History

UNITED STATES ARMY IN THE WORLD WAR 1917-1919

REPORTS OF THE COMMANDER-IN-CHIEF, STAFF SECTIONS AND SERVICES

VOLUME 15

WASHINGTON, D.C.:

U. S. ARMY CENTER OF MILITARY HISTORY, 1991

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HISTORY OF THE DENTAL SERVICE, A. E. F.

A history of the Dental Service, A. F. F. begins with the departure of the original 26 dental officers from the United States, during the latter part of July, 19 17. Of this number five were of the Regular Dental Corps of the army and 21 were of the Dental Reserve Corps. The five Regular officers in conjunction with one specialist of the Reserve Corps constituted the first Army Dental Unit ordered overseas, which came prepared to accomplish all operations of dental and oral surgery. In contemplating the initial representation of dental officers in the A. E. F., the 13 Dental Reserve Board Officers who came over with the six General Hospitals loaned to the British service must be included. These hospitals arrived in France during the latter part of May and June, 1917, and although functioning under British control, their dental officers were considered part of and therefore listed with the commissioned dental personnel of the A. E. F.

From this small beginning the strength of the dental personnel grew steadily through the number of dental officers arriving from time to time with the different organizations sent over from the United States. During the month of November, 1918, the high water mark was reached showing a maximum of 1,873 dental officers, with approximately 2,000 enlisted men, which included dental assistants and dental mechanics.

The commissioned personnel was distributed through the several grades as follows: three colonels, nine lt. colonels, 42 majors, 322 captains and 1497 lieutenants. Of this large number of dental officers, seventy-nine belonged to the Dental Corps,

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U. S. A., (Regular), twelve to the Dental Corps, United States Navy, about 225 to National Guard organizations, and the remainder to the original Dental Reserve Corps. The service rendered by officers of the Navy Dental Corps was of the highest professional type and characterized by laudable devotion to duty at all times, and by an admirable esprit and dash during combat activities. The first name on our roll of honor belongs to the navy. It is with sincere condolence to the Navy Dental Corps we thus announce the first death of a dental officer on the field of battle. Lt. Weedon C. Osborne, D. C., U. S. Navy, was killed in action May 10, 1918, by enemy shell fire, while actively engaged in caring for wounded of the 2d Division, A. E. F. The services of National Guard officers were of the type of military and professional quality expected of them by reason of their long experience in the service. The splendid services rendered by the great number of Reserve officers has been marked by close application to duty, willingness to meet any requirements of the service however arduous, and by a degree of loyalty and devotion that is highly commendable. Many of these officers have been men of outstanding professional and educational qualifications in civil life. Their special services rendered in higher professional and educational positions have redounded greatly to their credit and to the distinction of the Dental Service of the A. E. F. All the higher offices of administration were filled by selection from the older and more experienced officers of the army.

While the greater number of dental officers were serving in France, a large number arriving in England were detained there for duty at the several hospitals, aviation camps and instruction centers of the American army sent there for training to subsequently operate under British direction. Several dental officers with their enlisted assistants were also detailed for organizations serving in Italy and with organizations sent to northern Russia in the region of Archangel.

Of the original 26 dental officers arriving, disposition was made as follows: 20 were assigned to duty with organizations of the 1st Division then arriving in France. Those composing the First Army Dental Unit were distributed and assigned to duty in administrative positions. One to the Office of the Chief Surgeon, A. E. F., one to the 1st Division as Division Dental Surgeon, one to school duty for the initial instruction of the new inexperienced Dental Reserve Officers, one to the Headquarters of the Artillery Brigade at La Valdahon, one to the Medical Supply Depot, and one (the specialist), to G. H. Q., as Attending Dental Surgeon.

SCHOOLS

It was early recognized that a course of instruction would be required for the great number of inexperienced dental reserve officers coming into the service. Although these officers had been carefully selected as to their professional qualifications, and were undoubtedly good dentists, it was necessary to give them preliminary instructions for the purpose of making military dental surgeons out of them, and acquaint them in methods of carrying on a military dental practice: customs of the service, the system of obtaining supplies, military correspondence, making and forwarding reports, etc.

