CHAPTER VI
THE DENTAL SECTION
The dental subdivision of the chief surgeon's office, though part of the personnel division,1 was in a large degree separate therefrom.2 Because of its relationship with the personnel division, its activities are considered here, though these were of a much wider character than control of dental personnel alone. It exercised both general and technical control over all matters affecting the dental service throughout the American Expeditionary Forces; e. g., dental laboratories, procurement and distribution of dental supplies, dental organization, professional dental service, and liaison with the maxillofacial services.2
In view of the fact that the dental service was not classed among theprofessional services and, therefore, can not logically be discussed withthem in another part of this volume or in others, it appears expedientto consider here not only the activities of the dental section of the chiefsurgeon's office, but of the administrative activities of that serviceas a whole.
On June 12, 1917, General Pershing cabled through the American ambassador,London, to the Secretary of War, requesting that the senior dental officerof the Army be sent to France with the second convoy of troops, there toestablish a depot and organize work, and that dental officers be sent withall troops in proper proportion.3 Confidential orders were issuedby the War Department, June 25, 1917, in compliance with the above request.4During a conference with the Surgeon General of the Army, prior to embarking,the dental officer in question made request for authority to organize andtake with him a dental corps unit, to be composed, with himself, of sixspecially qualified dental surgeons.2 This request was granted,the necessary telegraphic orders were issued, and the members of this unitassembled in New York City, July 10-15.2 Regulation field equipmentand supplies, with which the five officers, other than the chief of thisgroup were supplied, were augmented through purchase of complete laboratoryequipment and supplies, and special oral surgical instruments and appliances.2Transportation was secured with the second convoy, due to sail on or aboutJuly 28.2
During the latter part of June the Surgeon General had also requestedorders directing 20 members of the newly organized Dental Service Corpsto proceed to New York for transportation with the second convoy of troops.2Several members of this corps, attached to Base Hospitals Nos. 8 and 9and to the First Regiment of Engineers, were at this time also assembledat the port of embarkation, and a total of approximately 30 dental officerswere provided transportation with the second convoy.2 Unfortunately,all the equipment and supplies of the First Army Dental Corps Unit wassubmerged in the sinking of the vessel on which its members were embarked,and though a large portion of the equipment and supplies was rescued severalweeks later, it proved worthless and a total loss.2 The unitwas reequipped by the local medical supply depot and finally sailed earlyin August, 1917.2
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Upon arrival in France, all the dental officers destined for organizationsof the 1st Division proceeded to the division training area to join theircommands; those attached to base hospitals accompanied these organizationsto their station, and all personnel of the First Dental Corps Unit proceededin accordance with their orders to headquarters, A. E. F., then in Paris,where, on August 22, 1917, the head of this group reported to headquarters.2He was then directed to report to the chief surgeon for duty as assistantin matters pertaining to the dental branch.5
Plans for the organization of the Medical Department, A. E. F., alreadyunder way, contemplated the utilization of dental personnel in severalnewly created administrative positions. At a conference in the chief surgeon'soffice, it was decided that the First Dental Corps Unit should be brokenup and its personnel assigned to stations where technical administrationand supervision would be required.2 Its members were then individuallyassigned to the office of the chief surgeon; headquarters, Field Artillerybrigade, Le Valdahon; headquarters, 1st Division, Gondrecourt; MedicalSupply Depot, Cosne; headquarters, field hospital company, 1st Division,Gondrecourt training area; and to the dental clinic at headquarters, A.E. F.2
Throughout the war, the dental section continued to function as a partof the personnel division in the chief surgeon's office, moving with itto Chaumont on September 1, 1917, and later to Tours in March, 1918.2
When headquarters, A. E. F., were moved to Chaumont, a headquartersdental clinic was established there.2 Here two complete fieldoutfits and a laboratory were installed under direction of the senior dentalsurgeon, and began operating within 48 hours after the establishment ofheadquarters. This establishment continued its activities until the lastday those headquarters remained at Chaumont.2
During September and October, 1917, plans were formulated and theirapplication inaugurated for an organization which would direct and controlthe dental service of the great number of troops expected.2 Considerationwas given to providing administrative positions whose occupants would supervisethe professional and official service of dental officers on duty with majorcommands; to the assignment of specially selected dental officers to supplydepots and service schools, and to provision of professional consultantsof chief clinicians at important hospitals and of oro-dental specialistsqualified for service at maxillofacial hospitals.2 The organizationof the office of the senior dental surgeon was completed and plans weremade for the instruction of all dental officers holding administrativepositions.2 Instruction was given to a large degree by meansof correspondence between the chief of the dental section and his subordinates.This was supplemented by his frequent inspections at the several divisionsand hospitals within the training areas. Instruction of division dentalsurgeons began with the establishment of a school for them in the 1st Divisionon September 15.2
On October 12, 1917, a cablegram was received from the Surgeon General'soffice, announcing that the Army Dental Corps reorganization bill had beensigned by the President on October 6, 1917.2 Office orders werethen issued assigning the senior dental surgeon to duty as chief dentalsurgeon, under general
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direction of the chief surgeon, A. E. F., and on October 27 his dutiesbecame wholly those of an administrator and director of the dental service,A. E. F.2 Though technically belonging to the personnel divisionof the chief surgeon's office, he was provided a separate office and clerks.During October and November, further consideration was given to the preparationof adequate plans for the organization of the Dental Corps on the comprehensivelines necessary to meet the need of an army of 1,000,000 men.2
Shortly after the arrival of the chief surgeon's office at Tours, inMarch, 1918, the office personnel of the dental section was increased by2 sergeants, Medical Department, for the record room and 1 additional enlistedstenographic clerk.2 Thereafter from time to time the divisionexpanded to meet the requirements of increased service until, in additionto the commissioned personnel, it had a maximum of 4 stenographers and9 record clerks.2
Until June, 1918, the only officer serving in the dental section wasthe chief dental surgeon; another officer charged with procurement anddistribution of dental supplies was then assigned, and in September, 1918,this personnel was reenforced by a third officer.2
ORGANIZATION OF THE DENTAL SERVICE
