the aforementioned installations was approximately as follows: 9

Type

Equipment

Building approximate

Total

DC-1

$33,684

$25,000

$58,684

DC-2

20,535

15,000

35,535

DC-3

11,356

10,000

21,356

DC-4

5,717

(1)

5,717

DC-5

2,425

(1)

2,425

DC-6

1,192

(1)

1,192

1None provided.

By September 1942, 100 DC-1, 150 DC-2, and 138 DC-3 clinics were in operation or nearing completion.10 11

THE DENTAL SERVICE IN A REPLACEMENT TRAINING CENTER

General Considerations

Major dental rehabilitation for the inductee was not initiated until arrival at a replacement training center, which was recognized to be the most favorable place in which to concentrate dental facilities. It was the first installation in which an inductee spent enough time to permit the completion of extensive treatment.

The replacement training center was a large, fairly stable establishment where the dental service could be organized for maximum efficiency. Specially qualified dental officers could be assigned to the more critical positions

    7MD Equipment List No. 95059, 6 Dec 44.
    8MD Equipment List No. 95054, 6 Dec 44.
    9Cost of equipment listed is taken from the ASF Medical Supply Catalog of 1 Mar 44, on file in HD. The cost of buildings of course varied greatly in different locations and at different times. The figures quoted are approximate, obtained from the Fiscal Div, CE, Mr. Jonas Stein. They were given the author in a telephone conversation, 7 Mar 47.
    10Mills, R. H. : Dentistry in the war. J. Am. Dent. A. 15 Sep 42, p. 1754.
    11At the time this history was prepared (1947) information was not available on the clinics constructed subsequent to 1942.


262

and trained auxiliary personnel and clerical assistants were available to take over many time-consuming, nonprofessional duties.

Soldiers usually went directly from a replacement training center to duty with operational units and a high percentage were sent overseas within a short time. It was therefore desirable that all possible treatment be completed during the training period, and absolutely essential that men leaving the center should at least meet minimum dental standards for foreign service.12 From the start of the war the Director of the Dental Division, SGO, recommended that replace-ment training center dental clinics meet the main burden of dental rehabilitation.

Operation of the Dental Service in a
Replacement Training Center

Time for the treatment of inductees in a replacement training center was limited; it was also necessary to avoid as far as possible interruption of normal activities. The dental service in a replacement training center was therefore organized to attain three primary objectives:

1. To examine every man with the least possible delay and start his treatment immediately.

2. To check the progress of his work and make such additional examinations as were necessary to insure completion of all required treatment before his departure from the center.

3. To provide dental treatment at times which would interfere least with scheduled training.

No uniform system was prescribed, and each dental surgeon used the methods which best conformed to his own ideas and to conditions encountered in his particular camp. The operation, of a typical training center dental service (Fort Knox, Kentucky) has been described as follows:13

    Dental surveys were conducted 3 times during each training cycle of 17 weeks. The first was made within 48 hours after the arrival of the trainees from the induction centers. A second was made at the completion of the basic training period, before the start of specialist training. The third or final dental check was conducted during the final week of the training cycle, just prior to shipment.

    All dental surveys were scheduled by the S-3 officer of the center as a part of training and the company commander was responsible for the presence of all trainees at every dental check within his unit. Surveys were conducted in the unit area by the dental surgeon and one assistant. Clerks for the examination were supplied by the unit.

    The company was requested to furnish duplicate copies of a current roster for every survey. At the time of examination an individual survey form was given to each trainee, who filled in all data on the form except the dental classification and infor- mation concerning his dental condition. This form was collected by the clerk at the time of examination and entry made of the dental classification and pertinent informa- tion regarding prosthetic appliances. Forms and rosters were then taken to the office

    12Memo, Brig Gen R. H. Mills for Exce Off SGO, 27 Apr 42. SG:322.0531.
    13Incl to Personal Ltr, Dr. H. L. Davidson to Col Walter Love, 2 Dec 46. SG: 703.


263

    of the dental surgeon where individual classifications were entered on both copies of the roster and a record of prosthetic appliances made on the original copy. This copy was retained by the dental surgeon and the duplicate sent to the company commander for use in filling appointments allotted his organization.

    From the data on the individual survey forms an MD Form 79 [now AG Form 8-116, Register of Dental Patients] was made out for each trainee in need of dental care and held in the files of the dental surgeon for use at such time as the man was ordered in for treatment.

    Patients were treated at four widely scattered clinics but all orders for trainees to appear for treatment were issued from the office of the dental surgeon as an official memorandum over the signature of the commanding general. The dental surgeon consulted flow charts and training schedules so that patients might be called for treatment during the least important parts of their training cycle, though dental care held preference over all training. A carbon copy of the memorandum directing men to report for treatment, a list of the trainees requiring care, and the previously prepared MD Forms 79 were forwarded to the clinic named in the memorandum.

    Patients were ordered for treatment by classification only, and the unit commander was charged with the responsibility for selecting men of the indicated classification from his dental roster, detailing them to the specified clinic. Changes in classification were reported directly from the clinic to the unit of the patient receiving care and to the office of the dental surgeon. All completed MD Forms 79 were returned daily to the files of the dental surgeon.

    Should the individual clinic chief find it necessary to make changes in the flow of patients, or should he be confronted by any delinquency in keeping appointments, he discussed the matter with the dental surgeon, who took the necessary steps to correct the situation.

    The midtraining survey was necessary because a considerable number of trainees were transferred to new companies due to sickness, emergency furloughs, etc. These men did not appear on the dental survey rosters of their new organizations and were easily lost to the dental service. It was therefore deemed advisable to conduct a new survey at the end of basic training and carry through a second time as the original had been handled, except that new MD Forms 79 were made for new patients only.

    The dental check made a few days before completion of training gave the dental surgeon a final chance to correct any defects still existing among the men about to be shipped out. These patients were given the highest priority.

    The aim of the dental service of this replacement training center was to put every man in Class III or IV prior to completion of his training. This policy was rigidly followed, especially in respect to men being sent to Army Ground Forces replacement depots. The dental surgeon had the authority to request the removal of specific persons from shipping orders for dental reasons.

    A check of original dental survey rosters over a period of 42 months revealed the following average classification of men arriving in the replacement training center from civilian life:

Class I

22.5% (35% of these would require prosthetic replacements before completion of treatment.)

Class I-D

5.0%

Class II

22.5%

Class III

1.5%

Class IV

48.5%


264

Treatment Rendered

The personnel of the larger camp dental clinics included specialists in oral surgery and prosthetics, and the station hospital was able to give institutional care when it was required. As a result, very few dental patients had to be sent off the post for other than highly specialized treatment. However, when such treatment was necessary for conditions which involved badly comminuted or displaced fractures, severe infections, the removal of tumors, or plastic reconstruction, the patient was usually transferred to a general hospital. Dental hygienists provided many soldiers with their first instruction in the individual care of the teeth and the supporting structures. In general, the centralized clinics of the replacement training centers and other major installations were well designed to provide rapid, efficient treatment of routine conditions and at the same time to give the more complex defects the extra attention they required.

