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AMEDD Corps History > U.S. Army Dental Corps> Walter D. Vail and the History of the U.S. Army Dental Corps

DENTAL BULLETIN SUPPLEMENT TO THE ARMY MEDICAL BULLETIN

VOLUME 5, NO. 2 (APRIL 1934)

THE DENTAL CORPS

(Continued from page 47)

The distribution of dental officers on June 30, 1903, was as follows: United States, 12; Philippine Islands, 18; total 30. (Ann. Rept., S.G, F.Y. 1903).

The following pertinent paragraphs concerning activities of the Dental Corps are taken from The Surgeon General’s Annual Report to the Secretary of War for the fiscal year ending June 30, 1903. (Note: Several tables appearing in the report on diseases and injuries of the teeth and gums treated, operations performed and restorations made, are omitted on account of lack of space: W.D.V.).

* * * The whole number of officers (regular and volunteer), enlisted men, female nurses, and general prisoners of the Army treated during this period by dental surgeons is 16,161, or 20 per cent of the mean strength of the entire Army, while operations and treatments upon the teeth, gums, mouth, and jaws reach the large number of 49,483, an average of 3.06 operations for each person treated.

Prevalence of Dental and Oral Diseases.

The prevalence of dental caries and other dental and oral diseases among the troops, as shown by the following tabulated statistics, is very marked, and when the fact is taken into account` that officers and enlisted men have been chosen for service after a rigid examination to determine their physical perfection, and that all but those in perfect health and of good physical development are rejected, it seems evident that excessive physical and mental strain predisposes the individual to dental diseases and that great care should be exercised in the examination of the teeth, a full complement of these organs in a sound

condition being such important factors in maintaining the general health of the individual.

* * *

* * * Dental diseases appear to be as prevalent among the officers and enlisted men of the Army as among individuals in civil life of the same social class, while with the troops who have served in the Philippines these diseases are much more prevalent, as a reference to the “Recapitulation of diseases and operations” will show. The increased percentage of dental diseases among the troops in the Philippine Islands over those stationed in the United States is 18.27, while among the troops in Cuba and Porto Rico it is 21.17. The increased percentage in Cuba and Porto Rico over those stationed in the Philippine Islands is due to the fact that these diseases are much more prevalent among the native troops of Porto Rico than among the white troops. Good, or at least serviceable, teeth are very necessary as a means of maintaining the general health, and consequently the highest efficiency of an army, particularly when campaigning in the tropics where conditions of the climate and necessary changes in the habits of life are so enervating and debilitating to the general system. Resistance to disease under these conditions is greatly lessened and the individual is consequently predisposed to a certain class of diseases, among which are dental caries, pulpitis, pericementitis, dento-alveolar abscess, pyorrhea alveolaris, necrosis of the jaws, and inflammatory and ulcerative conditions of the gums, of the oral mucous membrane, the throat, and tongue.

* * *

Character of Service.

The character of the services of the dental surgeons has changed considerably since the period covered by the last report. Then it was largely of an emergency nature, the chief aim and effort being to give relief from suffering and to return the men to duty with the least possible delay. Now, with the full complement of dental surgeons on duty, more time and attention are devoted to teaching methods of prophylaxis, to conserving the teeth by proper treatment of diseased conditions, restoring

them to usefulness by inserting appropriate fillings, and replacing lost teeth by suitable crowns, bridges, or artificial dentures.

Recapitulation of Diseases and Operations.

	United States	Philippine Islands	Cuba and Porto Rico	Total
Mean strength of troops on duty during year 1902	39,736	37,768	3,274	80,778
Total diseases and injuries treated	16,826	26,085	2,097	45,008
Percentage	42.85	61.12	64.02	55.72
Total operations	18,971	28,115	2,397	49,483
Percentage	47.74	74.44	73.32	6126

(Note: The number of teeth extracted as reported under table “Operations upon the teeth and gums” were: United States, 2,017; Philippine Islands, 3,632; Cuba and Port Rico, 394, a total of 6,043.—W.D.V.)