Though the organization which the Dental Corps finally developed wasbegun early in the history of the American Expeditionary Forces, its completionin a satisfactory manner was not practicable until after the bill reorganizingthe corps became a law on October 6, 1917.2 By this organization,each division was allowed 30 dental officers, under direction of a senior,the division dental surgeon.2 The latter was under the generaldirection of the division surgeon and was charged with the responsibilityof coordinating, supervising, directing, and inspecting the dental serviceof the division.2 The senior dental officer with regiments whichrequired more than one dental surgeon was designated regimental dentalsurgeon and charged with the responsibility of conducting the service ofhis specialty. When army corps were organized it became necessary to appointcorps dental surgeons, who were under general directions of the corps surgeon.These administrative officers were charged with the coordination and directionof all the dental service of their respective army corps, which includedthe inspection, supervision, and instruction of the several division dentalsurgeons, and supervision and control of all dental officers assigned toduty with corps troops.2 After the organization of field armies,experienced dental officers were assigned to duty as army dental surgeons,under general direction of the army surgeons and were charged with theresponsibility of supervising and coordinating the dental service in therespective commands in which they served, including the dental serviceof divisions, corps, army troops, evacuation, and mobile hospitals. Theiradministrative activities pertained chiefly to the service of dental surgeonsof corps and divisions. Those officers rendered reports to them throughmedical department channels and their own reports and returns were madein turn, through medical department channels to the chief surgeon, A. E.F.2 In the Services of Supply a supervising dental surgeon incharge of the service of his specialty in each section (including the districtof Paris) was vested with the responsibility of coordinating and con-
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ducting the service under general direction of the surgeon. He alsosubmitted reports and returns, through medical channels, to the chief surgeon.Hospitals centers, depot divisions, replacement depots and later, embarkationareas were provided with local dental supervisors, usually selected fromamong the senior dental officers of those commands.2 Their duties,in addition to those of a professional character, were the centralizationand coordination of the professional service and supply of the dental departmentin their respective jurisdictions under general direction of the seniormedical officer through whom their reports and returns were rendered tothe chief surgeon.2 In all of these organizations large dentalinfirmaries were established in favorable locations where a number of dentalsurgeons were assigned under centralized control.2 Each hospitalin the American Expeditionary Forces was staffed and equipped for dentalservice.6 Base and evacuating hospitals usually had two dentalofficers equipped with complete base outfits and laboratories; all otherhospitals had at least one dental officer equipped with operating outfitonly.6
In the early fall of 1917, the French turned over the artillery trainingarea at Mailly to the American forces for the development of Coast Artilleryorganizations.2 As the dental officers who accompanied the firstAmerican organizations moving into this area were all recently appointedfrom civil life, it was necessary to send an experienced officer to organizeand coordinate their services. This he accomplished partly through theestablishment of a small school of instruction.2
The general plans for the organization of the dental service, A. E.F., were made and tentatively approved early in its history. The approval,however, had the provision that none of them would be put into effect untilcalled for in the general scheme for the organization of higher commands.2Such organization, however, was immediately initiated for the units ofthe expedition then present and the 1st Division being well advanced inits combat training, was the first to receive the benefits accruing fromthis development.2 Among other provisions, orders were issuedannouncing a division dental surgeon and providing for dental inspection,technical supervision, a headquarters dental clinic, and schools.2When in the early fall of 1917, the 2d Division moved into its trainingarea with headquarters at Bourmont, dental officers were assigned to itsseveral units.2 No division dental surgeon had been sent overwith it, but one was designated from the American Expeditionary Forcesin the latter part of November. Under his direction the dental serviceof this division was organized, a division school established and the otheractivities were thoroughly coordinated. Like action was taken for the 26thand 42d Divisions.2
An important development within each combat division area was the establishmentof a headquarters dental clinic.2 Each of these clinics wasserved by competent operators and was fully equipped, including completelaboratories; each was technically in charge of the division dental surgeonwho was responsible for its efficient management. Later, when divisionsentered upon the last phase of combat training, instructions were issuedfor organization within each division of a portable dental laboratory.2This unit was placed in charge of a selected dental officer conversantwith dental labora-
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tory practice, who was assisted by a specially qualified dental mechanic.This laboratory, which assumed the necessary prosthetic service for thedivision and obviated need of transferring patients to points outside itscommand, usually was located at the division field hospital, which wasfarthest from the line. After our divisions assumed combat activities,this unit assisted in first aid at the front.2
When the line of communications was organized in August, 1917, withheadquarters in Paris, all dental surgeons except those attached to divisions,detached combat organizations, or to base hospitals, came under controlof the line of communications and were assigned by its headquarters toduty with detached commands in its several sections.2 A headquartersdental clinic was organized in the headquarters of the line of communications,its first equipment consisting of the old type portable dental outfit,with which all dental officers arriving from America were supplied. Thisequipment was augmented by complete base dental outfits for two operatorsand one complete laboratory.2
After removal of headquarters, line of communications, to Tours, inJune, 1918, this clinic, remaining in Paris, became known as the attendingdental surgeon's office, district of Paris.2 It was increasedin size by the assignment of additional dental officers with full baseequipment to meet the growing requirements of its service, and continuedto function until withdrawal of the American Forces in France from thedistrict of Paris toward the end of 1919.2
When the advance section was organized in the latter part of February,1918, a supervising dental surgeon was assigned to it, and the office ofthe chief dental surgeon thereby relieved to an appreciable extent.2This supervising dental surgeon was charged with the supervision and coordinationof all elements of the dental service throughout his jurisdiction. Themajority of troops then in the area were widely scattered; e. g., engineerorganizations making preparation at a number of camps for the early arrivalof large numbers of American troops, and signal corps battalions installingtelegraph and telephone lines.2Many other detached organizations were later located throughout this section.2The dental officers attached to these several commands were all under the technical direction and instruction ofthe supervising dental surgeon, advance section.2
Approximately 35 dental officers were serving within the advance sectionat the time of its organization. This number was more than doubled thereafteruntil November, 1918. But their number remained short of that requiredand it became necessary to assign several of them to an itinerant servicein order that they might visit some of the smaller units.2
The intermediate section, Services of Supply, with headquarters at Nevers,was in operation for some time without organized dental service, but increaseof the various activities throughout its area and the arrival of dentalofficers, newly appointed from civil life and unacquainted with militaryprocedure, necessitated the appointment in April, 1918, of a section dentalsurgeon.7 The duties of this officer were similar in every respectto those outlined above for the supervising dental surgeon, advance section.2