The "production line" organization of the larger clinics, with all surgical and prosthetic care given by specialists, undoubtedly increased output and improved the quality of the treatment rendered. It was not without disadvantages, however. In particular, the strain on men in the general operative section was severe. The placing of even routine fillings is meticulous work, hard on the eyes and nervous system, and requiring a tiring posture. In his civilian office the dentist is able to get a "change of pace" by doing surgical, prosthetic, or laboratory work, but in a large Army clinic, the officer works continuously at the chair "plugging amalgams," with another patient always waiting to take the place of the one just completed. The monotony and physical strain of performing one task over and over for months at a time was a constant cause of complaint. Further, the dentist had no chance to maintain his skill in other branches of dentistry. The bitterness of young officers toward the "amalgam line" was certainly a factor in their lack of interest in a career in the Army Dental Corps after the war.

Personnel Problems

In determining the number of dental officers to be assigned replacement training centers it was necessary to compromise between what was theoretically desirable and what was practical with available resources. The Dental Division, SGO, recommended a ratio of 1 officer for each 300 men in training and this figure probably represented both the largest number which could be spared and the smallest number which could provide effective treatment.14 However, the number of dentists actually provided varied greatly and cannot accurately be determined, but figures on the overall assignment of dental officers in the Zone of Interior give some indication of the working ratio.

On 30 November 1942 there was 1 dentist for each 473 soldiers in the United States. This ratio decreased steadily until April 1943 when each dental officer

    14Memo, Chief, Oprs Serv SGO, for CG ASF, 5 Jun 44, sub: Requirements for Dental Corps officers. HD: 314.


265

was responsible for 586 men. Thereafter the proportion of dentists again in- creased until in November 194415 it reached a fairly stable level of 1 officer for each 350 men. Some Zone of Interior installations (e. g. hospitals) had more than the average ratio; others had less (e. g. air fields); the proportion of 1 dentist for each 350 men is probably not far from the ratio actually provided replacement training centers in 1944.

THE DENTAL SERVICE IN A ZONE
OF INTERIOR REPLACEMENT DEPOT

The function of the dental service in Zone of Interior replacement depots was to detect and provide treatment,16 within a maximum of 15 days, for men who, when reporting for shipment overseas, still failed to meet minimum dental standards. The details of operating the dental service in a replacement depot varied in different installations, but two fundamental requirements had to be kept in mind: (1) early detection of the men needing treatment, and (2) a system for insuring that patients were called to the dental clinic without delay and with minimum chance that they would be "lost" administratively. At one replacement depot, Camp Reynolds, Pa., new arrivals were first assigned to a casual battalion where processing was completed. Men reporting to this battalion were marched directly to the dental survey office where 2 dental officers and 3 clerks were constantly on duty. Those in Class I were placed in a separate company and carried as "unavailable for shipment" until their essential treatment had been completed. The dental service notified the Classification and Assignment Section whenever a man was ready for shipment and he was then taken out of the "dental" company and returned to his unit, or to the regular processing line if he was a Casual.17

Personnel were allotted in about the same proportion as for replacement training centers, for though the men were passing through the replacement depot in a much faster flow they had generally received more or less complete dental care at previous stations, so that the average amount of work per individual was much less than in a replacement training center.

Since only the most essential treatment was rendered at replacement depots it might have been expected that extractions and dentures would have constituted a high proportion of all operations performed. Apparently, how-

    15The proportion of dental officers to total strength of the Army was calculated by author from data in Strength of the Army, 1 Mar 46.
    16This service was also to be rendered at ports of embarkation, redistribution and redeployment stations, but in actual practice these played a minor role in the process; ports of embarkation were primarily concerned with the supervision of embarkation, and with the sudden end of the war in Asia the activities of the redistribution and redeployment stations were curtailed almost before they could reach stable operation.
    17Annual Rpt, Surg Cp Reynolds, 1944. HD.


266

ever, these major dental deficiencies had usually been corrected at home stations, and work completed at replacement depots consisted of a higher proportion of permanent fillings. The following tabulation compares the treatment rendered in a replacement depot (Camp Reynolds) in 1944 with the treatment rendered in the total Army in the same period:18 19

Operation

Percentage of five principal operations in a replacement depot

Percentage of five principal operations in the Army as a whole

Permanent fillings

87.6

78.1

Extractions

6.3

18.0

Dentures

3.8

2.8

Denture repairs

2.2

0.9

Bridges

0.1

0.2

 

THE DENTAL SERVICE IN A SEPARATION CENTER

Prior to 1944 the problem of providing dental treatment for men being discharged from the Army was overshadowed by requirements for the rehabilitation of inductees. A circular letter of 2 September 1943 prohibited the practice of informing separatees that they could have their dental work completed in Veterans Administration facilities after discharge and also stated that "The status of the soldier with reference to his retention in the service should be clearly understood before any extensive dental treatment is started. Every effort will be extended to complete all essential dental treatment for a soldier, once begun, prior to his discharge."20 While this letter encouraged the completion of work which had already been initiated, it also had the probable unintentional effect of discouraging extensive treatment for men due for early discharge. It was not the desire of the Dental Division or The Surgeon General to limit treatment for men leaving the service and on 7 March 1944 the Dental Division recommended that care be made available for all Class I patients prior to relief from active duty.21 On 31 March 1944 this recommendation was substantially repeated in a memorandum to the Medical Practices Division, SGO, but no formal action resulted. In a Physical Standards Division conference on 27 December 1944 the following points were agreed upon with the concurrence of the Dental Division:22

1. Soldiers with Class I defects to be offered treatment prior to discharge.

2. Treatment to be optional with the man concerned.

3. Priority for treatment of separatees over other personnel to be given only at separation centers.

    18See footnote 17, p. 265.
    19Data on the Army as a whole taken from Army Medical Bulletin 4 : 632, Dec 1945.
    20ASF Ltr 156, 2 Sep 43.
    21Memo, Act Dir Dental Div for Oprs Serv SGO, 7 Mar 44, sub: Dental treatment for personnel during demobilization. SG: 703.
    22Memo for Record, 27 Dec 44, sub: Office policy regarding dental treatment at separation centers. HD: 314.


267

In spite of informal agreement on general policies for the operation of separation centers no official directive was issued until 10 September 1945. Technical Manual (TM) 8-255, published on that date, provided that:23

    Individuals having Class I dental defects which are incapacitating or likely to interfere with performance of duties in military or civilian life, or individuals who have lost anterior teeth in line of duty, will be provided with appropriate treatment and/or prosthetic appliances prior to separation if the individual so desires. Routine dental treatment, such as for Class II's, etc., may be provided for individuals, providing time, facilities and dental personnel are available, and providing the individual elects to have such treatment.

It was further directed that dental officers would be provided on examining teams, in accordance with the number of separatees processed daily, as follows:

Number of daily examinations

Number of dental officers on teams

75-150

1

200-300

2

400

3

500-600

4

800

6

1,000

7

1,800

12


These dental officers were concerned only with examinations; treatment was given in established clinics. In a memorandum of June 1944 it had already been recommended that dentists be provided separation centers in the, ratio of 1 officer for each 300 separatees,24 though the number actually assigned to each center was determined by the respective service command.

A letter to the service commands, dated 6 September 1945, quoted the tentative provisions of TM 8-255 and elaborated on them as follows:25

    Every effort should be made to use existing dental facilities to the fullest capacity, and when such facilities are inadequate, additional dental equipment should be installed in other available quarters to meet the local demands.