The large number of teeth reported as extracted in the United States and the Philippine Islands is due to the great prevalence of dental caries of an acute type among troops serving in the tropics or recently returned, which causes a very rapid destruction of teeth, making extraction necessary, because movement of troops would not in many cases permit the delay required to properly treat and fill them.: It has been repeatedly impressed upon the dental surgeons by the members of the supervising board that their “chief duty was the conservation of the teeth,” and that “no tooth should be extracted that gave any promise of responding to treatment or being restored to usefulness by appropriate filling or crowning, provided the individual could devote the proper amount of time and attention to the necessary treatment.” The comparatively small number of restorations of teeth by crowning, bridging, and the insertion of artificial dentures is due to the fact that a majority of the dental surgeons are only furnished with an operating outfit. The mechanical laboratory is too cumbersome to be transported from station to station in the ordinary itinerary or dental surgeons, consequently- all cases needing prosthetic treatment are sent to the base stations in the Philippines and to such general hospitals

and large stations in the United States as have a dental surgeon on constant duty.

* * *

The foregoing interesting tabulations, with professional comments, have been ably prepared for this report by Dr. John S. Marshall, contract examining and supervising dental surgeon, U. S. Army. The work of the contract dental surgeons has been of a high order and deserves commendation. Reports from experienced officers of the Army indicate that appreciation of the faithful and efficient services of the army dentists is steadily growing among officers and men.

The average number of enlisted men detailed from the Hospital Corps as “dentists’ assistants” and “clerks” for the year January 1, 1902, to December 31, 1902, inclusive, was 36. These men deserve mention, for without the valuable assistance they were able to perform, after they had been trained in their new duties, the great amount of service that has been rendered by the dental surgeons could not have been accomplished.

(End of Surgeon General's Report)

In connection with reports of the Dental Corps, the activities of the Corps in the Philippine Islands were covered in annual reports to the Surgeon General, prepared by Dr. Robert T. Oliver, Examining and Supervising dental surgeon. On October 15, 1904, Dr. Oliver made a report covering the period from April 1901 to June 30, 1904. The following is taken from the latter report:

HEADQUARTERS PHILIPPINE DIVISION

Office of the Chief Surgeon

Manila, P.I., Oct. 15, 1904.

To the Surgeon General, U.S.A.,

Washington, D.C.

(Through Military Channels.)

Sir :-

I have the honor to present herewith a report of the services rendered by the Dental Corps, U.S. Army, in the Philippines Division from April 1901 to October 1904; embracing the an-

nual report for the fiscal year ending June 30, 1904, which was not prepared at the usual time by reason of the absence of the Examining and Supervising Dental Surgeon on temporary duty with the United States Legation Guard in Peking, China.

STRENGTH OF CORPS ON DUTY IN THE DIVISION

Since the passage of the act of Congress, Feb. 2, 1901, creating a Dental Corps, there has been a total of 25 Dental Surgeons on duty in the Philippines Division, as follows:

Name	Date of Arrival	Date of Departure	No. of Months Service
S. W. Hussey	April 5, 1901	March 5, 1903	23
E. J. Craig	April 19. 1901	July 14, 1903	26 plus
W. H. Ware	June 28, 1901	July 15, 1904	36 plus
R. W. Waddell	June 28, 1901	July 15, 1904	36 plus
H. C. Rietz	June 23, 1901	July 15, 1904	36 plus
S. D. Boak	June 28, 1901	July 20, 1904	36 plus
C. E. Lauderdale	June 28, 1901	July 20, 1904	36 plus
F. F. Wing	June 28, 1901	July 20, 1904	36 plus
A. Carpenter	July 24, 1901	March 5, 1903	19 plus
C. A. Petrie	July 25, 1901	Feb. 12, 1902 (died)	6 plus
D. E. Foster	July 27, 1901	July 14, 1903	23 plus
J. C. Whinnery	Aug. 17, 1901	Aug. 20, 1904	36 plus
G. L. Mason	Aug. 17. 1901	Aug. 15, 1904	35 plus
F. P. Stone	Aug. 17, 1901	Oct. 10, 1903	25 plus
F. H. Wolven	Sept. 6, 1901	Sept. 15, 1904	36 plus
C. J. Long	Sept. 17, 1901	Sept. 17, 1904	36
R. T. Oliver	Oct. 16, 1901	Oct. 15, 1904	36
J. A. McAlister	March 10, 1902		31 plus
J. D. Milliken	April 12, 1902		30 plus
G. H. Casaday	April 21, 1902		29 plus
J. R. Bernheim	May 26, 1902		28 plus
R. H. Rhoades	Jan. 4, 1904		9 plus
W. G. Hammond	March 2, 1904		7 plus
G. E. Stallman	Sept. 2, 1904		1 plus
G. I. Gunckel	Oct. 3, 1904		2 weeks

Not all of this number have been on duty at any one time, owing to vacancies created by reason of death, and transfer to the United States, the largest number being twenty dental surgeons in 1902, or two thirds of the entire strength of the Corps, to wit:

June 30, 1901 11 dental surgeons.