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The wide dispersion of troops in the intermediate section also presentedmany difficulties in the furnishing dental service; furthermore, some organizationswere much expanded after arrival in France; e. g., an engineer regimentwhich landed with approximately 2,000 men had expanded before the end ofactivities to a strength of 20,000.2 Since the legal allowanceof dental officers for the American Expeditionary Forces was based on theproportion of one dental officer to every 1,000 men, and as units wereorganized when they sailed, it was not practicable to supply dental officersin a corresponding degree to those units which were expanded overseas.2
The organization of the dental service for base sections began withthe appointment of a supervising dental surgeon for base sections Nos.1, 2, and 5 in April, 1918.2 Owing to the shortage of experienceddental officers of field grade, it was necessary to utilize one officerto organize the dental service for the three sections. While it was appreciatedthat it would be difficult for one officer to exercise dental supervisionof three important base sections, this arrangement was maintained for severalmonths.2 In December, 1918, a supervising dental surgeon wasappointed for base section No. 1 (St. Nazaire) and in the same month anotherfor base section No. 2 (Bordeaux).2 This position in base sectionNo. 5 was at first filled by a temporary assignment but later a permanentdetail was made. The supervising dental surgeon of a base section dischargedduties similar to those mentioned above in connection with the advancesection, but he also exercised technical supervision over the receipt andstorage of dental supplies arriving at the port and organized and developeddental clinics at section headquarters and at the disembarkation campswhere troops were held temporarily.2
No supervising dental surgeon was designated for base section No. 3,for the surgeon of that section considered such an assignment unnecessary.2
Base section No. 4 having comparatively few American organizations oractivities, was therefore never provided with a supervising dental surgeon.The dental service of the permanent command and of detached organizationsthere was supplied by dental officers assigned to organizations temporarilywithin the section.2 A supervising dental surgeon for base sectionNo. 6 was not appointed until December, 1918.2
The dental service in the large areas occupied by depot divisions hadto be expanded in order that adequate clinics might be established in theseveral billeting towns and camps. In the First and Second Depot Divisionareas this was effected by the division dental surgeons, each of whom alsoorganized and equipped a central dental clinic and dental laboratory.2The establishment provided at St. Aignan (First Depot Division) proveda model for this type of clinic, being the first organized for group dentistry.Later, in order to meet local requirements, a course of instruction wascarried on in the first depot division area in order to develop dentalassistants from selected young men serving in medical detachments of thedivision concerned.2
At the five replacement depots, located, respectively, near Amiens (withthe American Second Corps), to the northwest of Paris, adjacent to St.Dizier, adjacent to Toul, and near the town of Meaux, the dental servicewas similar in every respect to that of the First Depot Division.2It comprised the organi-
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zation of large dental clinics where the mouths and teeth of soldierspassing through the depot might be placed in first-class condition withoutappreciable loss of time. These clinics gave full opportunity for groupdentistry and proved of the greatest value as time-saving expedients.2
PERSONNEL
The total number of officers who served in the Dental Corps, A. E. F.,was 1,876.8 The highest officer strength of that corps was 1,805,which it attained on January 11, 1919.8 Of these officers 79belonged to the Dental Corps, United States Army, 12 to the Dental Corps,United States Navy, about 225 to the National Guard, and the others tothe Dental Reserve Corps.8
The total personnel, including enlisted men of the Medical Departmentassigned to its service, approximated 4,000, of whom more than 2,000 (includingthe officers above mentioned) were graduate dentists.8 The enlistedmen, Medical Department, assigned for duty to the Dental Corps served eitheras dental assistants or as dental mechanics. Many of them were undergraduatesin dentistry.8
The full quota of commissioned dental personnel authorized at the rateof 1 to 1,000 men was never attained in the American Expeditionary Forces,and there was a shortage of over 300 dental officers at the time the armisticewas signed.8 A dental officer was sent with approximately everythousand men of large organizations embarking from the United States, butthis ratio was not extended to small organizations and to casuals, so thata shortage accrued for the American Expeditionary Forces as a whole.8This shortage was most apparent in organizations that greatly expandedoverseas, as noted above. Furthermore, it was found necessary to give threedental officers to each combat division in excess of the pro rata allowance,because of the fact that certain units; e. g., field signal battalions,machine-gun battalions, with less than 1,000 men each, operated as separateorganizations.8 But after the armistice began a general planfor equalization was carried out whereby each command was assured of dentalservice. The full quota eventually was reached by reassignment of abouttwo-thirds of the dental personnel from each division sent home, for onlya skeletonized dental force was authorized to return with the divisionwhich it had served.8 That contingent remained with the divisionfor the purpose of rendering professional services during the voyage. Thispractice of retaining part of the divisional personnel was discontinuedin April, 1919.8
Though the great majority of dental officers came from the United States,either with troops or as casuals, several American dentists, among otherpatriotic citizens already in Europe, offered their services shortly afterAmerican headquarters were established in France.2 It was announcedthat the policy of the Medical Department would be to accept the servicesof all physicians and dentists, subject to a professional examination whichwould determine that they were professionally qualified.2 Fiveapproved civilian candidates were eventually commissioned in the DentalCorps after examinations and a considerable number of enlisted men were also examined for temporary commissionsin the Dental Corps.2 A total of 123 passed their examinationsin
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France, but only 40 of these were enabled to serve as officers on accountof a War Department decision not to commission after the armistice begancandidates who passed the examination.2 Recommendations weremade to the adjutant general, A. E. F., that the 83 successful candidateswho had not been commissioned at the time of the signing of the armisticebe appointed and commissioned in the grade of first lieutenant, DentalReserve Corps (inactive status), and that their commissions be given themas a reward of merit on the date of their final discharge from the Army.2This recommendation was approved and was largely carried out. In many instances,however, the commissions were not forthcoming until several months afterdischarge.2 The regular Dental Corps was increased by nine officersthrough appointments made in the American Expeditionary Forces from theDental Reserve Corps.2
While the majority of dental officers of the American ExpeditionaryForces served in France, a large number arriving with organizations inEngland were detained there temporarily or permanently for duty at ourseveral hospitals, aviation camps, and instruction centers.8Several dental officers were detailed for duty with organizations servingin Italy and northern Russia, and in March, 1919, 20 dental officers, withenlisted assistants and full portable outfits, were sent to the UnitedStates military mission, Berlin, Germany, for special duty in the Russianmilitary prison camps.8
During the fall of 1917 it was announced that the six American basehospitals then loaned to the British would eventually come under controlof the American Expeditionary Forces, but this was never actually accomplished.2Nevertheless, a number of medical and dental officers belonging to theseunits were detached and assigned to service in the American ExpeditionaryForces. Thirteen dental officers were obtained in this manner.2