    Dental personnel, officers and enlisted men, should be shifted within the Service Command to permit the greatest service.

    Under the provisions of AR 40-510, C 1, paragraph 5b (3), 10 September 1942, the procurement of civilian dental laboratory service may be authorized by the Commanding Generals of Service Commands where adequate dental laboratory facilities are not available and when there is insufficient time to have the cases completed at Central Dental Laboratories. . . .

At many stations the Dental Service operated a double shift.

The Dental Division was not in a position to predict how much work would have to be accomplished at separation centers. The, dental classification of the Army was known, but this classification was based on the urgency of the treatment required rather than upon its amount. A man in Class II, for instance,

    23TM 8-255, Terminal physical examination on separation from military service, 10 Sep 45.
    24See footnote 14, p. 264.
    25Ltr, SG to CG 1st SvC, 6 Sep 45, sub: Dental treatment prior to separation from the Army. HD: 314.


268

might have 1 cavity or 10, so that information on total classifications was of little value in estimating future needs. Above all, it was impossible to predict 9 what percentage of men needing treatment would ask for it. Previous experience had indicated that only a small proportion of separatees would risk delaying their discharge even a few hours, but many factors influenced their decisions. It was found, for instance, that more men applied for dental care during the period when 45-day furloughs for recuperation and recreation were being granted than after that privilege was discontinued.26

Since the requirements for separatee dental service might change from day to day faster than personnel could be shifted, the service command dental surgeons could only establish the separation center clinics to meet average expected demands, thereafter maintaining an even flow of patients by varying the types of service rendered. When the flow of separations was slow, all kinds of treatment were offered and every effort made to complete routine fillings without delaying the departure of patients from the center. When the flow of separations was rapid, treatment had to be limited to the urgent cases specified in TM 8-255.

The organization of the dental service of a separation center offered peculiar problems which were solved in different ways on different posts. Separatees were understandably impatient to be released from the Army, even when they had asked to be held for dental care. They wanted furloughs and passes and often failed to return in time for appointments. Keeping in touch with the men under treatment was in itself a major problem, and constant supervision was needed to insure that service was rendered is speedily as possible and that patients were released for discharge as soon as their dental work was completed. Men requiring prolonged treatment were withdrawn from processing, but every effort was made to complete minor care without delaying departure of the patient, although in many cases only a few nighttime hours were available for such treatment out of the 48 which the separatee spent in the center.

The system in operation at Fort Monmouth was typical of the elaborate methods used to control the dental patient in a separation center.27 The salient points of the Fort Monmouth plan were as follows:

1. Patients were classified into three broad groups according to the type and amount of treatment needed:

a. Men for whom treatment was urgent, including those requiring replacement of missing teeth, received first priority and at their own request were withdrawn from processing until treatment was completed. No man in this group was refused care regardless of the backlog of patients.

    26Incl to ltr, Col Arne P. Sorum to Dental Div SGO, 30 Oct 46, sub: Dental treatment at a separation center. HD: 314.
    27Memo, Maj Joseph G. Rosen for CG 1260th SCU, 16 Nov 45, sub: Plan of dental treatment at separation center, Fort Monmouth, N. J. SG: 703 (Ft. Monmouth) N. J.


269

b. Men needing extensive but routine dental care were also withdrawn from processing at their own request if the backlog of patients was sufficiently small to permit starting their work within a reasonable time. But these were not accepted unless they could be given appointments within 36 hours.

c. Men needing routine care which could be completed at one sitting were given appointments during free periods of their processing schedule if such were available. Because these men were often fully occupied during the few daylight hours they passed in the installation, their work was frequently done at night. If no free time was available for completing their work during the normal processing period they could be voluntarily withdrawn from the schedule under the same provisions as men in group b.

2. A dental officer was on duty at the Initial Receiving Point (IRP) at all times when separatees were being processed. This officer was notified in advance as to how many appointments of each type he might give out during the day. The IRP dental officer explained to each group the possibilities of getting dental treatment. If ample appointments of all types were available he notified the separatees that those requiring extensive care could be withdrawn from processing for such treatment and that those with minor defects could have their work completed without delaying their departure from the separation center. If appointments could not be given during the normal period of processing, but would be available within 36 hours, it was explained that all men needing treatment could be given appointments but that it would be necessary to withdraw them from processing until such treatment was completed. If the accumulated backlog of patients was such that no appointments could be given within 36 hours it was explained that only urgent cases would be accepted and that it would be necessary to hold these from processing. The IRP dentist then examined those separatees who felt that they qualified for treatment and who volunteered to delay their departure if that was necessary. Those in the first two groups were immediately suspended from processing by notification to the IRP officer and given colored cards which they took to the dental clinic as authority for starting treatment (blue cards for Class, I's, pink cards for Class II's). Men in the third group were given white appointment cards to the dental clinic for a period when they were not required for processing.

3. All separatees were given a chance to request dental care at the TRPI as explained above. Those in Class I were given another opportunity to request treatment when they were given the dental examination during processing. To avoid withdrawing partially-processed men from the line, those who did not require urgent care were not accepted later unless they had asked for treatment when given the opportunity at the IRP.

4. On arrival at the dental. clinic men in the first two groups were given appointments and their names entered on "suspense logs." The IRP dentist also sent in a list of those placed on suspense during the day and this was


270

checked against the clinic suspense log to insure that all men withheld had actually reported to the dental clinic. This log was checked periodically to detect for investigation any patient who had been on suspense for an unusually long period. Any Class II patient who failed to keep an appointment was automatically released from suspense. The colored cards which patients brought to the dental clinic were clipped to their dental records and, when treatment was completed, were filled in on the reverse side and placed in a box which was emptied every hour. Separation center headquarters was in turn given, by telephone, an hourly list of men whose cases had been closed, and this list was verified in writing at the end of the day. A patient was thus released to continue his processing within an hour after his treatment had been completed. No special check was needed for men given white cards for minor care since they were not withdrawn from the processing schedule. The proportion of separatees needing treatment was only a fraction of the number who had needed care when they entered the service. Of 278,309 separatees processed at Fort Dix between 1 March and 30 September 1946 only 0.86 percent needed extractions or other urgent treatment, only 1.75 percent, replacement of missing teeth, and 10.15 percent, fillings or other routine care.28 Of those requiring treatment only a small percentage were willing to delay their discharge even a few days.

The total number of separatees who received dental treatment at the time of separation is not known since a report was made only of those suspended from processing, and many thousands had minor work completed while on the normal separation center schedule. During the demobilization period, from May 1945 through October 1946, about 111,800 persons were withdrawn from the examining line because they needed urgent oral treatment requiring a delay in their separation. Of these, about 104,900 were for dental defects, and about 6,900 for mouth and gum defects. These withdrawals constituted 1.6 percent of all personnel processed for separation during this period: 1.5 percent for teeth, and 0.1 percent for mouth and gum defects. While the proportion of men withdrawn from the line for dental reasons may seem to be relatively small, the number of persons who received such care is obviously quite important. In fact, the withdrawals for dental reasons made up about 36 percent of the withdrawals for all physical reasons. About 2.6 percent of the persons withdrawn for dental reasons required inpatient treatment.29

Among the soldiers willing to wait for dental treatment, a high proportion needed extensive prosthetic replacements. Over 65 percent of the men held for treatment at Fort Dix required replacement of missing teeth. Special prosthetic sections had to be set up in many clinics and civilian laboratories called

    28See footnote 26, p. 268.
    29Unpublished data, from Medical Statistics Div SGO, based on special reports dealing with the processing of military personnel at separation centers, points, and bases.