June 30, 1902 20 dental surgeons.

June 30, 1903 18 dental surgeons.

June 30, 1904 17 dental surgeons.

The present quota of fourteen (14) dental surgeons, prescribed for this Division, per letter S.G.O., April 21, 1904, is not considered adequate to meet the requirements of the 15896 troops on duty here (August returns), unless it is contemplated that only the white troops (numbering 11896) are to receive dental

treatment, and even then it is doubtful, owing to the large number of stations to be visited. The demands for dental treatment by the native troops, numbering 4,484, are steadily increasing, showing the effects of their higher education and demonstrating our inability to render more service than, heretofore contemplated for the relief of pain to native troops, when they have been stationed with white troops at stations visited by a dental surgeon, or, when at substations; but in a few instances they have been given conservative treatment when the time of the dental surgeon would permit. In this connection it would seem, if the native troops are considered a part of the Army, that it is important to keep them in as fit condition for martial duty and long continuous service as it is for the white troops, who spend only a short period of their time in the division. Instructions along this line, defining the specific duties of dental surgeons in regard to the treatment of native troops, will be greatly appreciated by those dental surgeons on duty here. The question has frequently arisen, and on being referred to. this office, has been settled by stating that owing to the small number of dental surgeons in the Division, it has been considered impracticable to assign one to duty at Scout stations and that those native troops who were actually suffering would have to be transferred to the nearest dental surgeon for emergency treatment.

The quota of fourteen dental surgeons is hardly considered adequate for the white troops, on account of the large number of stations to be visited, necessitating a great loss of time for the dental surgeon on account of transportation facilities with infrequent sailings, indirect routes, and uncertainty of sailing dates; which makes it necessary for the dental surgeon to have every thing packed for shipment at the earliest expected date of the inter island transport’s arrival, when, usually, he is compelled to wait several days in idleness before he finally gets away.

At regimental posts where the dental surgeon is not moved for a considerable length of time, the character of his service is based from the standpoint of our greatest efficiency i.e. tooth conservation; but at the smaller stations where he is rushed for a short period, it of necessity is based upon emergency treatment in order that the greatest number may obtain benefits in the smallest space of time.

This unfortunate condition of affairs is much to be regretted, as it is considered only fair that every soldier should have an equal opportunity of having his teeth filled and saved, especially when he is detailed for duty at remote stations in this division where it is absolutely impossible for him to obtain dental treatment from civilian dentists, even at his own expense. It is believed that there should be at least seventeen (17) dental surgeons assigned to duty in this Division, as follows:

One (1) Supv. in C.S.O., P.D.

Two (2) Dental Base Station No. 1, Manila.

Six (6) Dept. of Luzon.

Three (3) Dept of the Visayas.

Five (5) Dept. of Mindanao.

ASSIGNMENTS, CHARACTER OF SERVICE, ETC.

The assignment of dental surgeons and the entire management of the Corps in the Division was controlled from this office until Aug. 8, 1903; upon which date G.O. No. 81, Hdqrs. Division of the Philippines, directed that dental surgeons on duty in departments would report by letter to the commanding generals of the respective departments for assignment to duty. This inaugurated a change in the control of dental surgeons to the Chief Surgeons of Departments, that did not, at first, produce beneficial results, on account of the unfamiliarity of medical officers with the technicalities of this particular branch of the service. Their errors of judgment in regard to length of time required for the dental treatment of the strength of command at various stations, character of treatment necessary, etc., were early manifested and corrected as soon as understood. However, it must be stated that the character of the Corps service was not maintained at the standard previously prescribed, as there seemed to be an idea prevailing with Chief Surgeons to eliminate as much as possible the lengthy treatment of teeth, often necessary to save them, and fillings of a permanent character. This was done that the dental surgeon could give some emergency service to a large number of patients and hurry on to the next station to continue the same unsatisfactory and ill-advised treatment. In this connection it seems pertinent to quote the following from a

letter of instruction, dated August 22, 1903, and sent to all dental surgeons in a department, by a Department Chief Surgeon, to wit:

“In view of the largest amount of dental work needed in the department, and the limited number of dental surgeons, it is necessary that their operations be expedited as much as possible. It is therefore directed that none but emergency work will be done at the several stations * * * protracted treatment with the hope of ultimately saving a tooth * * * is one of the main causes of delays in dental work.”