SCHOOLS
Division schools for the instruction of recently joined and inexperienceddental reserve officers were established in the early fall of 1917.2It was recognized that these officers, however well qualified professionally,were unacquainted with methods of conducting a military dental practice,with customs of the service, the system of obtaining supplies, militarycorrespondence, and the formulation of reports and returns.2The instruction, therefore, considered the methods of conducting a militarydental practice, duties of an officer, customs of the service, procurementof supplies and equipment, preparation of reports and records. The division dental schools were in charge of the divisiondental surgeons and under general direction of the division surgeon concerned.2Sessions were held two afternoons a week. The advantages of this instructionwere soon apparent in the dental service of the 1st Division, in whichthe first school of this character was established, and which became themodel for the dental section of the Army sanitary school. Similar schoolswere conducted in all the other early divisions in France.2
The plan for division instruction was changed in November, 1917, bythe organization of the dental section of the Army sanitary school at Langres.2
With a full realization that a large number of specially qualified officers,both medical and dental, would be needed for face and jaw surgery, immediately
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upon entry of the American Army into combat activities, preparationswere made to establish a post-graduate course of instructions in oral,plastic and prosthetic surgery.2 This was conducted at the AmericanRed Cross Military Hospital No. 1, Neuilly, which was selected for thispurpose because of its central location and the excellence of the facilitieswhich had long been established there.2 A competent facultyof well-qualified and experienced instructors was assembled at this hospital,under the direction of a colonel of the Medical Corps.2 Theseveral subjects of the curriculum were as follows: Special anatomy, bacteriologyand infections, face and jaw fractures, plastic surgery, oral surgery,prosthetic surgery (fracture appliances), postoperative care, Roentgenologyand photography, anesthesia, and Medical Department administration in war.2
A schedule for lectures and clinical instruction was prepared and itwas planned that the school would open in January, 1918, but this was deferreduntil March.2 Owing to the enemy offensive, which started March21 and the necessity for using in large degree as evacuation hospitalsall hospitals in the Paris district, this important course was indefinitelypostponed.2 It was finally abandoned on account of the continuousbattle activities immediately north of Paris and because of the arrivalin March, 1918, of 40 medical and dental officers, specially trained inmaxillofacial surgery. The availability of these officers, obviated anyneed for the school. They were organized with teams and distributed asdescribed below.2
A school for the instruction of enlisted men as dental assistants wasearly organized at headquarters, First Depot Division, St. Aignan.2Through diligent investigations conducted in the several units of the 41stDivision, now designated First Depot Division, and of the several casualgroups arriving from the United States as replacement troups, several hundredyoung soldiers were found and brought to this school for instruction asdental assistants. A large percentage were undergraduates in dentistrywho in consequence readily took up this special work. They were given anintensive course of instruction and upon its completion were awarded certificatesof proficiency. A list of each class was sent to the chief surgeon, A.E. F. who made assignments from it throughout the dental service.2
In order to meet the demands for competent laboratory assistants-dentalmechanics-a school was organized at the central dental laboratory headquarters,First Depot Division, in extension of the course for dental assistants.2The men sent here were given intensive instructions in primary laboratorywork for a period of one month. Upon its completion they were classifiedand those rated as most proficient were sent to a second school for dentalmechanics, which was established in the dental laboratory at American RedCross Military Hospital No. 1, Neuilly.2 Here they were givenadvance instruction in dental and oral surgical prosthesis, which comprehendedthe construction of swaged and cast-metal splints and all other fracturedjaw appliances required in maxillofacial surgery. Upon completion of asix-week course of instruction, the graduates were given certificates andassigned to duty at the various base hospitals where this special typeof surgery was being conducted.2
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After the armistice began a school for instruction of dental assistantsin oral hygiene and prophylaxis was organized at headquarters, Base SectionNo. 2, Bordeaux. It admitted students selected from among 400 enlistedmen and gave them instruction on a number of subjects pertaining to thepractice of dentistry. On graduation these men were assigned to serviceat the larger clinics.2
In February, 1919, the American University was established at Beaune.2Its dental department began work on March 12, 1919, being the first departmentto open.2
During the autumn of 1918 a special course of clinical instruction wasconducted in dental and maxillofacial prosthesis by the senior consultantin prosthetic dentistry. This officer visited each hospital center andimportant base hospital and then gave instruction to officers and dentalmechanics in the highly specialized technique of maxillofacial prosthesis.2
SUPPLIES AND EQUIPMENT
Originally the types of dental equipment for the American ExpeditionaryForces were those prescribed by the Surgeon General, viz, portable dentaloutfits for dental officers attached to field organizations, and the basedental equipment (as far as practicable) for all base hospitals.4
The plans promulgated by the headquarters, A. E. F., in the summer of1917, for the shipment of all Army supplies provided for a reserve of approximatelyfour months, but requisitions issued by the Medical Department for theshipment of supplies for the 1st Division included approximately a fivemonths reserve.4 Its subsequent instructions in regard to the2d, 26th, 42d, and 41st Divisions contemplated but a four months reserveand thereafter until the inauguration of the automatic supply table, excesssupplies were issued on the basis of three months reserve. The plan contemplatedthe storage of 15 days supply at the advance depots, 30 days supply atthe intermediate depots, and 45 days supply at base sections. While thisplan was never completely followed, it proved of value as it assured storagein France of a reserve supply. The plan was materially changed after theadoption of the automatic supply system which became effective in March,1918.2
The Medical Department automatic supply table was prepared after dueconsideration and elaborate study based on plans outlined by the generalstaff in the summer of 1917. Six months experience and observation wereutilized in its formulation and preparation. The dental department participatedin its preparation in so far as its own supplies were concerned.2
The dental tables of the automatic supply were formulated to meet actualrequirements of portable dental outfits for the 30 dental officers authorizedfor each combat division, for the outfits of the various detached commandsin the Services of Supply, and for normal replacement of these assignments.2The calculations for base dental outfits were made upon the requirementsof hospitals which pertained to divisions and of those that were to bestationed in the Services of Supply plus the normal replacement for equipmentof this character.2 The arrival of certain kinds of dental equipmentand supplies was delayed by the priority shipment of other articles-rations,clothing, ammunition, etc.-by con-