This was first accomplished by organizing division schools in charge of the Division Dental Surgeon, under direction of the Division Surgeon, with instructions to convene the dental officers two afternoons a week for this purpose. The benefits derived thereby were readily apparent and a great improvement in the coordination of the dental service of the 1st Division and the character of service rendered was manifest after the first month. This plan was carried out with the several divisions arriving in France during the following four months. It afterward gave way to the course of instruction carried on by the Dental Section, Army Sanitary School.

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The Dental Section, Army Sanitary School, was organized in November and its first session began Dec. 3, 1917, at the Hqs. Army School Area, Langres. The term of instruction covered two weeks intensive study and application. The course was conducted under direction of an experienced dental officer termed Director, who was assisted by a number of specially qualified instructors. This course embraced all the subjects laid down for division schools and in addition took up the subjects of approved methods of practice in war dentistry and a practical knowledge of face and jaw surgery. In view of the probabilities that all medical personnel would undoubtedly be called on to function in any capacity in which it could best perform during stress of active military operations, it was deemed prudent to incorporate sufficient instruction in the duties of medical officers, as would qualify dental officers for service as auxiliary medical officers. It was realized that inasmuch as the preliminary education of both dental and medical officers were along similar lines, it would be comparatively easy to prepare these men for the special duties that might be required of them. Therefore, instructions in minor surgery, bandaging, splinting, first aid for wounded and gassed cases, transportation of wounded, duties in advance dressing and triage stations, special drill instructions, the administration of antitetanic serum and anaesthesia were incorporated in the course.

The wisdom of the creation of this school has been proven many times since in the improvement shown in military dentistry and by the splendid work dental officers have performed as auxiliary medical officers during combat activities. Letters and citations of special meritorious service have been given dental officers by many division commanders and division surgeons for excellence of the service thus rendered, and for good loyal fearless devotion to duty.

Realizing that after the American army entered into active combat there would be great necessity for a large number of specially qualified officers in face and jaw surgery, a post graduate course in oral, plastic, and prosthetic surgery was organized at American Red Cross Military Hospital No. 1. (Old American Ambulance, Neuilly). A competent faculty of well qualified instructors were assembled at this hospital: a schedule of lectures and clinical instructions prepared, and the school ready to function April 1, 1918, but owing to the enemy’s offensive which started March 21, and the necessity for all hospitals within the Paris District to function as casualty clearing stations or evacuation hospitals, this course of instruction was indefinitely postponed and finally abandoned on account of the continuous battle activities immediately north of Paris.

A special school for instruction of enlisted men, as dental assistants, was organized at Hq. 1st Depot Division, St-Aignan, and two schools for special instruction of dental mechanics were organized. One at Hq. 1st Depot Division, St.-Aignan, for course in primary dental laboratory work, and a second at American Red Cross Military Hospital No. 1 for advanced instruction in swedged and cast metal splints and other fracture jaw appliances required in maxillo-facial surgery. In addition to the above cited schools, general instruction was carried on by correspondence from the Chief Surgeon’s Office in subjects of general military administration, technical dentistry, and official procedure.

ORGANIZATION

A great majority of base hospitals arriving in France had two dental officers with enlisted assistants and full equipment, base outfits, including laboratories. Wherever this plan was deviated from, dental officers were assigned to make up this quota. The senior dental officer was designated Chief of the Dental Service and instructed in all duties pertaining to that position. It soon became evident that twenty dental officers to a division, of the size of division adopted for the American army, (approximately

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28,000 men), were not sufficient for the dental needs of the command. This number, therefore, was increased to thirty dental officers which, with the Division Dental Surgeon, made 31 commissioned dental personnel for a division. While this number exceeded the proportion of one to 1,000 men, the excess number became necessary on account of the incohesion of some of the division commands.