271

upon to carry some of the unusual load. At Fort Dix, when 4,500 men were being discharged daily, 1 officer with a staff car was kept busy delivering and picking up cases from civilian laboratories.30

As a means of saving money the program for dental treatment of separatees was not too successful. The Veterans Administration soon provided dental care for "service connected" defects of former military personnel and the many men who had refused such treatment at a separation center were able to have their work completed later at Government expense. The program did give the soldier a last chance to have essential work completed before he returned to civilian life, however, and those who took advantage of the offer were generally the most urgently in need of care and the most deserving of consideration by the Army.

Summary, Dental Service in Separation Centers

1. After extensive service in the Army the average separatee needed relatively little dental care.

2. The majority of the men willing to delay their discharge to receive dental treatment required extensive replacements, necessitating special prosthetic facilities and the use of civilian laboratories.

3. To be effective, the dental service of a separation center must have the facilities and organization adequate to handle as many patients as possible during the normal separation period. Very few men will take advantage of the proffered treatment if they must be suspended from processing to receive it. To reach as many of these as possible it becomes necessary to operate extensive facilities outside of regular duty hours.

THE DENTAL SERVICE IN ZONE OF
INTERIOR STATION HOSPITALS

Each Zone of Interior post of any importance had its own station hospital for the institutional medical care of local personnel. These hospitals were not expected to render highly specialized treatment but were equipped and staffed to handle all routine medical and surgical conditions. They varied in size from 25 to 1,000 beds or more. In small hospitals of less than 100 beds the dental clinic normally occupied a part of the administration building. Intermediate hospitals of from 100 to 200 beds were authorized a separate dental clinic of 8 chairs (DC-3), while hospitals of 250 beds or larger were provided a separate clinic building of 15-chair capacity.31 The hospital clinics were

    30See footnote 26, p. 268.
    31Data on the dental clinics provided the smaller station hospitals obtained by the author from Mr. James J. Souder, Act Chief Hospital Construction Br Hospital Div SGO, on 14 Apr 47. Hospitals of 250 beds or larger were authorized DC-2's by 3d ind, TAG, 20 Nov 40, on Ltr, SG to TAG, 2 Nov 40, sub: Dental service in cantonment hospitals-dental laboratory service, divisional areas. AG: 632.


272

authorized base-type chairs, units, cabinets, x-ray machines, and laboratories. Equipment and instruments were adequate for all routine operations.

Unlike overseas station hospitals, the Zone of Interior station hospitals had no prescribed allotments of personnel. The number of officers and enlisted men required in each situation was determined within the service command on the basis of relative strength, the primary activity of the post, and individual ideas of the staff officers concerned. Late in the war (October 1945), ASF published a "guide" for the allotment of officers and men to station hospitals. It suggested that I dental officer and 11/2 enlisted men be provided for each 200 hospital beds. Since the hospital dental clinics on the smaller posts had to furnish all dental care for the troop areas as well as for hospital patents, it was recommended that they be allowed 2 additional dental officers and 3 enlisted men for each 1,000 troops.32 This directive was only advisory, however, and not binding on local commanders.

The station hospital dental clinics fulfilled different functions on posts of different sizes, as follows:

1. On posts of less than 10,000 men the hospital dental clinic normally furnished all definitive dental treatment f or the command, including routine care for outpatients, laboratory service, and any treatment of hospital patients which was not of a highly specialized nature. If tactical units were present on the post their own dental officers conducted surveys, held sick call, and rendered emergency care to their men, but all other treatment was carried out in the hospital clinic, sometimes with the aid of the tactical dentists on temporary duty. The hospital clinic constructed prosthetic appliances, placed permanent restorations, treated infections about the mouth, extracted diseased or impacted teeth, and rendered emergency treatment to serious facial injuries pending their transfer to a hospital where specialized care would be given.

2. On posts of more than 10,000 men the hospital dental clinic provided routine care only for hospital patients. In addition it undertook the more difficult types of treatment such as the construction of complicated prosthetic replacements or the extraction of impacted teeth. It provided care for infections or other conditions which could not be treated on a duty status and rendered emergency treatment for serious facial injuries. Simple fractures might be handled in the, hospital dental clinic but more difficult surgical cases were normally transferred to a general hospital. Routine fillings, prosthetic restorations, and extractions for nonhospitalized personnel were taken care of in the troop-area clinics.

The maximum number of station hospitals in the United States was reached at the end of 1943 when 611 hospitals provided bed space for 270,499 patients.33

    32ASF Ltr 389, 16 Oct 45.
    33Info from files of Medical Statistics Div SGO.


273

THE DENTAL SERVICE IN ZONE OF
INTERIOR GENERAL HOSPITALS

Zone of Interior general hospitals were strategically located to provide highly specialized medical and surgical care which could not be furnished in the station hospitals. A circular letter of 1 January 1943, stated that:34

    General hospitals are established and maintained to afford better facilities than ordinarily can be provided in station hospitals for the observation, treatment, and disposition of complicated or obscure cases; for the performance of the more formidable surgical operations; and to provide beds for the evacuation of station hospitals. . . .

    No hard and fast rules can be laid down, but in general it will be the policy of the Medical Department to treat as general hospital cases all patients who require more than 90 days' hospitalization, as well as all cases requiring specialized treatment which is not available at station hospitals. . . .

    Complicated or severe fractures of the long bones, facial bones, and fractures of the vertebrae should be transferred to a general hospital as early as possible. . . .

It was soon apparent, however, that not even all of the general hospitals could provide certain types of treatment. The Adjutant General therefore directed, in March 1943, that maxillofacial cases would be sent to one of the following general hospitals:35

    Bushnell General Hospital, Brigham, Utah.
    O'Reilly General Hospital, Springfield, Mo.
    Valley Forge General Hospital, Phoenixville, Pa.
    Walter Reed General Hospital, Washington, D. C.

The number of hospitals offering maxillofacial care increased gradually until the following eight installations were designated as maxillofacial hospitals in August 1944:36

    Baker General Hospital, Martinsburg, W. Va.
    Beaumont General Hospital, El Paso, Tex.
    Cushing General Hospital, Framingham, Mass.
    Dibble General Hospital, Menlo Park, Calif.
    Northington General Hospital, Tuscaloosa, Ala.
    O'Reilly General Hospital, Springfield, Mo.
    Valley Forge General Hospital, Phoenixville, Pa.
    Wakeman General Hospital, Camp Atterbury, Ind.

These installations were given specially trained personnel and every item of equipment needed for performing the most exacting operations on the oral and facial structures. The other general hospitals had qualified oral surgeons, prosthodontists and operative personnel, and laboratory and x-ray equipment, for the treatment of any but the most unusual cases.

As in the case of the station hospitals, allotments of personnel for general hospital dental clinics were determined within the service commands. Pro-

    34SG Ltr 1, 1 Jan 43.
    35WD AG Memo W40-9-43, 6 Mar 43, sub: General hospitals designated for special surgical treatment. AG: 705.
    36WD Cir 347, 25 Aug 44.