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gestion at the ports of embarkation and debarkation, by lack of adequatefacilities at the base ports for systematic storage and by lack of facilitiesfor prompt movement by rail to place of destination.2 Becauseof this delay it was necessary to make some emergency purchases of dentalequipment and supply in France, through the medical member of the generalpurchasing board in Paris.2 With a view of facilitating thesespecial purchases, a dental officer was assigned temporarily to duty withthat board. Until the automatic supply became effective and continuousthe purchase of certain articles of dental equipment was conducted on sogreat a scale as seriously to embarrass the French market.2The French authorities soon observed this situation and placed an embargoon the further purchase of dental supplies by the American Army, but uponour protest to this inhibition the embargo was raised for a few weeks andfurther purchases were authorized to the value of 1,000 francs per month.2The demands for laboratory equipment were so great and the supply so limitedin France that it was necessary to investigate the possibilities of purchasingthis type of equipment in England.2 The supply officer for theMedical Department who was ordered to London for this purpose succeededin purchasing laboratory equipment and supplies in amounts considered sufficientto last until material of this type was received from the United States,through operation of the automatic supply table.2 The BritishWar Office, on observing the depletion of this type of special material,also placed an embargo on further purchases of it by the American Army.None of this much-needed laboratory equipment which had been purchasedby the medical supply officer in England ever reached France, for the Britishvessel on which it was shipped was sunk by enemy submarines.2
The original plans for shipment of dental equipment contemplated thateach dental officer embarking with his organization for overseas duty takewith him a complete portable outfit, whose several chests were filled withsix months' supply.2 Theoretically this arrangement was eminentlysatisfactory, and proved to be so in the early months of the war beforethe overseas transportation became congested. Later, dental equipment wasplaced aboard ship with all the other elements of the cargo which wereunloaded en masse at the base ports in France. Here the dental equipmentswere lost in the overcrowded warehouses or at the large supply dumps adjacentthereto.2
In the effort to remedy this situation, a cablegram was sent to theSurgeon General recommending that previous instructions on this matterbe so modified as to direct each dental officer to carry his portable outfitas baggage, for which he would be personally responsible both on shipboardand after arrival in France.2 This plan was carried out moreor less satisfactorily and was insisted upon as the only possible methodthat would insure the dental officer having his equipment in his possessionon arrival.2 But in maintaining this plan the dental serviceran counter to that general instruction to port commanders which directedthat equipment be unloaded from ships and placed in a pool, to be subsequentlyclaimed if possible, and if not, replaced through emergency requisitionon supply depots.2
In accordance with previously arranged plans of organization, competentdental officers were assigned to duty at the important supply depots, thefirst officers thus assigned reporting at the depot at Cosnes on September1, 1917.2
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His duties were later extended to include purchase of dental equipmentand supplies through the medical member, general purchasing board. On March1, 1918, a dental officer was assigned to the advanced medical supply depot,Is-sur-Tille.2 On account of the great amount of dental suppliesreceived at medical supply depot No. 1, base section No. 1, in the earliermonths of 1918, a dental officer was placed there on duty as assistantto the medical supply officer, where he remained until June, 1919.2In 1918 one or two more dental officers were detailed to serve with theother large supply depots. These officers remained for short periods ontemporary duty.2 In the late autumn of 1918 a dental officerwas sent to the Gievres depot for temporary duty to develop certain articles of field equipment.2No dental officers were permanently assigned to supply duty at the baseports other than at St. Nazaire (base section No. 1), but the supervisingdental surgeons in the base sections were available to render counsel concerningdental equipment.2
Actual field experience in combat divisions early demonstrated the factthat the old pre-war portable dental outfits were not practicable for activefield service. The bulk and weight of the several containers seriouslyhandicapped their transportation with mobile units. After careful studythe following conclusions were reached concerning the field dental equipment:2The full portable outfits were to be retained for use at camp hospitalsand at such other detached organizations of the Services of Supply as couldreadily furnish transportation for them. Modified portable outfits packedin three chests were provided for combat divisions.2 These consistedof the essential equipment of medicines and of a small stock of supplieswhich were considered sufficient for the practice of field dentistry.2
An even more reduced outfit, termed "campaign equipment," was providedfor the use of dental officers with divisions in battle areas.2This consisted of a dental engine chest and its normal contents, plus thecontents of the emergency dental kit. This kit was designated personaldental equipment and was to be carried by each officer at all times whilein the combat area. It comprised a few essential instruments and medicinesin cloth rolls and a very small amount of supplies, all contained in HospitalCorps pouches carried over the shoulder by the dental officers and theirassistants.2 Thus officers were enabled to render first-aiddentistry at all times for the relief of pain and for minor oral surgicalor dental operations. This modification of dental equipment helped solvemany of the transportation problems for the dental service in combat divisions,and while it increased the weight carried by dental officers, it provedadvantageous by making it possible for anyone requiring emergency dentalservice to obtain it at any time from the dental officer of his command.2
In combat divisions, the transportation of dental equipment and supplieswas always a problem and when not carried individually, a source of irritationto division commanders, transportation officers, and division surgeons.2This was largely due to the fact that no provisions had ever been madein the Tables of Organization for dental personnel, commissioned and enlisted,or for dental equipment. Omission in these tables of the Dental Corps andof provision for transport of its supplies resulted in the loss of muchequipment and the consequent temporary lack of dental service in severalof the divisions.2 The
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1st Division on its movement into a combat area in May, 1918, foundit expedient to abandon all its dental equipment on account of the lackof transportation, for this material had not been considered by its transportationofficer in making his allowances for the rapid movement of equipment andsupplies.2 This loss was immediately investigated and effortswere made for finding and salvaging the abandoned equipment. Though notfound at the time it was subsequently redeemed through the salvage service.2In the interim, through efforts made at intermediate medical supply depotNo. 3, the dental service of the division was reequipped with modifiedportable outfits. As a result of the information obtained by the chiefdental surgeon, who was sent to investigate the matter, the dental service,both personnel and equipment, was for the first time provided for in divisiontables of organization.2 Instructions on the subject were publishedin General Orders, No. 99, G. H. Q., A. E. F., June 19, 1918, which providedfor a divisional dental service comprising 31 officers and 32 enlistedmen, with 10 portable dental outfits, 20 modified portable outfits and1 portable laboratory. The total weight of this equipment was 12,000 poundsand its bulk 574 cubic feet.2
A portable dental laboratory was also adopted to meet the prostheticrequirements of a division.2 All essential equipment for thiswas packed in one dental supply chest, which weighed approximately 200pounds.