With the intention of making the dental service of a division a complete entity, wherein any character of dental defect could be remedied, each division was provided with a portable dental laboratory and a specially qualified dental mechanic assigned to duty therewith as assistant to the specially selected dental officer. Thus the necessary prosthetic service was assured. The dental laboratory was usually located with one of the Division Field Hospitals.

In proportion to the development of the A. E. F., and the organization of the army corps units and field armies, the dental service was accordingly developed; therefore, administrative officers for field armies, termed chief dental surgeons, and administrative officers for army corps, termed corps dental surgeons, were created and appointed. To meet the demands for better dental service in the sections of the Line of Communications (later known as the Services of Supply), experienced dental officers were selected for each and designated supervising dental surgeons of the respective sections. Their duties were to coordinate the service within their area: inspect, supervise, instruct, and render reports on same to the Chief Surgeon’s Office. Local dental supervisors were appointed from among specially qualified officers at each hospital center and for each army area.

These officers functioned as coordinating officers and were instructed to organize a central dental laboratory and dental clinics in the several centers or areas: to take charge of requisitions and receipts for supplies: the storing of same, reissue as required, centralization of the service, and generally supervising, inspecting and assuming control of instruction of the dental officers in their respective areas.

The several detached organizations located throughout the different sections of the S. O. S., namely: engineer regiments, labor battalions: coast and railway artillery batteries: tank corps organizations: gas service: remount stations, graves registration service: motor reception parks: antiaircraft organizations: salvage depots: prisoner of war camps: storage depots, stevedore companies, forestry camps, signal corps and school areas, were each supplied with the necessary dental service. The dental officers functioning therewith came under the instruction and administrative control of the supervising dental surgeon of their respective sections in the S. O. S.

The need for dental ambulances, mobile dental offices, has been manifest throughout the entire dental service of the A. E. F. All efforts prior to the cessation of hostilities, Nov. 11, 1918, to obtain tonnage priority for their transportation to France has met with failure. The use of these dental ambulances with outlying commands or detachments within divisional training areas or in rear of combat sectors would have proven of great value inasmuch as the mobile units could proceed from place to place with little loss of time, either in actual transportation or in the unpacking and repacking of equipment ordinarily required of a dental officer on itinerary service.

Only two dental ambulances have been utilized in the A. E. F., both of which were presented to the service: one through individual donation and the other through the American Red Cross. Dental Ambulance No. 1. which was the first acquired, has been functioning with Mobile Motor Transport organizations in the Zone of the Armies, and Dental Ambulance No. 2, has been operating with various squadrons of the Aviation Service in the Advance Section.

A group of 40 specialists in general surgery and dental surgery for special duty in the Maxillo-Facial Surgical Service was sent over by the Surgeon General’s Office early in May, 1918. The dental personnel of this group soon afterward came under

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administrative control of the Chief Surgeon’s Office. Maxillo-Facial Teams, composed of one surgeon and one dental surgeon, were sent to the important hospitals or hospital centers, and several specially qualified officers were sent to the Vichy Hospital Center, where Base Hospital No. 115, was designated the Head Hospital. This group of specialists came over under direction of a well known specialist in this mine of surgery, who upon arrival was designated the Chief Consultant of maxillo-facial surgery. The excellent results obtained in this class of special surgery will no doubt be shown in special reports, surgical, rendered through the Surgical Section.

ARMY DENTAL BOARDS

Army dental boards for the examination of candidates for appointment and commission in the Dental Reserve Corps, have been appointed from time to time as required. The candidates for these examinations were from two classes of professional men: American dental surgeons then engaged in the practice of their profession in Europe who desired to enter the American service; and graduate practitioners of dentistry from among the enlisted men of the A. E. F., who had been drafted into the service. We secured, in this manner, the services of about 40 dental officers. The last examination held at which 88 candidates were successful, was finished shortly after the signing of the Armistice, but this large number of dentists were not permitted to enter the service on account of cable instructions from Washington prohibiting further appointments in view of the cessation of hostilities.