274

curement was based on the following hypothetical authorization of dental officers, but the hospitals concerned were not necessarily provided the numbers listed:37

Number of beds

Number of dental officers

1,000

7

1,500

8

1,750

9

2,000

12

2,500

14

3,000

16

3,500

19

4,000

21


The maximum number of general hospitals in the United States was reached in 1945 when 65 installations provided bed space for 153,595 patients.38

DENTAL SERVICE ON HOSPITAL SHIPS

Since the primary purpose of hospital ships was transportation rather than definitive treatment, the Dental Service operated on a slightly smaller scale than in a hospital of corresponding size. Ships of 400-bed capacity or less had a single exodontist in the grade of captain or lieutenant; with 500 beds an oral surgeon in the grade of major was authorized; with 600 to 800 beds 2 officers were allotted, with the senior in the grade of major; ships with 900 or 1,000 beds had a lieutenant colonel, a major, and a captain or lieutenant; vessels carrying 1,500 beds had a lieutenant colonel, a major, and 2 captains or lieutenants.39

Hospital ships carried full base dental equipment, including prosthetic and x-ray facilities. As mentioned, the smaller vessels were authorized an exodontist, larger craft an oral surgeon. All types of work were possible and needs of seriously wounded or ill patients could be met en route.

The Dental Service of hospital ship platoons proved less satisfactory. These auxiliary units were used to provide medical care for patients returning to the Zone of Interior on ordinary transports. Each platoon with a capacity of 100 or more patients was authorized a dental officer.40 A large proportion of all patients with maxillofacial injuries were transported by air, however, and these small contingents had little need for a dentist. Also, much valuable time was wasted in long "layovers" between trips. Since specially qualified exodontists or oral surgeons could not be spared for such minor organizations it was found that the men assigned were often young and inexperienced.41 In view of these considerations the Dental Division decided that it would be in

    37WD Cir 209, 26 May 44.
    38See footnote 33, p. 272.
    39T/O&E 8-537T, 7 Dec 43; T/O&E 8-537, 3 Mar 45.
    40T/O&E 8-534, 21 Oct 43.
    41History of the Dental Division, Hq ETOUSA, 1 Sep-31 Dec 1944. HD.


275

the best interests of all concerned if the dental officers and their equipment were removed from hospital ship platoons.

A recommendation to this effect was made to the Operations Service, SGO, 7 March 1944.42 No action being taken, it was repeated 7 December 1944.43 The new recommendation was approved by the Technical Division, to which it was first sent, and forwarded on 20 December 1944 to the Hospital Division for comment. The Hospital Division disapproved the proposed action because (1) it was felt that the dental officer would be of some use treating patients, (2) dentists were filling administrative positions which would have to be filled by Medical Administrative Corps officers if the dental officers were removed, and (3) it was believed that the dentists with the hospital ship platoons would serve as a useful pool of officers from which to draw in case of special need.44 Faced with this nonconcurrence the Dental Division dropped the matter, though it still held that the use of dentists in hospital ship platoons was wasting manpower needed elsewhere.

DENTAL SERVICE ON ARMY TRANSPORTS

In World War I regular dental service on Army transports, as distinguished from incidental treatment rendered by transient dental officers, was not inaugurated until the latter part of 1919, when most ships on the Atlantic run were provided dental personnel and equipment. The Surgeon General's annual report for that year stated that experimental installations had proved so successful that new transports were being built with space for a dental clinic especially provided.45 In the period of retrenchment following World War I, however, and with the withdrawal of most troops from overseas areas, this project was neglected. In the period preceding World War II the transport surgeon was normally equipped with a few essential dental instruments, and if no dental officer was on board as a passenger he took what measures he could to relieve pain until the ship docked. Army regulations authorized the assignment of dentists "if required," but did not specify definite conditions under which such assignment would be made.46 So long as transports were small the absence of a dental officer was not serious, but when ships capable of carrying 10,000 men were taken over at the start of the war adequate dental facilities became a necessity.

On 26 January 1942 the Dental Division recommended to the Finance and Supply Division, SGO, that a dental field chest be placed on every transport

    42Biweekly Dental Service Reports, 1 Jan 1944-30 Oct 1945. HD: 024.
    43Memo, Dir Dental Div for Dir Technical Div SGO, 7 Dec 44. HD: 314.
    44Memo, Col A. H. Schwichtenberg, Dep Chief Hosp Div for Chief Technical Div SGO, 23 Jan 45, sub: Dental officers in medical hospital ship platoons. HD: 314.
    45Annual Report of The Surgeon General, U. S. Army, 1920, Washington, Government Printing Office, 1920, p. 303.
    46AR 30-1150, 16 Sep 42.


276

so that emergency treatment could be rendered, presumably by personnel traveling on the ship.47 No specific action was taken, and in August 1942 the Dental Division resubmitted the recommendation, accompanied by the following extract from a letter received from the European theater:48

    One of my greatest headaches, and the source of my greatest complaints, is the dental service on board transports en route to this theater of operations. As previously stated, in many cases there is little or no dental equipment on board these transports to relieve the urgent dental emergencies. Reports come to me of acute conditions going untreated during the entire voyage.

The Chief of the Finance and Supply Division answered that he knew of no convoys which had not had an adequate number of field chests assigned and suggested that the trouble lay in coordination at the ports.49 On 16 September 1942 The Surgeon General directed all port surgeons to make maximum use of the available dental equipment and officers to insure that each transport complement was afforded at least emergency dental care.50 On 23 November 1942 Col. Thomas C. Daniels, DC, was assigned to the New York Port of Embarkation to supervise the transport dental service under the port surgeon, and to take any action required to provide dental officers and equipment on transports leaving the harbor. These steps were apparently effective, at least so far as the eastern seaboard was concerned, for the dental surgeon of the European theater reported in October 1943 that he had had no further trouble due to inadequate dental treatment on transports bound for England.51 Dental field chests were, still not standard components of the medical equipment of transports, however, and on 7 March 1944 the Dental Division again recommended to the Operations Division of the SGO that M. D. Chest No. 60 be routinely authorized for all ships carrying Army personnel.52 An equipment list published about a month later listed the dental field chest as a regular item for troop ships.53

When used on the larger transports field equipment left much to be desired. The amount of treatment to be rendered might equal that of a small post, and one ship reported that the dental clinic was in constant use from 8 a. m. to 9 p. m.54 In addition, the light wooden chair of the field set proved very unstable at sea and the foot engine was difficult to operate on an undulating platform. On 20 June 1944, after a conference with the Director of the Dental Division, the surgeon of the San Francisco Port of Embarkation

    47Memo, Col Don G. Moore for Finance and Supply Div SGO, 28 Jan 42. SG: 444.4-1 (BB).
    48Memo, Col Rex McDowell for SG, 26 Aug 42. SG: 703.1 (BB).
    49Memo, Col F. C. Tyng, Finance and Supply Div SGO, for Gen J. C. Magee, 28 Aug 42. SG: 703.1 (BB).
    50Ltr, SG to CGs of all ports of embarkation, 16 Sep 42, sub : Dental attendance of troop transports. SG: 703.-1.
    51Ltr, Col William D. White to Maj Gen Robert H. Mills, 22 Oct 43. HD: 703 (ETO).
    52See footnote 42, p. 275.
    53Incl 4, Equipment List No. 9N809, to Ltr, Chief Oprs Serv to CofT, 3 Jul 44, sub: Dental equipment for transports. SG : 444.4 (BB).
    54Rpt, dental surg of an unnamed transport, 21 Jul 44. HD: 460 (Army Transport).