When the several army corps were organized provision was made for supplyparks at or near the headquarters of each, except for the Second Army Corps,which was operating under the British.2 In accordance with theAbbeville agreement replacement supplies were to be furnished by the BritishArmy for the troops composing divisions of that corps. Therefore, the AmericanExpeditionary Forces were not directly concerned in its replacement suppliesuntil the late fall of 1918, when the corps reverted to American control.2The initial dental equipment and supply for the troops in that corps wouldhave been amply sufficient to carry them through their campaign under Britishcontrol, had it not been that all their equipment was reduced to a minimumand excess supplies abandoned immediately prior to their entry into thecombat zone. Each division was directed to organize supply dumps in itsarea for replacement purposes.2 The corps parks and divisiondumps were fed from the advanced medical supply depot, Is-sur-Tille, aswere also the army supply depots at the time of the organization of theFirst Army, August 12, 1918.2
Great difficulty was experienced in procuring the necessary specialequipment for maxillofacial surgery and for the prosthetic and reconstructionprocedures required in the practice of that specialty.2 Adequateconsideration and study had been given this subject prior to the departurefrom the United States of specialists in this line, and provision had beenmade whereby special chests containing maxillofacial unit equipment wouldbe shipped immediately on their departure.2 These plans failedand the much needed special equipment for this service was not receiveduntil after the signing of the armistice. It was found subsequently in the midst of a quantity of supplies at the port ofMarseille.2 Loss of this equipment necessitated the purchaseof all articles of this type that could be found in France and the manufactureof such parts of it as were not found in that market.2 The Britishand French afforded the
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benefit of their experience in the treatment of face and jaw woundsand this greatly appreciated assistance helped materially in procuringmuch of this special equipment through purchase and manufacture.2Though this equipment was not available on many occasions when it was neededby the dental officers at evacuation hospitals, mobile hospitals and atsome few base hospitals, the deficiency was well met by individual ingenuityand by improvisation.2
Generally speaking, the system of dental supply through operation ofthe automatic table was satisfactory, this being especially true in regardto field equipment.2 Theoretically, the automatic table metthe situation in an admirable manner, and had ocean, rail, and storagefacilities permitted its movement according to the priority schedule, noshortage or delayed replacement or replenishment would have occurred.2As it actually worked out, the lack of laboratory equipment and supplieswas embarrassing on several occasions and there was a long period extendingover several months when the shipment of greatly needed base outfits, includingelectrical equipment, was withheld.2 Consequently projects forinstallation of this type of equipment in all base hospitals and majorclinics were delayed. A large consignment of this class of equipment andsupplies arrived in November, 1918, and was thus available for the severalhospitals and the many large clinics then being established in base sections,embarkation camps and army areas.2 In these places efforts werebeing made to render complete dental service for the troops who had beentemporarily deprived of it, through the exigencies of an active campaign.2
The following special appliances were developed in the American ExpeditionaryForces to meet the requirements of its dental service:2
AMEX DENTURE
A denture cast in aluminum of one piece, wherein the base plate andthe teeth themselves were reproduced in this light, inexpensive metal.This process of plate construction lent itself admirably to the militaryservice, inasmuch as more than 98 per cent of the dentures required werefor partial loss of teeth. For full dentures, well-matched porcelain incisorsand cuspids were attached thereto solely for esthetic purposes. These appliancesmaterially reduced the expense of dentures, the supply stock, and necessaryequipment.2
AMEX CASQUE
A surgical appliance for face and jaw reconstruction; the further developmentof a similar article used in the surgical services of the British and FrenchArmies. It consisted of an adjustable steel band, fitting around the circumferenceof the head, with adjustable cranial bands and an adjustable perpendicularrod and horizontal face bow. Its use in facial and jaw reconstruction permittedof absolute fixation for either soft parts or osseous fragments, and itwas of great value in this class of highly specialized surgery.2
EMERGENCY KITS
These consisted of two Hospital Corps pouches to be slung from the shoulder,one for the dental officer and one for his enlisted assistant.2 Theycontained the essential instruments and medicines, secured in cloth rolls,and sup-
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plies for administering first-aid dentistry and for the simpler operationsof field dentistry. They were prescribed articles of personal equipmentfor dental officers and were ordered carried whenever combat organizationsentered the combat area. Through them it became possible for the troopsto receive emergency dental treatment for the relief of pain without leavingtheir commands.2
FOLDING TRENCH CHAIR
This article of equipment was developed for the purpose of supplyinga seat, with stabilized head rest, in order that dental services mightbe rendered conveniently in trenches, dugouts, and advanced dressing stations.2It was made of aluminum, reinforced by steel rods and was capable of beingfolded and carried in a musette bag with the two pouches of the emergencykit. It weighed, complete 4½ pounds.2
DENTAL AMBULANCES
The difficulties of supplying dental care to troops at outlying stationsemphasized the great need for dental ambulances, which when fully equippedas "mobile dental clinics" would be capable of traveling under their ownpower from station to station.2 Plans were made to have suchmobile dental clinics; further, it was planned that they would remain ateach station a sufficient number of days to permit of the emergency dentaltreatment of the command. Eleven such vehicles voluntarily contributedin America, and only requiring transportation overseas, unfortunately remainedat a home port of embarkation for many months through lack of shipping facilities. Several communications urgingtheir transportation were made by cable and letter to the United States,but these were fruitless.2