EQUIPMENT AND SUPPLIES

Under original instructions from the Surgeon General’s Office, each dental surgeon leaving for overseas duty was to be fully equipped with a portable dental outfit for field service. If these plans had not miscarried, through the exigencies of transportation, by reason of the great number of fighting men and battle supplies hurriedly sent to the A. E. F., little difficulties would have accrued, but owing to the fact that many dental officers arrived in France without the equipment supposed to have been shipped with them, and never again found their original equipment, the problem of supplying them with dental outfits has proven one of considerable magnitude. Arrangements were made at an early date by the Medical Supply Division, prior to the arrival of the 2d Division in France, for an adequate supply stock of dental equipment and supplies for field service. This supply was augmented later by the establishment of an automatic monthly dental supply, based upon the embarkation of every 25,000 men for overseas duty. Owing to accidents in overseas shipments, to congestion of supplies at base ports, to lack of facilities for early rail shipment to locations in France, and to other causes, it became necessary to make emergency purchases of dental supplies in France. This was carried out through the medical member of the General Purchasing Board and proceeded to such extent that an embargo was placed by the French authorities upon the purchases of dental supplies by the American army. This embargo prevailed a few weeks when the restrictions was removed to the extent of permitting 1.000 franc purchases only

It was therefore found necessary to develop the resources of supply in England, and a large amount of dental laboratory equipment and supplies were purchased in London and ordered shipped to the supply depots in France. A restriction was placed upon further purchases of dental material in England as soon as the British War Office learned of the extensive purchases made. This restriction was never removed. This particular purchase of much needed dental laboratory equipment never reached the A. E. F., depots, as the ship carrying it was sunk by enemy submarines in crossing the channel.

This serious loss of dental materiel was followed by the loss of several tons of equipment on one of the U. S. transports sunk off the Irish Coast. It then became necessary

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to strain to the utmost our supply resources, and to modify our field equipment accordingly.

About this time, experience in combat divisions taught us that much of the so-called portable dental outfits for field service would have to be cut down in bulk and weight to meet the transportation problems of mobile divisions. This resulted in a reclassification of dental equipment into camp equipment: (full portable outfits), for such detached organizations in the S. O. S. as could furnish transportation for same: modified portable outfits for combat divisions, consisting of only the essential equipment and supply in three chests for carrying on field dentistry, and campaign equipment for divisions in battle areas, consisting of one dental engine chest and contents, plus the contents of an emergency dental kit, containing cloth instrument rolls, for a few of the essential instruments and medicines with a small amount of supplies, which were to be contained in hospital corps pouches, carried slung over the shoulder. (This was later augmented by addition of a folding aluminum trench chair of 4 l/2 lbs., weight, carried in container slung over the assistant’s shoulder.)

Instructions were issued that every dental surgeon in combat divisions would carry with him, at all times, one of these emergency kits, equipped with a few practical instruments and standard remedies and thus be available at any time to render first aid dentistry for the relief of pain, and for minor oral surgical or dental operations.

These modifications of dental equipment helped solve many of the transportation problems of the dental service in combat divisions, and while it increased the physical burden of dental officers, yet it was made possible for anyone requiring emergency dental service to obtain same at any time from dental officer of his command.

During the period of combat activities from May to November 11, 1918, only the simpler dental operations and services of an emergency character were attempted in combat divisions. This naturally resulted in very meagre reports of dental operations being forwarded to the Chief Surgeon’s Office. These reports show comparatively a large number of extractions, palliative treatments, minor oral surgical operations, and a few fillings of a temporary character. Incidentally this furnishes ample testimony of the attentive occupation of all concerned in the pursuance of the important work at hand, that of completely engaging the enemy. In contradistinction to said reports, the reports recently received, covering the months subsequent to the cessation of hostilities and for the period since the several armies have gone into rest areas, billeting areas, embarkation areas and winter quarters generally, indicate that a bona-fide practice of high class dentistry has been seriously and consistently carried on, wherein tooth conservation, repairative and reconstructive dentistry, and the long arduous treatments for tooth reclamation are every day achievements and that masticatory restoration through various methods of prosthesis is being afforded those officers and men who have lost teeth through the enforced dental negligence of battle activities. These reports are in marked contrast to those submitted during the preceding months and illustrate pleasing resumption of magnificent professional activity, that is commendable in the highest degree.