277

asked that permanent outfits be authorized for troop transports operating out of that base,55 and 4 days later his medical supply officer submitted a requisition for 50 units, chairs, cabinets, air compressors, and operating lights.56 On the recommendation of the Dental Division this requisition was approved.

On 28 June 1944 the Dental Division recommended to the Technical Division, SGO, that current equipment lists be amended to authorize base-type dental outfits for Army transports.57 For reasons which remained obscure, this recommendation was neither adopted nor disapproved. Its status on 14 December 1944 was described in a letter from the Chief of the Technical Division to the Chief of Operations Service, in which it was stated, in effect, that all efforts to get a decision from the Chief of Transportation had failed but that under existing instructions port surgeons could get the necessary equipment when they wished. It was further stated that "It is informally understood that the Chief of Transportation prefers this arrangement to. any set requirement, which would necessitate the automatic installation of dental equipment on all transports regardless of the circumstances under which they operate or the availability of permanent dental personnel."58 By 6 February 1945 the Dental Division had apparently given up any hope of having permanent dental outfits authorized as standard equipment and asked the Technical Division to distribute a list of recommended items to assist port surgeons in ordering supplies on their own responsibility.59 The Technical Division concurred in this request since it also had many inquiries from port surgeons concerning appropriate outfits.60 The Supply Service, SGO, disapproved, however, for the reason that it would be tantamount to authorizing the issue of items for which no formal procurement authority existed.61 Meanwhile, port surgeons had been able to have the desired equipment installed in many transports without the formal approval of either the Chief of Transportation or The Surgeon General. By the end of November 1944, 35 ships had been so equipped62 and by March 1945, 63 transports had permanent chairs and units. Since the most important needs had been met by these conversions the Dental Division notified the Technical Division on 7 March 1945 that no further efforts would be made to have the base outfits placed on the standard equipment list.63

    55Ltr, Brig Gen Wallace DeWitt to Col Rex McDowell, 20 Jun 44. SG : 444.4-1 (BB).
    56Incl 3, ltr, Col F. C. Tyng to Chief of Supply Div SGO, 24 Jun 44, sub: Requisition No. D 4424-44, to ltr, Chief Oprs Serv to CofT, 3 Jul 44, sub: Dental equipment for transports. SG: 444.4 (BB).
    57Incl 1, Memo, Col Rex McDowell for Technical Div SGO, 28 Jun 44, to ltr, Chief Oprs Serv to CofT, 3 Jul 44, sub: Dental equipment for transports. (SG: 444.4 (BB).
    58Ltr, Chief Technical Div to Chief Oprs Serv SGO, 14 Dec 44, sub: Dental equipment for Army transports. HD : 314.
    59Memo, Dental Div for Chief Technical Div SGO, 6 Feb 45. HD: 314.
    60Memo, Chief Technical Div for Chief Supply Serv SGO, 21 Feb 45, sub: Dental equipment for Army transports. HD: 314.
    611st ind, Chief Supply Serv, 26 Feb 45, to memo cited in footnote 60 above. HD: 314.
    62Memo, Col Rex McDowell for Chief Technical Div SGO, 30 Nov 44. HD: 314,
    63Ibid.


278

PROSTHETIC FACILITIES IN THE ZONE OF INTERIOR

Prior to World War II, prosthetic facilities were concentrated in central dental laboratories (figs. 22, 23, and 24). For a peacetime Army, or for small stations scattered over a corps area, these well-equipped laboratories, staffed with skilled technicians, could complete dentures or appliances with enough 7 efficiency and economy to outweigh the disadvantages of transporting these cases considerable distances. However, with a fully mobilized Army, it was recognized that the facilities of the existing central dental laboratories were64 inadequate to meet the demands of the increased prosthetic needs and plans were made to inaugurate laboratory facilities in the larger camps.

From the outset some laboratory space and equipment was provided in all the larger dental clinics. To reinforce these facilities The Surgeon General recommended to The Adjutant General on 2 November 194065 that a DC-2 clinic be established in each station or general hospital of 250 beds or more. On 20 November 1940 The Adjutant General approved this action with additional comment as follows: 66 67

    In camps of less than 10,000 strength the building will provide dental chairs for all camp personnel, including hospital patients, and laboratory space for necessary making of prosthetic appliances. In camps of over 10,000 strength the building will provide dental chairs for hospital patients only, and laboratory space for making prosthetic appliances. The division of floor space between chairs and laboratory will be made locally.

Four months later, in March 1941, the Dental Division found it necessary to ask that laboratory equipment for these station hospitals be increased slightly, though it was still expected that the hospital laboratories would sufficiently reinforce the small prosthetic facilities in the camp dental clinics.68

By May 1941 the Director of the Dental Division foresaw that larger laboratories would be required in training camps and other strategic locations and announced a plan for their construction.69 Responsibility for obtaining these installations, however, was left largely to local dental surgeons. In fact, Maj. Gen. Robert H. Mills, who became Director of the Dental Division early in 1942, subsequently stated that he had at first attempted to have additional CDL's authorized, and only after this recommendation had been rejected by The Surgeon General did he definitely decide to establish laboratories in each

    64Final Report for ASF, Logistics in World War II. HD: 319.1-2 (Dental Div).
    65Ltr, SG to TAG, 2 Nov 40, sub: Dental service in cantonment hospitals--dental laboratory service, divisional areas. AG: 632.
    663d ind, TAG, 20 Nov 40, to ltr cited in footnote 65.
    67The footnote referred to here is found only on a single copy of the basic communication. AG : 632.
    68Memo, Brig Gen Leigh C. Fairbank for Finance and Supply Div SGO, 13 Mar 41. SG: 444.4-1.
    69Fairbank, L. C.: Prosthetic dental service for the Army in peace and war. J. Am. Dent. A. 28: 798-802, May 1941.


279

Surveying and designing unti, Central Dental Laboratory

 

 

Figure 22.  Surveying and designing unit, Central Dental Laboratory.

 

 

Flasking and deflasking unit, Central Dental Laboratory

 

 

 

Figure 23.  Flasking and deflasking unit, Central Dental Laboratory.

 


280

Vitallium unit, Central Dental Laboratory

 

 

 

Figure 24.  Vitallium unit, Central Dental Laboratory.

 

camp of 10,000 men or more.70 Standard camp laboratory equipment was prescribed in March 1943. In the annual report of the Dental Service for the fiscal year ending 30 June 1943, it was noted that "An increasing number of the larger camps have been able to institute their own laboratory service, thereby reducing the load on the central dental laboratories."71 From the annual report of the Dental Service for fiscal year 1944 it was noted "The tremendous requirements for dentures made it necessary to expand the laboratory facilities to include those camps of 10,000 or over . . . . "72 It was not until 1946, however, that a War Department circular stated unequivocally that:

    All general hospitals, camps and stations with a military strength of 10,000 or over will furnish their own laboratory service, with the provision that each of those stations is authorized to forward cases to the central dental laboratory serving its service command when local facilities cannot meet the demands, and cases which require special fabrication methods available only at central dental laboratories.73

Laboratories established in the more important camps were often larger than the peacetime CDL's. Fort Knox, Ky., for instance, had 2 laboratories employing a total of about 25 men to provide prosthetic service for a strength of from 15,000 to 20,000 trainees.74

    70Memo, Brig Gen R. H. Mills for Supply Serv SGO, 15 Feb 43. SG: 322.15-16.
    71Annual Rpt, Dental Serv, 1943. HD.
    72Annual Rpt, Dental Serv, 1944. HD.
    73WD Cir 21, 22 Jan 46.
    74Info given to author by Col Walter D. Love, former dental surg at Ft. Knox.