Two dental ambulances were, however, presented in France to the dentalservice, A. E. F.2 One, donated conjointly by two American dentists,had come originally from American Red Cross hospital at Neuilly. It wasthoroughly overhauled, equipped, and put in charge of a dental officerNovember 1, 1917, being designated dental ambulance No. 1, A. E. F.2Assigned to the motor transport division, Mailly, then located back ofthe line to the southeast of Soissons, this vehicle continued to operateduring the entire period of activities, its station assignment being withone or another of the several units of the motor transport corps in thevicinity of Mailly. The second ambulance was presented to the dental serviceby the American Red Cross, through its medical director in Paris.2This ambulance was delivered at headquarters, Chaumont, about March 1,1918, and was immediately placed in charge of a dental officer and designateddental ambulance No. 2.2 Its station assignment was with theAir Service of the advance section, with headquarters near Colombe la Belle,and its first location at the second bombardment airdrome.2Throughout the entire subsequent period of activities this vehicle renderedservice to the several small detached stations adjacent to the headquarters,Air Service.2
INSPECTION
It was early realized that the best service could be obtained only throughproviding direct supervision and inspection of dental work by qualifieddental inspectors.2 Instructions therefore were issued requiringthat each dental sur-
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geon in an administrative position make regular and systematic inspectionsof the dental officers attached to the command.2 These inspectionswere to consider personnel, both commissioned and enlisted, disciplineand efficiency, character of service, etc. Reports of inspections wereforwarded through medical channels to the office of the chief surgeon,A. E. F. In addition to these inspections, it was found necessary at firstfor the chief dental surgeon to make frequent visits to the headquartersof each division in the American training area. There he inspected theoffice records, and the methods of the division dental surgeon, as wellas the headquarters dental clinic.2 At the same time he gaveinstructions to remedy defects or to effect a development of the service.As these inspections by the chief dental surgeon were later extended toinclude base hospitals, he visited during the first six months of the AmericanExpeditionary Forces, base hospitals Nos. 15, 18, 21, 23, 31, 32, 36, andAmerican Red Cross Hospital No. 1, Neuilly. His personal inspections intraining areas were made regularly until March, 1918, when the chief surgeon'soffice was moved from general headquarters, Chaumont, to the headquartersof the Services of Supply at Tours.2
SERVICE RENDERED
The character of the dental service in the American Expeditionary Forcesdiffered considerably in different zones and from time to time, dependingon resources and campaign activities.2 When the combat divisionswere in training areas it was possible to conduct a high-class tooth-conservationservice, with a view of rendering all men dentally fit for the period ofthe campaign.2 Therefore, consistent efforts were made thento survey and record oral and dental conditions for the entire personnelof organizations. These records were carefully studied so as to give priorityfor cases requiring oral prophylaxis as a health measure; i. e., for extractionof broken-down teeth and roots, evacuation of abscesses, and removal ofrough calcareous deposits.2 This was followed later by suchfilling operations for tooth conservation and masticatory restoration aswere deemed practicable.2 Later, when divisions entered combatareas, and when dental outfits were reduced to combat equipment it wasimpossible to give more than emergency treatment for the relief of pain,and dental service was necessarily of a simpler character.2On the march, and during actual engagements, as already mentioned, dentalofficers and enlisted assistants carried emergency kits, for the sole purposeof rendering immediate treatment, which mainly consisted of extraction,minor surgical operations, medicinal applications and sometimes plasticfillings, so that the soldier might return to the front line without lossof time.2
During the armistice, when the troops had returned to rest and billetingareas for the winter, the character of dental service again changed. Morecareful consideration was now given to tooth conservation, through permanentfillings, tooth restorations, and the construction of crowns, bridges,and dentures.2 Every effort was made to put the teeth of themen in first-class condition, prior to their return to the United Statesand release from service.2 The number treated for the monthof March, 1919, as compared with the number treated in September, 1918,showed an approximate gain of 300 per cent in dental activities and accomplishments.2The former was a period of
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rest, the latter one of active field operations. The consolidated reportfor February, 1919, shows that during that month 119,792 persons were treatedand 183,031 dental operations performed.2
The service rendered at base hospitals was of high order at practicallyall times. Their superior equipment materially enhanced the performanceof high-grade professional work, but during the stress of battle the dentalservice rendered at these units and at evacuation hospitals consisted mainlyin the emergency treatment of wounded with special consideration of faceand jaw cases.
The practice of dentistry was carried on very thoroughly wherever moderndental equipment, consisting of base dental outfits with electrical apparatus,high-low base chairs, white-enamel steel cabinets and complete laboratories,was installed.2 Such facilities were provided at the large dentalclinics organized in the base sections, Services of Supply, in embarkationareas, at hospital centers and at several important headquarters.2
The various base section dental clinics and those at replacement depot,St. Aignan, embarkation area, Le Mans, American University, Beaune, andat the central dental infirmary, district of Paris, were organized forthe purpose of centralizing, standardizing, and directing dental service,for coordinating the problems of equipment and supply, and for obtainingthe greatest efficiency through technical direction and by friendly competition.2From 10 to 30 operators were occupied in these large clinics; they becameshow places of great interest to visitors.2
Comparatively few dentures were required by the (approximately) 2,000,000men in the American Expeditionary Forces, and those constructed were mostlypartial dentures for the replacement of a few lost teeth. The full denturesrequired were less than 2 per cent of all dentures constructed.2
A consolidated report covering dental service rendered in the AmericanExpeditionary Forces from July, 1917, to May, 1919, inclusive, shows thata total number of 1,396,957 persons were treated; 2,626,368 sittings weregiven; 497,948 treatments (medicinal) were administered; 2,013,580 operationsperformed (which included 1,605,424 fillings and 384,427 extractions);and the following prosthetic operations performed: 60,387 crown and bridgeconstructions, including repairs and resets, and 13,140 denture constructionand repairs.2