This instruction given to five dental surgeons on duty in one department was not consistent with the main object of the Dental Corps’ creation, and certainly was in contradistinction to instructions issued from this office after the reorganization of the Division, January 14, 1903, to wit:

“Since the great reduction and concentration of troops in the Division it is ;contemplated that increased length of time at stations will give greater opportunities for tooth conservation, permitting more extended treatment in cases of Pyorrhea, Alveolaris, Dento-Alveolar Abscess, Putrescent Root Canals, Chronic Pulpitis, Pericementitis, Gingivitis, etc., and for the permanent filling of all morsal surface cavities and compounding morsal surfaces (in bicuspid and molar teeth) with metal and the filling of incisor and cuspid teeth with gold, when the consent of the patient permits. It is desired that hereafter efforts be made to finish all dental treatment required in the mouth of each patient and it is recommended that all emergency cases be taken early in order that sufficient time can thus be obtained later to give each operative case the required attention.”

It will be observed that the tenor of the two letters was diametrically opposed and it can be imagined with what confusion it was received by the dental surgeons of that department who had nothing else to do but obey and flit around among the

stations, rendering emergency and temporary treatment to many, with no material permanent benefits to any. This condition continued only about two months when the error was so apparent that the above quoted instruction had to be modified as to length of time required at stations and character of service required. This the Department Chief Surgeon deemed proper after due consideration and consultation. The following quotation from the Chief Surgeon’s letter to this office is cited:

“In view of the apparent anomaly in our respective relations to dental surgeons, I desire to assure that I shall consider it a pleasure and my duty to avail myself of your knowledge and experience in managing the part of the work connected with the dental surgeons assigned me.”

The two other department Chief Surgeons had similar experiences in managing the dental surgeons to the best advantage of the service, but were not so preemptory in their demands for only “emergency work.” The final settlement of the matter was to the effect that in all matters having a professional bearing or requiring a technical knowledge the instructions should be issued by the supervising dental surgeons, under which assignment every thing began to run smoothly again, until the great reduction in the number of dental surgeons for the Division.

EQUIPMENTS AND SUPPLIES

The portable outfits used by dental surgeons at the various stations throughout the department are very compact and complete, and are considered wholly adequate to meet the requirements for operative dental treatment in the Division.

The Post or stationary outfits used only at dental base stations could be improved by furnishing various articles of dental furniture, such as electric appliances, fountain cuspidors, etc., that would give a more complete and up-to-date equipment to these important stations, minimize the expenditure of the dental surgeon's energy, facilitate and expedite his service.

The Laboratory outfit at base stations seems complete in every, detail for the needs of the Division. They could be im-

proved, however, by the installation of electric lathes, for the above stated reasons.

* * *

The Dental Stock at Medical Supply Depot, Manila, has been in regard to many articles inadequate to meet the demands of dental surgeons in the Division. This has been due largely to the great delay in receiving supplies after the approval of annual requisitions. The last annual requisition was forwarded Feb. 25, 1904, and supplies did not begin to arrive until June, 1904, and then only small part, with additions coming Sept. 10, and a large part yet to arrive. During the past six months the following articles of the operative supplies have been exhausted

* * * * Of all these articles of shortage, the only ones that could be purchased in the local market were: Rubber, red and pink. Instructions were therefore issued from this office directing dental surgeons to carefully sterilize all pieces of rubber dam after using so that they could be reuse ; to use nerve broaches instead of Donaldson’s cleansers; surgical ligature silk in place of floss silk, waxed ; and metallic mercury in place of mercury redilstilled until the arrival of supplies from the United States. Instructions were also sent to the Medical Supply Officer to issue the above named articles in the place of the ones requested (not on hand) to meet the emergency.

In this connection it is the opinion of the writer that semiannual requisitions for dental supplies for the stock at Manila Medical Supply Depot would obviate the recurrence of this shortage of stock and incidently insure such supplies as rubberdam, nerve broaches, root canal cleansers, oxyphosphate cement and several other articles being in a better condition, as they deteriorate in this climate by long storage.

It would be a material benefit to the Medical Supply Officer here if the issuing Medical Supply Officer in New York would notify him of the articles on his requisition that could not be issued; as it would then give an opportunity to purchase said articles in the local market to meet an emergency, instead of having to wait several months to see if said articles would arrive in the next consignment of goods.

(To be continued)