281

General approval by the War Department did not in itself insure that adequate facilities would be provided these camp installations, however. Under the usual system of assigning enlisted men, camp dental surgeons still had to obtain allotments of personnel in competition with all other branches. Moreover, there was no backlog of trained laboratory men in replacement centers in 1942 and 1943. Often a large proportion of all enlisted men allotted to the dental clinic had to be put on duty in the laboratory, leaving few assistants for the operating sections. Later, civilian assistants were hired to replace the technicians so lost, but at first, when demands were greatest, the activities of many dental clinics were hampered by the necessity of assigning half or more of their men to the construction of prosthetic appliances.

The camp laboratories reduced the strain on the CDL's, but prosthetic service still had to be provided for a large number of stations too small to operate their own establishments. It was therefore necessary to multiply the facilities of the five existing CDL's, and their increasing output from 1940 through 1944 is shown in the following tabulation:75 76 77

Year

Total cases completed

1940

10,658

1941

10,658

1942

48,012

1943

216,358

1944

178,034

1945

153,908


But while the total output of the CDL's expanded about 2,000 percent between 1940 and 1943, they completed in 1943 only 22 percent of all prostheses constructed in the United States, as compared with over 50 percent in 1940.

Operation of the Laboratory Service

There can be no doubt that the prosthetic service was severely hampered by shortages of personnel and equipment at a period when the demand for dental appliances was increasing many times as rapidly as the strength of the Army.78 In spite of these difficulties there was surprisingly little delay in the processing of cases. In July 1943 the Director of the Dental Division stated that the current time interval from impression to insertion of the finished appliance was as follows: 79

    75Data on the annual output of the CDL's in 1940 are taken from Annual Report . . . Surgeon General, 1941.
    76Figures for 1941-43 are found in Annual Rpt, Dental Serv, 1944. HD.
    77Figures for 1944 are found in Annual Rpt, Dental Serv, 1945. HD.
    78For discussion of personnel and supply difficulties see chapters on "Personnel and Training" and "Equipment and Supply."
    79Memo, Brig Gen R. H. Mills for Chief Prof Serv SGO, 19 Jul 43, sub: Construction of dentures. SG: 444.4-1.


282

Elapsed Time

Percentage of appliances completed

1-7 days

33

8-10 days

21

11-14 days

18

15-21 days

17

22-28 days

6

over 28 days

5


Actual laboratory time (CDL's and station laboratories combined) was:

Elapsed Time

Percentage of appliances completed

1-7 days

54

8-10 days

18

11-14 days

11

15-21 days

10

22-28 days

5

over 28 days

2


A comparison of the time required for the completion of cases in CDL's and station laboratories is given in the following tabulation, based on 21,156 appliances processed in CDL's and 73,416 in station laboratories between 1 June and 31 August 1943:80

Elapsed Time

Percentage completed in camp laboratories

Percentage completed in CDL's

0-6 days

39.9

67.3

7-10 days

23.8

17.7

11-14 days

14.8

7.2

15-21 days

12.4

4.8

22-28 days

4.0

1.6

over 28 days

5.1

1.4


It is evident that CDL's were able to process cases in considerably less time than the camp laboratories. This advantage was somewhat reduced, of course, by loss of time in the mails for cases sent to the CDL's, and 21.8 percent of all cases completed in camp laboratories were actually inserted within 6 days after the impression was taken, compared with only 15.3 percent of the cases completed in CDL's. But for any laboratory time over 6 days the greater speed of the CDL more than offset the time required for mailing, so that except for the 21.8 percent of the camp laboratory cases completed in less than 6 days the actual elapsed time between taking of impressions and insertion of the finished denture was less for appliances made by the CDL's than for appliances completed at the patient's home station. Actual elapsed time from impressions to insertion of the finished dentures for cases completed in CDL's and camp laboratories is shown in the following tabulation:81

    80History of the Army Dental Corps, 1941-43, Table 16. HD.
    81Ibid.


283

Elapsed Time

Percentage completed in camp laboratories

Percentage completed in CDL's

0-6 days

21.8

15.3

7-10 days

24.8

35.8

11-14 days

17.6

22.8

15-21 days

17.8

15.6

22-28 days

8.6

5.7

over 28 days

9.4

4.8


Data on the output per technician are limited to the larger laboratories because of obvious difficulties in determining how much time was actually devoted to technical procedures in the smaller units. Figures given for the large laboratories include all dentures, repairs and bridges, though the latter item constituted a negligible part of the total. On this basis each technician completed 58.6 cases per month in 1943 and 51.0 cases per month in 1944.82 83 The decrease in output per technician in 1944 was probably due to a slackening in the demand for dental appliances, which had made it necessary to operate with considerable overtime in 1943.

Use of Civilian Laboratories

In some individual centers the situation was more critical than indicated by the aforementioned figures. In July 1943 Fort Bragg reported that minimum time required for completion of a prosthetic case was 35 days; average time 56 days, while some patients had had to wait 120 days for their appliances. Fort Riley reported an average period of 91 days between impression and completion of dentures.84 To meet these emergency situations the Dental Division was forced to make temporary use of civilian laboratories. In a letter of 26 November 1942 The Surgeon General called the attention of local commanders to their authority to send cases to civilian installations and requested that they take necessary action when military facilities were inadequate.85 86 The following day a second letter placed some restrictions on the amounts and types of service to be obtained from the civilian laboratories, as follows:87

    a. This is an emergency measure to relieve the present critical situation in construction of needed prosthetic appliances only until our dental laboratories are established and equipped to take care of our needs. It is in no manner to be construed as a reason for any delay of effort to establish and place in full operation laboratories adequate to care for all local needs in all large camps. The Central Dental Laboratories will then be able to meet the demands made upon them by smaller stations.

    82Data for 1943 computed from History of the Army Dental Corps, 1941-43. HD.
    83Data for 1944 computed from Annual Report of the Dental Service, Jan-Dec 1944. HD.
    84Memo, Lt Col R. S. Nourse, AG Replacement and School Command AGF for CG AGF, 13 Jul 43, sub: Eye correction and dental restorations. SG : 444.4-1.
    85AR 40-510, C 1, 10 Sep 42.
    86Ltr, SG to CG 1st SvC, 26 Nov 42, sub: Prosthetic dental appliances. SG: 703.
    87Ltr, SG to CG 1st SvC, 27 Nov 42, sub: Dental appliances constructed by civilian laboratories. SG: 703.


284

    b. When laboratories are established as above, except in isolated cases, there will be no need for further employment of civilian laboratories for the construction of dentures.

    c. No special appliances, such as all-cast dentures of gold, ticonium, vitallium, or similar materials, are to be authorized under provisions of this letter.

    d. In approving vouchers for payment care will be taken to assure that the prices charged are reasonable and not above those charged civilian dentists for similar work in the locality.