In the early months of the American Expeditionary Forces, considerationwas given to the selection of certain base hospitals and providing thoseso selected with special personnel and appliances for handling the maxillofacialcases of the American Army.2 The following hospitals were tentativelychosen for this work: Base Hospital No. 18, Bazoilles; Base Hospital No.15, Chaumont; Base Hospital No. 21, Dijon; Base Hospital No. 26, Angers;Base Hospital No. 6, Bordeaux, and Base Hospital No. 8, Savenay.2Theseunits were held in reserve for the accumulation of cases that would requireevacuation to the United States.2 These plans were changed inMay, 1918, upon the arrival of the above-mentioned group of 40 specialistsin general and dental surgery for duty in the maxillofacial surgical service.These officers came over under direction of a medical officer who was awell known specialist in this line of surgery and who was soon designatedchief consultant of maxillofacial surgery, A. E. F.2
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The dental personnel of this group soon came under the administrativecontrol of the dental division of the chief surgeon's office.2The chief surgeon decided to make temporary assignment of a medical anddental officer to each of the several important centers in England, Belgium,and France, where this work was being done, in order that they might observeand study the latest method of procedure.2 They could be sparedat this time because American troops had not yet largely entered into activecombat, nor had the special equipment which these officers required, beenreceived from the United States.2
Upon the return of these officers from their tours of observation, theywere organized by the chief surgeon into maxillofacial teams, each composedof one surgeon and one dental surgeon, and were assigned to the importanthospitals or to hospital centers.2 The original plan of designatingcertain hospitals for maxillofacial surgery was therefore abandoned, thenew arrangement providing that each important hospital center and everyevacuation hospital would carry on this work.2 Base HospitalNo. 115, Vichy, was designated the "head hospital," and an adequate groupof surgical and dental specialists was sent there to organize and developit.2
Between 2,000 and 2,500 cases of face and jaw injuries occurred amongthe American wounded.2 Of this number, about two-thirds treatedin the hospitals in France were cured, and were returned to duty there.2About700 cases of severe type, requiring reconstruction operations, were evacuatedto the United States.2 The cases selected for such evacuationwere of five classes: First, compound, comminuted fractures of the jawin process of consolidation and having splinted fixation; second, compound,comminuted fractures, with delayed union due to sequestra, presence ofinfected teeth or foreign bodies and requiring long-continued drainage-splintedwith fixation; third, united fractures with loss of bony substance, requiringbone graft or prosthetic replacement-splinted with fixation; fourth, caseswith healed scars involving either of the conditions mentioned above andrequiring a series of plastic operations; fifth, cases of any of the abovetypes, with extensive loss of soft tissue partially healed and distorted,for corrective plastic operations. The first convoy of these wounded embarkedin October, 1918.2
The technique employed in the hospitals of the American ExpeditionaryForces for the treatment of the injuries classed in the foregoing categorieswas based to a large degree upon that developed through the experiencegained by the French, British, Belgian, and Italian services, for in thesearmies, through opportunities covering a period of four years, severalmen had become masters in maxillofacial surgery.2
The selective methods of making bone grafts, in cases in which appreciableloss of bony substance occurred, were of three types.2 First,free graft from a rib, the tibia, or the crest of the ilium; second, osteoperiostealgrafts from the tibia; third, pedicled graft from the mandible itself,shifted into position.2 Some form of splint was used in allthese cases to assure fixation of fragments in normal relation.2The policy ultimately adopted for this class of cases contemplated thatthe simpler ones would all be cared for in the hospitals in the AmericanExpeditionary Forces and that the severer cases, after the first stagesof the work, would be evacuated to a hospital at a base port, where theywould
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receive the properly adjusted "open bite" splints to prepare them forthe ocean voyage.2 In this connection, it should be remarkedthat none of the "closed bite" splints could be used in these cases, forit was feared that because of seasickness they would endanger the lifeof the patients through subjecting them to strangulation by vomitus.2
Many types of splints were made for these cases and many names weregiven to the several types.2 With a view of standardizing them,the following terms were finally adopted: Interdental splints were splintsmade for one jaw, either upper or lower. Intermaxillary splints were thosemade for both upper and lower jaw and connected by some mechanical methodfor fixation.2 This latter type was made for both the "open-bite"method and the "closed-bite" method, to meet requirements, and, as manyof the cases required at different times both the open- and closed-bitesplint, a combination splint was devised which could be used in eithercircumstance.2 This splint was provided with lock pins throughthe bicuspid region, which held the upper and lower parts firmly togetheras a closed bite, but when the pins were withdrawn and the jaws opened,the insertion of metal stilts to retain the open bite was feasible. Thesestilts were firmly held in position by the reinsertion of the lock pins.2
PERSONNELa
(July 28, 1917, to July 15, 1919)
Col. Robert T. Oliver, D. C., chief.
Lieut. Col. William S. Rice,D. C.
Maj. Richard K. Thompson,D. C.
First Lieut. John D. Brown,D. C.
REFERENCES
(1) Memorandum from the chief surgeon, A. E. F., to thechief of staff, A. E. F., July 28, 1917. Subject: Weekly war diary. Onfile, Historical Division, S. G. O.
(2) Report from Col. Robert T. Oliver, D. C., chief ofthe dental service, A. E. F., to the Surgeon General, U. S. A., April 13,1921. Subject: The dental service. On file, Historical Division, S. G.O.
(3) Letter from The Adjutant General to the Surgeon General,June 19, 1917. Subject: Extract from cablegram (cipher cable) receivedat War Dept., from Page to Secretary of State, London, June 12, 1917. Onfile, Record Room, S. G. O. (138036).
(4) Confidential Orders, No. 2, par. 2, War Department,Washington, D. C., June 25, 1917. On file, Personnel Record, PersonnelDivision, S. G. O.
(5) Par. 8, Special Orders, No. 76, general headquarters,A. E. F., August 23, 1917.
(6) Report from Brig. Gen. Jefferson R. Kean, M. C., tothe chief surgeon, A. E. F., April 24, 1919. Subject: Data to be used bymilitary board of allied supply. Copy on file, Historical Division, S.G. O.
(7) Par. 77, Special Orders, No. 37, headquarters, intermediateSection, Nevers, A. E. F., April, 1918. On file, A. G. O., World War Division,Intermediate Section (Special Orders).
(8) Report from the chief surgeon, A. E. F., to the SurgeonGeneral, U. S. A., May 1, 1919. Subject: Activities of the chief surgeon'soffice to May 1, 1919. On file, Historical Division, S. G. O.
aIn this list have been included the names of those who at one time or another were assigned to the division during the period July 28, 1917, to July 15, 1919.
There are two primary groups-the heads of the division or the section and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