Transportation of dental equipment and supplies in combat divisions has ever been a problem, and a source of irritation to division commanders, transportation officers, and division surgeons. This was largely due to the fact that no accounting has ever been made in Tables of Organization for the accomodation of dental personnel, commissioned and enlisted, and the dental equipment. The results of this failure to mention the dental service, and equipment, has resulted in the loss of much equipment and the consequent loss of dental service in several of the divisions: one of which, the 1st Division, lost all it’s dental equipment in the first big move of the division into combat area in May 1918. All their equipment was abandoned and subsequently salvaged on account of lack of transportation facilities for same. It required all the resources of Intermediate Medical Supply Depot No. 3 to resupply dental equipment of an

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emergency character for this division after its arrival in the new area. In this connection, it is hoped that adequate provision will be made in Tables of Organization for both dental personnel, and dental equipment, and adequate transportation for each.

Sufficient dental personnel, selected from specially qualified officers of the Regular Dental Corps were assigned to duty at medical supply depots for the purpose of assisting the medical supply officer in handling this special class of materiel. Adequate plans for the development of this scheme and the assignment of a dental officer at each of the supply depots, and at the receiving depots at base ports was proposed, but never put into operation.

The officers of the maxillo-facial units arrived in France without the special instruments and equipment for their service. It therefore became necessary to improvise it, making careful selection from surgical and dental equipment on hand, purchase such as could be found in French markets, and specially manufacture appliances necessary in this class of surgery. This lack of preparation has, in certain instances, retarded the activities of the maxillo-facial services. Eventually all the necessary equipment was procured, issued to the several hospitals, and utilized to the fullest extent. In this connection, attention is invited to the development and manufacture of the so-called Amex Casque, which was used to great advantage in this special service in maintaining fixation, of both osseous and soft parts, in reconstruction of faces and jaws, for this class of battle casualties.

A Dental Equipment Board operating in conjunction with the Medical Equipment Board, was convened for consideration of the essential dental equipment for dental officers with combat divisions for an army on campaign. The findings and recommendations of this board, will result in greatly modifying the old portable dental outfits for field service, and will reduce to the minimum, the size and number of containers for articles deemed necessary in field dental surgery.

INSPECTIONS

The need for special technical inspections of dental officers, by officers thoroughly conversant with dentistry, was early manifest. Directions were issued which resulted in regular and systematic inspections being carried on by division dental surgeons within their divisions, corps dental surgeons with corps troops and the divisions of their command. Army dental surgeons with field army troops and their respective corps and division dental surgeons: and by supervising dental surgeons of the several sections S.O. S., with the dental officers of their respective sections. This has also been augmented by inspections, when deemed practicable, by the Chief Dental Surgeon, A. E. F. Adequate reports covering said inspections have been forwarded to the Chief Surgeon’s Office, with the result that the dental service in the several commands and areas, has been greatly improved.

CASUALTIES

Several dental officers in combat divisions have been killed on the field of honor and a large number have been wounded or gassed during the combat activities during the period from May to November, 1918.

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Most of these officers were killed while performing the duties of auxiliary medical officers. Commendation and citation orders and special reports of division commanders and division surgeons have been forwarded for a number of dental officers in the A. E. F. Several officers have been awarded the distinguished service cross

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(two posthumous awards), and the Croix de guerre. In addition to the dental officers listed in the roll of honor, we have several records where enlisted dental assistants have also made the supreme sacrifice in the service of their country, and several that have been wounded or gassed in the discharge of their duty. These names will appear in another report of enlisted men of the Medical Department.

ROBT T. OLIVER,

Col., D. C., U. S. A.