After March 1944 payment for civilian laboratory service was made by the service commands and it is therefore not known how many cases were completed under this plan. In 6 months, from March through July 1943, 16,607 dentures were constructed by civilian laboratories,88 amounting to 5 percent of the total of 327,838 appliances constructed for Army personnel in the United States in the same period. From April 1943 through January 1944 a single medical depot at Los Angeles paid vouchers for dentures constructed for 8,643 patients, costing $276,271.35, or an average of $31.96 per patient.89 At this installation the cost of dentures increased gradually from $23.09 per patient at the start of the program to well over $30.00 at the end of the period reported upon. (About 40 percent of these patients received 2 appliances.)

Important as the civilian laboratory service was in an emergency, it did not supply a significant proportion of the total cases completed. By September 1944 the central laboratories were able to handle all cases not completed in their home stations and a circular letter announced that a station unable to complete any appliance within 1 week would forward such appliance to a CDL. It also directed that station laboratories would be discontinued where diminishing activities warranted this step.90

Coordination of the Activities of
Camp and Unit Dental Officers

Tactical units in training in the United States or awaiting shipment overseas were concerned primarily with the instruction of their personnel in the duties they would have to perform in action. They were unable and unwilling to assume responsibility for the routine operation of the permanent stations on which they were temporarily quartered. Nevertheless, many post functions had to go on whether the units housed there were in barracks or absent on maneuvers or field exercises. A camp where tactical units were quartered was therefore authorized a permanent service detachment which provided the neces-sary utilities and such special facilities as medical and dental service. Since it was undesirable to change the camp administrative staff with each successive tactical organization, this service detachment was put under a post commander and its activities were independent of those of the tactical units.

    88Memo, Voucher Audit Br AGO, for Col Rex McDowell, 18 May, 3 Jun, 22 Jul, and 11 Aug 43. SG: 703.
    89Weekly Civ Lab Rpts, LA Med Depot, 24 Apr 43-8 Feb 44. SO: 703.
    90SG Ltr 295, 8 Sep 44.


285

During the early period of mobilization the fact that tactical unit dentists were administratively independent of the post dental surgeons led to some confusion. Unit dental officers had to devote much of their time to training activities, and were equipped with field dental chests only. They were therefore not expected to meet the routine needs of their organizations. However, though post dental officers were expected to assist the unit dentists, they were not authorized in sufficient numbers to enable them to provide full dental care for both permanent and temporary personnel. Adequate treatment could be rendered only by using both groups of dentists to the limit of their availability. Post clinics were planned to provide extra working space for as many tactical unit dentists as could be spared from their units, but some difficulty was encountered in obtaining their services when needed. Organization commanders disliked to release their dental officers for duty in the camp clinic and often gave them nonprofessional duties to occupy their time when not engaged in training. Unit dental surgeons also felt that they should have control of any installation where their men were receiving dental treatment and sometimes refused to cooperate when told that the camp dental clinic would remain under the direction of the camp dental surgeon.

To clear up any misunderstanding concerning respective responsibilities for dental care on posts having both types of dental personnel, The Adjutant General directed in January 1941 that:91

1. Camp dental clinics would operate under the camp commander.

2. Camp dental facilities would be operated and maintained so that the using troops would derive the utmost benefits therefrom.

3. Tactical unit dentists would be used in the camp dental clinic whenever they were not required for essential duties in their own organizations.

4. The use of tactical unit dentists in camp clinics would be arranged by mutual agreement between the commanding officers concerned. In case of failure to come to an agreement the matter would be forwarded to the War Department for decision.

At the same time it was explained in the Dental Bulletin that:92

    ... under its provisions [the directive mentioned above] the dental clinics will be activities operated by the personnel assigned or attached to the post, camp, or station complements and not by field force personnel, although the dental clinics may be operated in areas occupied by the field force. Under this same authority, the permanent personnel of the dental clinics (i. e. those assigned to post, camp, or station complements) has been limited to that necessary for the operation and maintenance of the post when all units of the field forces are absent therefrom. This personnel will be augmented by members of units of the field forces only when the field forces are present. When the field forces leave the post for maneuvers or for any other reason, these men will be relieved from duty with the dental clinic and will rejoin their units. . . .

    91Ltr, TAG to CGs of Armies and Corps Areas, 11 Jan 41, sub: Station complement activities and agencies. SG : 320.3-1.
    92The control and operation of central dental clinics. The Dental Bulletin, supp. to the Army Medical Bulletin 12 : 118, Apr 1941.


286

A second directive of 11 April 1941 provided that:93

    a. Dental service at regimental and separate battalion dispensaries and aid stations will consist of emergency service and dental surveys in the tactical units to which the dispensaries are attached and will be provided by dental officers attached to the regimentor separate battalion.

    b. Definitive dental treatment, serious extractions, and treatment which demands more extensive dental equipment will be provided in camp or hospital dental clinics and will be under the control of the Corps Area Service Command.

    c. Dental officers of the tactical units will receive training in medical tactics as auxiliary medical officers and in emergency treatment of jaw casualties in their respective units. Technical instruction in more extensive definitive dental treatment will he provided in the camp or hospital dental clinics. . . .

    d. Training activities in medical tactics and functions of the regimental and separate battalions will be under the direction of the division or unit surgeon. Technical training in camp or hospital dental clinics will be under the direction of the camp or station surgeon.

In July 1942 still more specific instructions were issued, as follows:94

    1. a. The current shortage of Dental Corps officers requires the maximum utilization for professional duties.

    b. It is desired that all Dental Corps officers under your jurisdiction who are now engaged in nonprofessional duties be relieved of those duties and returned to professional work with the Dental Corps as soon as practicable, and that in the future no dental officers be assigned to nonprofessional duties. You are authorized to make exceptions to the foregoing policy only when the immediate release of such officers will severely interfere with the functions of the medical service. In these exceptional cases dental officers will be permitted to continue on nonprofessional duties only until they can be replaced by qualified Medical Administrative Corps officers.

    2. a. Instructions are being issued to division and other tactical unit commanders that up to 50 percent of the dental officers assigned to and present for duty with such organizations while they are at camps or stations where dental clinics are in operation are to be made available for duty at such clinics at all times.

    b. It is desired that in cases of dental officers from tactical units made available for duty in clinics under your jurisdiction, mutual arrangements be effected locally to insure that although the clinics will be fully staffed at all times, no individual dental officer from a tactical unit will spend more than 50 percent of his time on such duty and that during the remainder of the time, each officer be returned to his organization for such training as may be directed by the appropriate tactical commander.

The restriction on the nonprofessional use of dental officers curbed the tendency of some commanders to use dentists for purely administrative functions, and at the same time the provision that 50 percent of the dentists with tactical units would be on duty in the camp dental clinics whenever their organizations were on the post helped the service detachments complete essential dental treatment for these units before they were sent overseas.

    93Ltr, TAG to CGs of Armies and Corps Areas, 11 Apr 41, sub: Organization, training, and administration of medical units. SG: 320.2.
    94Ltr, TAG to CGs all SvCs, 31 Jul 42, sub: Utilization of dental officers for professional duties. HD: 314.